article · eLife
This research demonstrates that mammalian skin serves as a significant anatomical reservoir for African trypanosomes, challenging the long-held view that these parasites are primarily blood-dwelling. Experiments showed that substantial numbers of trypanosomes reside in the skin following infection and can be transmitted to tsetse vectors, even when parasites are not detectable in the blood. Crucially, extravascular parasites were identified in human skin biopsies from individuals who had not been diagnosed. This finding suggests that the skin plays a critical role in the infection cycle and transmission of diseases like Human African Trypanosomiasis, necessitating a re-evaluation of current diagnostic approaches and control strategies.
This research fundamentally changes our understanding of how African trypanosomes, which cause sleeping sickness, persist and spread. Recognising the skin as a reservoir could lead to more effective diagnostic tests and control programmes, particularly for individuals with low or undetectable blood infections, thereby improving public health outcomes.
This early-stage research indicates a need for new diagnostic tools capable of detecting trypanosomes in skin samples, potentially leading to the development of novel diagnostic kits or methods. It also suggests opportunities for developing improved control strategies that target skin-dwelling parasites, which could be of interest to public health organisations and pharmaceutical companies working on neglected tropical diseases.
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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 by <i>Trypanosoma brucei gambiense</i>. 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.
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DOI: 10.7554/elife.17716
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