Daniel Romero-Alvarez

Declining Prevalence of Disease Vectors Under Climate Change

More than half of the world population is at risk of vector-borne diseases including dengue fever, chikungunya, zika, yellow fever, leishmaniasis, chagas disease, and malaria, with highest incidences in tropical regions. In Ecuador, vector-borne diseases are present from coastal and Amazonian regions to the Andes Mountains; however, a detailed characterization of the distribution of their vectors has never been carried out. We estimate the distribution of 14 vectors of the above vector-borne diseases under present-day and future climates. Our results consistently suggest that climate warming is likely threatening some vector species with extinction, locally or completely. These results suggest that climate change could reduce the burden of specific vector species. Other vector species are likely to shift and constrain their geographic range to the highlands in Ecuador potentially affecting novel areas and populations. These forecasts show the need for development of early prevention strategies for vector species currently absent in areas projected as suitable under future climate conditions. Informed interventions could reduce the risk of human exposure to vector species with distributional shifts, in response to current and future climate changes. Based on the mixed effects of future climate on human exposure to disease vectors, we argue that research on vector-borne diseases should be cross-scale and include climatic, demographic, and landscape factors, as well as forces facilitating disease transmission at fine scales.

An analysis of reported cases of leishmaniasis in the southern Ecuadorian Amazon region, 1986-2012

An analysis of reported cases of cutaneous leishmaniasis (CL) was performed using the data registered in the southern Ecuadorian Amazon region during 27 years from 1986 to 2012. The cases/subjects with both the suspected CL lesions and the amastigote-positive results were recruited for the analysis. The yearly occurrence of cases showed a markedly higher number during the six years, 1988 and 1993. After 1994 when the insecticide spraying campaign using helicopter in 1993-1994, the number dropped remarkably. Then, the yearly occurrence gradually fluctuated from 101 cases in 1996 to 11 in 2009, maintaining a low number of cases after the campaign. The monthly occurrence of cases showed a markedly high number during March and August, suggesting a correlation to the rainy season (months) in the areas. A statistical significance was found between the monthly average number of the CL case and the average precipitation (p=0.01474). It was suggested that the time of transmission of CL would depend on the rainy seasons at each endemic area of Ecuador, which has a diverse climatic feature depending on the geographic regions. Such information at given leishmaniasis-endemic areas of Ecuador would be important for the future planning of the disease control. Molecular analysis and characterization of clinical samples revealed the presence of Leishmania (Viannia) braziliensis.

Geographic Distribution of Leishmania Species in Ecuador Based on the Cytochrome B Gene Sequence Analysis

A countrywide epidemiological study was performed to elucidate the current geographic distribution of causative species of cutaneous leishmaniasis (CL) in Ecuador by using FTA card-spotted samples and smear slides as DNA sources. Putative Leishmania in 165 samples collected from patients with CL in 16 provinces of Ecuador were examined at the species level based on the cytochrome b gene sequence analysis. Of these, 125 samples were successfully identified as Leishmania (Viannia) guyanensis, L. (V.) braziliensis, L. (V.) naiffi, L. (V.) lainsoni, and L. (Leishmania) mexicana. Two dominant species, L. (V.) guyanensis and L. (V.) braziliensis, were widely distributed in Pacific coast subtropical and Amazonian tropical areas, respectively. Recently reported L. (V.) naiffi and L. (V.) lainsoni were identified in Amazonian areas, and L. (L.) mexicana was identified in an Andean highland area. Importantly, the present study demonstrated that cases of L. (V.) braziliensis infection are increasing in Pacific coast areas.

Forecasting distributions of an aquatic invasive species (Nitellopsis obtusa) under future climate scenarios

Starry stonewort (Nitellopsis obtusa) is an alga that has emerged as an aquatic invasive species of concern in the United States. Where established, starry stonewort can interfere with recreational uses of water bodies and potentially have ecological impacts. Incipient invasion of starry stonewort in Minnesota provides an opportunity to predict future expansion in order to target early detection and strategic management. We used ecological niche models to identify suitable areas for starry stonewort in Minnesota based on global occurrence records and present-day and future climate conditions. We assessed sensitivity of forecasts to different parameters, using four emission scenarios (i.e., RCP 2.6, RCP 4.5, RCP 6, and RCP 8.5) from five future climate models (i.e., CCSM, GISS, IPSL, MIROC, and MRI). From our niche model analyses, we found that (i) occurrences from the entire range, instead of occurrences restricted to the invaded range, provide more informed models; (ii) default settings in Maxent did not provide the best model; (iii) the model calibration area and its background samples impact model performance; (iv) model projections to future climate conditions should be restricted to analogous environments; and (v) forecasts in future climate conditions should include different future climate models and model calibration areas to better capture uncertainty in forecasts. Under present climate, the most suitable areas for starry stonewort are predicted to be found in central and southeastern Minnesota. In the future, suitable areas for starry stonewort are predicted to shift in geographic range under some future climate models and to shrink under others, with most permutations indicating a net decrease of the species’ suitable range. Our suitability maps can serve to design short-term plans for surveillance and education, while future climate models suggest a plausible reduction of starry stonewort spread in the long-term if the trends in climate warming remain.

Vegetation loss and the 2016 Oropouche fever outbreak in Peru

BACKGROUND Oropouche virus causes Oropouche fever, an arboviral disease transmitted mainly by midges of the genus Culicoides and Culex mosquitoes. Clinical presentation of Oropouche fever in humans includes fever, headache, rash, myalgia, and in rare cases spontaneous bleeding and aseptic meningitis. Landscape change has been proposed as a driver of Oropouche fever emergence. OBJECTIVE To investigate the landscape epidemiology of the Oropouche fever outbreak that began in April 2016 in Cusco, Peru. METHODS We used information of vegetation and multivariate spatial analyses including ecological niche modeling. Vegetation was characterised using16-day composite enhanced vegetation index (EVI) images at 500 m spatial resolution from the MODIS sensor carried by the Terra satellite. FINDINGS Cases were distributed across seven Peruvian districts in two provinces. La Concepcion was the province with most of the affected districts. EVI time series across 2000 to 2016 suggested a decline in the vegetation in sites with Oropouche fever cases before the epidemic. Our ecological niche modeling suggests that other areas in Junin, Apurimac, and Madre de Dios departments are at risk of Oropouche fever occurrence. MAIN CONCLUSIONS Our results may provide a guide for future fieldwork to test hypotheses regarding Oropouche fever emergence and habitat loss in tropical Latin America.

Amblyomma ticks and future climate: Range contraction due to climate warming

Ticks of the Amblyomma cajennense species complex are important vectors of spotted fever in Latin America. Environmental conditions determine the geographic distribution of ticks, such that climate change could influence the distribution of tick-borne diseases. This study aimed to analyze the potential geographic distribution of A. cajennense complex ticks in a Brazil region under present-day and future climate models, assuming dispersal limitations and non-evolutionary adaptation of these tick populations to climate warming. Records of A. cajennense sensu stricto (s.s.) and Amblyomma sculptum were analyzed. Niche models were calibrated using Maxent considering climate variables for 1950-2000 and projecting models to conditions anticipated for 2050 and 2070 under two models of future climate (CCSM4 and HadGEM2-AO). Broad suitable areas for A. cajennense s.s. and A. sculptum were found in present-day climate models, but suitability was reduced when models were projected to future conditions. Our exploration of future climates showed that broad areas had novel climates not existing currently in the study region, including novel extremely high temperatures. Indeed, predicted suitability in these novel conditions would lead to biologically unrealistic results and therefore incorrect forecasts of future tick-distribution. Previous studies anticipating expansions of vectors populations due to climate change should be considered with caution as they assume that model extrapolation anticipates that species would evolve rapidly for adaptation to novel climatic conditions.

Oropouche fever, an emergent disease from the Americas

Oropouche virus is the aetiological agent of Oropouche fever, a zoonotic disease mainly transmitted by midges of the species Culicoides paraensis. Although the virus was discovered in 1955, more attention has been given recently to both the virus and the disease due to outbreaks of Oropouche fever in different areas of Brazil and Peru. Serological studies in human and wild mammals have also found Oropouche virus in Argentina, Bolivia, Colombia, and Ecuador. Several mammals act as reservoirs of the disease, although the sylvatic cycle of Oropouche virus remains to be assessed properly. Oropouche fever lacks key symptoms to be differentiated from other arboviral febrile illnesses from the Americas. Sporadic cases of aseptic meningitis have also been described with good prognosis. Habitat loss can increase the likelihood of Oropouche virus emergence in the short-term in South America.

First case of New Delhi metallo-β-lactamase in Klebsiella pneumoniae from Ecuador: An update for South America

OBJECTIVES To describe a clinical case of Klebsiella pneumoniae harboring a New Delhi metallo-β-lactamase (NDM) plasmid in Ecuador and to present a map of reports of NDM isolates in South America. METHODS The modified Hodge test, carbapenem inactivation method, imipenem-EDTA disk method (synergy), and Rapidec Carba NP test were used to identify antibiotic resistance mechanisms. The presence of resistance genes was explored with a conjugation assay, and molecular confirmation of NDM was performed by PCR and DNA sequencing. Plasmid characterization was conducted by PCR-based replicon typing. A literature review was performed in Google Scholar and PubMed to identify reports from South America. RESULTS An HIV-infected patient, who had never traveled abroad, developed a bloodstream infection caused by K. pneumoniae ST147 harboring the NDM-1 resistance gene in a plasmid from the IncA/C group. Local circulation of NDM has also been described in other South American countries, in particular in Colombia and Brazil, although published scientific records were not found for other countries. CONCLUSIONS This report presents the first evidence of autochthonous circulation of the NDM-1 resistance gene harbored by an IncA/C plasmid isolated from a K. pneumoniae ST147 in Ecuador. Efforts should be implemented to monitor and characterize the spatial and temporal distribution of NDM in Ecuador and other countries of South America.

Inferring the Ecological Niche of Toxoplasma gondii and Bartonella spp. in Wild Felids

Traditional epidemiological studies of disease in animal populations often focus on directly transmitted pathogens. One reason pathogens with complex lifecycles are understudied could be due to challenges associated with detection in vectors and the environment. Ecological niche modeling (ENM) is a methodological approach that overcomes some of the detection challenges often seen with vector or environmentally dependent pathogens. We test this approach using a unique dataset of two pathogens in wild felids across North America: Toxoplasma gondii and Bartonella spp. in bobcats (Lynx rufus) and puma (Puma concolor). We found three main patterns. First, T. gondii showed a broader use of environmental conditions than did Bartonella spp. Also, ecological niche models, and Normalized Difference Vegetation Index satellite imagery, were useful even when applied to wide-ranging hosts. Finally, ENM results from one region could be applied to other regions, thus transferring information across different landscapes. With this research, we detail the uncertainty of epidemiological risk models across novel environments, thereby advancing tools available for epidemiological decision-making. We propose that ENM could be a valuable tool for enabling understanding of transmission risk, contributing to more focused prevention and control options for infectious diseases.

A comparison of Kato-Katz technique to three other methods for diagnosis of Amphimerus spp. liver fluke infection and the prevalence of infection in Chachi Amerindians of Ecuador

Background Recently, a high prevalence of infection by the liver fluke Amphimerus spp. has been documented in the Chachi Amerindians of Ecuador. For diagnosis, no studies exist that compare the sensitivity of different coproparasitological detection techniques. The present study compares the Kato-Katz technique with three other coproparasitological methods for detecting eggs of Amphimerus in stools, as well as determines the prevalence of infection in Chachi residents in a Tropical rain forest area in the northwest coast of Ecuador. Methodology/Results A total of 105 samples, utilizing the Kato-Katz technique (KK), the spontaneous sedimentation technique in tube (SSTT), the formalin-ether concentration technique (FEC), and direct smear microscopy (DM), were examined. Combining the four methods (fixed “gold” standard), 38 samples were positive with a prevalence of infection of 36.2%. The sensitivities of individual methods were 71%, 58%, 50% and 3% for KK, SSTT, FEC, and DM respectively. Our results indicated that KK alone had the best performance, detecting 27 (71%) of the 38 positive samples. The combination of KK and SSTT detected amphimeriasis in 36 (95%) samples, and KK and FEC in 31 (82%) samples. Conclusions DM showed the lowest sensitivity, which raises concern for its value, because it is the standard technique for stool examination for detection of parasites in both public and private laboratories in Ecuador. SSTT alone detected eggs in 22 samples (58%) and would be recommended for field studies because of its simplicity. Performing two techniques on a single sample enhances the detection of Amphimerus infection. Its sensitivity is relative to a fixed “gold” standard, determined as the combined results of the four techniques performed. This study confirms the high prevalence of human infection by Amphimerus in the indigenous Chachi group where the first human cases were described.