title: The skin is a significant but overlooked anatomical reservoir for vector-borne African trypanosomes.
abstract: The role of mammalian skin in harbouring and transmitting arthropod-borne protozoan parasites has been overlooked for decades as these pathogens have been regarded primarily as blood-dwelling organisms. Intriguingly, infections with low or undetected blood parasites are common, particularly in the case of Human African Trypanosomiasis caused byTrypanosoma brucei gambiense. We hypothesise, therefore, the skin represents an anatomic reservoir of infection. Here we definitively show that substantial quantities of trypanosomes exist within the skin following experimental infection, which can be transmitted to the tsetse vector, even in the absence of detectable parasitaemia. Importantly, we demonstrate the presence of extravascular parasites in human skin biopsies from undiagnosed individuals. The identification of this novel reservoir requires a re-evaluation of current diagnostic methods and control policies. More broadly, our results indicate that transmission is a key evolutionary force driving parasite extravasation that could further result in tissue invasion-dependent pathology.
authors.affiliation: Wellcome Trust Centre for Molecular Parasitology, University of Glasgow, Glasgow, United Kingdom.|College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom.|Henry Wellcome Building for Comparative Medical Sciences, University of Glasgow, Glasgow, United Kingdom.
authors.forename: Paul
authors.initials: P
authors.lastname: Capewell
authors.affiliation: Trypanosome Transmission Group, Trypanosome Cell Biology Unit, INSERM U1201, Paris, France.|Department of Parasites and Insect Vectors, Institut Pasteur, Paris, France.
authors.forename: Christelle
authors.initials: C
authors.lastname: Cren-Travaillé
authors.affiliation: Veterinary Diagnostic Services, Veterinary School, University of Glasgow, Glasgow, United Kingdom.
authors.forename: Francesco
authors.initials: F
authors.lastname: Marchesi
authors.affiliation: Veterinary Diagnostic Services, Veterinary School, University of Glasgow, Glasgow, United Kingdom.
authors.forename: Pamela
authors.initials: P
authors.lastname: Johnston
authors.affiliation: Wellcome Trust Centre for Molecular Parasitology, University of Glasgow, Glasgow, United Kingdom.|College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom.|Henry Wellcome Building for Comparative Medical Sciences, University of Glasgow, Glasgow, United Kingdom.
authors.forename: Caroline
authors.initials: C
authors.lastname: Clucas
authors.affiliation: College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom.|Institute of Infection, Immunology and Inflammation, University of Glasgow, Glasgow, United Kingdom.|Glasgow Biomedical Research Centre, University of Glasgow, Glasgow, United Kingdom.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Benson
authors.affiliation: Wellcome Trust Centre for Molecular Parasitology, University of Glasgow, Glasgow, United Kingdom.|College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom.|Henry Wellcome Building for Comparative Medical Sciences, University of Glasgow, Glasgow, United Kingdom.|Institute of Infection, Immunology and Inflammation, University of Glasgow, Glasgow, United Kingdom.|Glasgow Biomedical Research Centre, University of Glasgow, Glasgow, United Kingdom.
authors.forename: Taylor-Anne
authors.initials: TA
authors.lastname: Gorman
authors.affiliation: Trypanosome Transmission Group, Trypanosome Cell Biology Unit, INSERM U1201, Paris, France.|Department of Parasites and Insect Vectors, Institut Pasteur, Paris, France.
authors.forename: Estefania
authors.initials: E
authors.lastname: Calvo-Alvarez
authors.affiliation: Trypanosome Transmission Group, Trypanosome Cell Biology Unit, INSERM U1201, Paris, France.|Department of Parasites and Insect Vectors, Institut Pasteur, Paris, France.
authors.forename: Aline
authors.initials: A
authors.lastname: Crouzols
authors.affiliation: Human Histopathology and Animal Models Unit, Institut Pasteur, Paris, France.
authors.forename: Grégory
authors.initials: G
authors.lastname: Jouvion
authors.affiliation: Institut de Recherche pour le Développement, Unité Mixte de Recherche IRD-CIRAD 177, Campus International de Baillarguet, Montpellier, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Jamonneau
authors.affiliation: Wellcome Trust Centre for Molecular Parasitology, University of Glasgow, Glasgow, United Kingdom.|College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom.|Henry Wellcome Building for Comparative Medical Sciences, University of Glasgow, Glasgow, United Kingdom.
authors.forename: William
authors.initials: W
authors.lastname: Weir
authors.affiliation: Veterinary Diagnostic Services, Veterinary School, University of Glasgow, Glasgow, United Kingdom.
authors.forename: M Lynn
authors.initials: ML
authors.lastname: Stevenson
authors.affiliation: Wellcome Trust Centre for Molecular Parasitology, University of Glasgow, Glasgow, United Kingdom.|College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom.|Henry Wellcome Building for Comparative Medical Sciences, University of Glasgow, Glasgow, United Kingdom.
authors.forename: Kerry
authors.initials: K
authors.lastname: O'Neill
authors.affiliation: Wellcome Trust Centre for Molecular Parasitology, University of Glasgow, Glasgow, United Kingdom.|College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom.|Henry Wellcome Building for Comparative Medical Sciences, University of Glasgow, Glasgow, United Kingdom.
authors.forename: Anneli
authors.initials: A
authors.lastname: Cooper
authors.affiliation: University of Kinshasa, Kinshasa, Democratic Republic of the Congo.
authors.forename: Nono-Raymond Kuispond
authors.initials: NK
authors.lastname: Swar
authors.affiliation: Institut de Recherche pour le Développement, Unité Mixte de Recherche IRD-CIRAD 177, Campus International de Baillarguet, Montpellier, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Bucheton
authors.affiliation: Department of Parasitology, National Institute of Biomedical Research, Kinshasa, Democratic Republic of the Congo.
authors.forename: Dieudonné Mumba
authors.initials: DM
authors.lastname: Ngoyi
authors.affiliation: College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom.|Institute of Infection, Immunology and Inflammation, University of Glasgow, Glasgow, United Kingdom.|Glasgow Biomedical Research Centre, University of Glasgow, Glasgow, United Kingdom.
authors.forename: Paul
authors.initials: P
authors.lastname: Garside
authors.affiliation: Trypanosome Transmission Group, Trypanosome Cell Biology Unit, INSERM U1201, Paris, France.|Department of Parasites and Insect Vectors, Institut Pasteur, Paris, France.
authors.forename: Brice
authors.initials: B
authors.lastname: Rotureau
authors.affiliation: Wellcome Trust Centre for Molecular Parasitology, University of Glasgow, Glasgow, United Kingdom.|College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom.|Henry Wellcome Building for Comparative Medical Sciences, University of Glasgow, Glasgow, United Kingdom.
authors.forename: Annette
authors.identifier: 0000-0002-0150-5049
authors.initials: A
authors.lastname: MacLeod
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D006801:Humans; D008807:Mice, Inbred BALB C; D008810:Mice, Inbred C57BL; D012867:Skin / Q000469:parasitology*; D014347:Trypanosoma brucei gambiense / Q000302:isolation & purification*; D014353:Trypanosomiasis, African / Q000469:parasitology* / Q000635:transmission; D014370:Tsetse Flies / Q000469:parasitology
keywords: Human African Trypanosomiasis; Trypanosoma brucei gambiense; epidemiology; global health; human; infectious disease; microbiology; mouse; reservoir; skin; transmission; trypanosomes