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An Assay for the Identification of Plasmodium Simiuminfection for Diagnosis of Zoonotic Malaria in the Brazilian Atlantic Forest

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An Assay for the Identification of Plasmodium Simiuminfection for Diagnosis of Zoonotic Malaria in the Brazilian Atlantic Forest www.nature.com/scientificreports Corrected: Author Correction OPEN An assay for the identifcation of Plasmodium simium infection for diagnosis of zoonotic malaria in the Received: 5 September 2017 Accepted: 5 December 2017 Brazilian Atlantic Forest Published online: 08 January 2018 Denise Anete Madureira de Alvarenga 1, Richard Culleton2, Anielle de Pina-Costa3,4,5,10, Danielle Fonseca Rodrigues 1, Cesare Bianco Jr.4,5, Sidnei Silva3, Ana Júlia Dutra Nunes6, Julio César de Souza Jr.7,8, Zelinda Maria Braga Hirano7,8, Sílvia Bahadian Moreira9, Alcides Pissinatti9,10, Filipe Vieira Santos de Abreu11, André Luiz Lisboa Areas12, Ricardo Lourenço- de-Oliveira11, Mariano Gustavo Zalis12, Maria de Fátima Ferreira-da-Cruz4,5, Patricia Brasil3, Cláudio Tadeu Daniel-Ribeiro4,5 & Cristiana Ferreira Alves de Brito 1 Zoonotic malaria poses a unique problem for malaria control. Autochthonous cases of human malaria in the Atlantic Forest have recently been attributed to Plasmodium simium, a parasite that commonly infects non-human primates in this Brazilian biome. However, due to its close similarity at both the morphological and molecular level to Plasmodium vivax, the diagnosis of P. simium in this region remains problematic. Therefore, a diagnostic assay able to accurately identify P. simium is important for malaria surveillance. Based on mitochondrial genome sequences, primers were designed to amplify a region containing a SNP specifc to P. simium. This region can then be digested with the restriction enzyme HpyCH4III, which results in digestion of P. simium sequences, but not of any other malaria parasite. Fifty-two human and monkey blood samples from diferent regions and infected with diferent Plasmodium species were used to validate this protocol. This easy and inexpensive tool can be used for the diagnosis of P. simium in non-human primates and human infections from the Atlantic Forest region to monitor zoonotic malaria transmission in Brazil. Zoonotic malaria constitutes a major challenge to malaria elimination. Until recently, it was thought that there were four species of malaria parasite responsible for disease in humans; Plasmodium falciparum, Plasmodium vivax, Plasmodium malariae and Plasmodium ovale. However, recent studies in Southeast Asia have demon- strated the widespread zoonotic transmission of Plasmodium knowlesi, a species previously thought to be con- fned to macaques1. Tese fndings led to the recognition of P. know l esi as a ffh human malaria parasite and demonstrated the zoonotic potential of non-human primate (NHP) malaria in sylvatic settings2–4. In addition to 1Grupo de Pesquisa em Biologia Molecular e Imunologia da Malária, Instituto René Rachou (IRR), Fundação Oswaldo Cruz (Fiocruz), Belo Horizonte/MG, 30190-009, Brazil. 2Malaria Unit, Department of Pathology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, 852-8523, Japan. 3Laboratório de Doenças Febris Agudas, Instituto Nacional de Infectologia Evandro Chagas (INI), Fiocruz, Rio de Janeiro/RJ, 21040-360, Brazil. 4Centro de Pesquisa, Diagnóstico e Treinamento em Malária (CPD-Mal), Fiocruz, Rio de Janeiro/RJ, 21040-360, Brazil. 5Laboratório de Pesquisa em Malária, Instituto Oswaldo Cruz (IOC), Fiocruz, Rio de Janeiro/RJ, 21040-360, Brazil. 6Núcleo de Educação Ambiental Fábio Perini, Perini Business Park, Joinville/SC, 89219-600, Brazil. 7Centro de Pesquisas Biológicas de Indaial, Indaial/SC, 89130-000, Brazil. 8Universidade Regional de Blumenau – FURB, Blumenau/SC, 89012-900, Brazil. 9Centro de Primatologia do Rio de Janeiro (CPRJ/INEA), Guapimirim/RJ, 25940-000, Brazil. 10Centro Universitário Serra dos Órgãos (UNIFESO), Teresópolis/RJ, 25964-004, Brazil. 11Laboratório de Mosquitos Transmissores de Hematozoários, Fiocruz, Rio de Janeiro/RJ, 21040-360, Brazil. 12Laboratório de Infectologia e Parasitologia Molecular, Hospital Universitário Clementino Fraga Filho, Universidade, Federal do Rio de Janeiro/ RJ, 21941-901, Brazil. Denise Anete Madureira de Alvarenga and Richard Culleton contributed equally to this work. Correspondence and requests for materials should be addressed to C.F.A.B. (email: [email protected]) SCIENTIFIC REPORTS | (2018) 8:86 | DOI:10.1038/s41598-017-18216-x 1 www.nature.com/scientificreports/ P. know l esi , there are other Plasmodium species that infect NHPs and can also be transmitted to humans, such as Plasmodium cynomolgi in Asia and Plasmodium brasilianum and Plasmodium simium in the Americas5–8. Malaria transmission in Brazil occurs almost entirely within the Amazon region9. However, there are a con- sistent number of autochthonous cases reported in Southern and Southeastern Brazil, predominantly in areas under infuence of the Atlantic Forest. From 2006 to 2016, 1047 autochthonous cases were reported in these areas9–11. Most of these episodes are attributed to P. vivax and essentially afect non-resident visitors11. Tese areas are particularly rich in bromeliads, which provide a highly suitable habitat for Kerteszia mosquito species, espe- cially Anopheles Kerteszia cruzii and Anopheles Kerteszia bellator12–14. Tese mosquitoes are the primary vectors of the called “bromeliad malaria”12,15–17. Tese species may bite humans and non-human primates (NHPs) with similar frequencies, depending on the area and environmental/climatic situation16,18–20. Based on this, zoonotic transmission has been hypothesized in these areas, with NHPs acting as a reservoir of Plasmodium species capa- ble of infecting humans5. Tere are two species of malaria parasites infecting non-human primates in this region; Plasmodium simium, a tertian malaria and Plasmodium brasilianum, a quartan malaria. Plasmodium simium natu- rally infects primates of the Atelidae and Cebidae families, genera Alouatta (howler monkeys), Brachyteles (wooly spider monkeys), Cebus and Sapajus (capuchin monkeys) in South and Southeastern Brazil21,22. Plasmodium brasilianum has been detected in nearly 50 NHPs species belonging to 13 genera distributed from Panama to the South of Brazil21,23,24. Plasmodium simium is highly similar at the morphological, genetic and immunological levels to P. vivax, the most prevalent human malaria parasite in Brazil21,25,26. Due to this, human malaria in the Atlantic Forest has previously been misdiagnosed as P. vivax, either by microscopy or through molecular diagnosis based on PCR of the 18S rRNA gene. However, recently, a study in the Rio de Janeiro Atlantic Forest described morphological and genetic diferences (based on mitochondrial genome sequencing) between these two species, and incriminated P. simium as the causative agent of the great majority of human malaria cases in the region27. Tis observation was confrmed by other authors analyzing diferent Brazilian states under the infuence of the same biome28,29. As morphological discrimination is highly dependent on the subjective consideration of very well-trained microscopists, we have developed a new methodology able to identify P. simium samples using nested PCR fol- lowed by enzyme digestion without the need for nucleotide sequencing. Tis methodology relies on the fact that all known P. simium mitochondrial genome sequences (derived from infection of NHPs from Atlantic forest) difer from the most closely related P. vivax sequences (derived from infection of humans) by two unique single nucleotide polymorphisms (SNPs). Tis protocol can be used for the screening of the local NHPs and humans malaria cases during surveillance of zoonotic malaria transmission in the Brazilian Atlantic Forest. Methods Non-human primate samples from the Atlantic Forest. Sixteen P. simium and two P. brasilianum infected whole blood samples were obtained from captive and free-living NHPs from the Brazilian Atlantic Forest of Rio de Janeiro and Santa Catarina States (Additional fle 1)22,24. Animals used in this study were captive pri- mates from the Primate Centre of Rio de Janeiro (CPRJ) (n = 2) and from Biological Research Centre of Indaial (CEPESBI) (n = 7) and free living NHPs from Santa Catarina State (n = 6) and Rio de Janeiro State (n = 1). Te CPRJ (Brazilian Institute of Environment and Renewable Natural Resources-IBAMA, register number 458460) is a unit for wild monkey protection. It is geographically located between latitude 22°7′ and 22°32′ S and longitude 42°50′ and 42°56′ W in the municipality of Guapimirim (one of the municipalities where human malaria occurs in the Rio de Janeiro Atlantic Forest), on the Serra dos Órgãos slopes, in an area of the Atlantic Forest, about 100 km from the city of Rio de Janeiro. Serra dos Órgãos is part of the Serra do Mar, a large coastal mountain chain in southeast Brazil. As the handling of NHPs was exclusively performed by CPRJ technicians, the Fiocruz Animal Ethics Committee agreed to the protocol for sample collection. Captive Southern brown howler monkeys (Alouatta guariba clamitans) from CEPESBI (Indaial, SC) (IBAMA register number 197351) were also included30. Free-living NHPs from the Atlantic Forest in Joinville municipality, in Santa Catarina State in southern Brazil, were obtained from a behavioral study of Alouatta g. clamitans in the Brown Howler monkeys conservation program (Perini Business Park). Te Brazilian government authorized this study and the access to and transport of biological samples through Biodiversity Information and Authorization System (SISBIO) no. 43375-4/2015. P. simium DNA extracted from the spleen and liver of a single Alouatta g. clamitans found dead in Guapimirim was used as positive control in the PCR because it was
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