Albasrah university

Science Department
Department of pathological analyzes

SandFly

Student name :Ruaa Abduljabbar hadi

Grad:Second stage

Subject : Medical insects

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 Albasrah university
Science Department
Department of pathological analyzes

Abstract
Phlebotomine sandflies are delicate, hairy flies with long slender legs. Of the 700 or so
species, only about 70 species are thought to be involved in the transmission of disease
to man. The flies are easily distinguished from other small Diptera when alive by the
characteristic manner in which they hold their pointed wings above their body (like a
vertical V), especially from other members of the family Psychodidae to which they
belong.

Phlebotomine sandflies are delicate, hairy flies with long slender legs. Of the 700 or

so species, only about 70 species are thought to be involved in the transmission of

disease to man. The flies are easily distinguished from other small Diptera when

alive by the characteristic manner in which they hold their pointed wings above

their body (like a vertical V), especially from other members of the family Psychodidae to
which they belong.

It is important to distinguish phlebotomine sandflies from other small biting flies

known colloquially as 'sand flies' in certain parts of the world, especially midges of

the genus Culicoides which abound in coastal areas of the southeastern United

States, Central America and the Caribbean, and Simuliidae in Australasia. These

other flies have very different biologies and medical importance from phlebotomines.

Only female sandflies suck blood, and two genera contain anthropophagous

species: Phlebotomus in the Old World and Lutzomyia in the New World. Rarely,

some species of the genus Sergentomyia, which feed principally on reptiles, will bite

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man but there is no evidence to suggest they are ever capable of transmitting

human parasites.

Phlebotomines are mostly known as vectors of Leishmania, protozoan parasites

which cause visceral leishmaniasis (kala-azar) and various forms of cutaneous

leishmaniasis (oriental sore, espundia etc.) in man. However, they also transmit

bartonellosis (Oroya fever, Carrion's disease) in northwestern South America

caused by the bacterium Bartonella bacilliformis, and sand fly fever virus throughout

North Africa and the Middle East.

Sand flies are found mainly in the tropics and subtropics, with a few species

penetrating into temperate regions in both the northern (to SOON) and southern

hemispheres (to about 40°5). There are no sand flies in New Zealand or on Pacific

islands. In the Old World, man-biting sandflies (and therefore leishmaniasis) are

confined to the subtropics, there being very few anthropophilic species in Africa

south of the Sahara and none in South East Asia (although species of Phlebotomus

are present). In contrast, the transmission of leishmaniasis in the New World is

principally in the tropics.

Sandflies occur in a very wide range of habitats from sea level (a major focus of

leishmaniasis around the Dead Sea is below sea level!) to altitudes of 2800 m or

more in the Andes and Ethiopia, and from hot dry deserts, through savannas and
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Department of pathological analyzes

Medical Insects and Arachnids Edited by Richard P. Lane and Roger W. Cr~sskey.

Viruses
Among the viruses that sandflies can carry is the Chandipura virus, which, as a cousin
of rabies, is very deadly. There was an outbreak in India in 2010.

Health Concerns
Lutzomyia Longipalpis feeding on human blood.
As sand fly females suck blood from vertebrate animals, including humans, they can
transmit leishmaniasis, arboviruses and bartonellosis

Prevention of sand fly-borne diseases

Both sand fly sexes are found to consume plant-derived sugar meals as a source of
energy, and certain plants upon which sand flies feed can shorten their life or reduce
their capacity for transmitting leishmaniasis. Therefore, the structure of plant
communities is found to influence the transmission dynamics of sand fly-borne diseases.

A next-generation sequencing (NGS)–based assay for determining the source of sand fly
plant meals, based upon the chloroplast DNA gene ribulose bisphosphate carboxylase
large chain (rbcL), found the predilection of several sand fly species, vectors of
leishmaniasis in different parts of the world, prefer feeding on Cannabis sativa. The plant
DNA detected in sand flies was from plant cells damaged by their mouthparts as they
pierced plant tissues to reach the phloem.

Pollinator insects, including mosquitoes, are attracted to plants that emit volatile
molecules such as terpene, and sixty-eight volatile compounds were detected and
partially characterized in pollen and vegetative parts of Cannabis sativa by GC-MS. As
cannabinoids from C. sativa exhibit antimicrobial activity against some bacteria and fungi,
and a potent antileishmanial, and since thriving gut microbiomes are crucial for the
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development of Leishmania infections in the sand fly gut, a microbicidal effect could
harm the infections.

Therefore, a novel approach for controlling blood-sucking mosquitoes and sand flies, is
by exploits their plant feeding habit by utilizing attractive toxic sugar baits (ATSBs) that
emit olfactory cues to attract the sand flies and mosquitoes, by adding C. sativa plant
extracts, augment the efficacy of ATSBs for controlling sugar-questing disease vectors

Gallery: anatomy of Phlebotominae

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Science Department
Department of pathological analyzes

Epidemiology
In the Old World, Phlebotomus sand flies are primarily responsible for the transmission
of leishmaniasis,[2] an important parasitic disease, while transmission in the New World,
is generally via sand flies of the genus Lutzomyia.[3] The protozoan parasite itself is a
species of the genus Leishmania. Leishmaniasis normally finds a mammalian reservoir
in rodents and other small animals such as canids (canine leishmaniasis) and hyraxes. The
female sand fly carries the Leishmania protozoa from infected animals after feeding, thus
transmitting the disease, while the male feeds on plant nectar.
The parasite Leishmania donovani is the main causative agent of visceral
leishmaniasis (VL) in India, Nepal, and Bangladesh, where it is transmitted by the sand
flies of the species Phlebotomus argentipes.[4] This species of sand flies was on the brink
of elimination in India during the 1960s following the widespread use
of DDT for malaria control. However, there was a resurgence in their population a decade
later.
Phlebotomus species are also vectors for bartonellosis, verruga peruana, and pappataci
fever, an arboviral disease caused by sandfly fever viruses such as the Naples and Sicilian

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strains of the genus Phlebovirus (family Bunyaviridae), which also includes the closely
related Toscana virus.[5][6] In Egypt, two species of medical importance are Phlebotomus
papatasii and P. langerni. These flies are short-lived. Females are bloodsuckers at night;
males feed on plant juices. Adults are poor fliers, they usually hop for short distances.

Lifecycle
Batches of thirty to seventy eggs are laid in cracks and holes in the ground, in crevices in
masonry and among leaf litter. The eggs require a humid environment to avoid
desiccation, and hatch within about twenty days. The larvae are mainly scavengers,
consuming fungi, leaf mould, rotting vegetation and detritus. The larvae are recognisable
by their black heads, greyish twelve segmented bodies and conspicuous feathery,
branching bristles on head and body, and two pairs of long hairs on the tip of the
abdomen. The larvae pass through four instars over the course of three to four weeks,
before selecting an upright position and pupating, with the final larval skin remaining
attached to the pupa, the long hairs protruding. In cooler climates, the larvae
may diapause over winter. Adults emerge from the pupae after about one to two weeks.
The whole cycle takes thirty to sixty days unless the larvae diapause, when it may take
four or five months.[7] Laboratory colonies of several Phlebotomus species have been

established for experimental study of their biology, behaviour, mutual relations with
disease agents, and for testing methods of vector control

Behaviour
The adult flies are nocturnal, spending the day sheltering in dark humid places such as on
bark, among foliage, among leaf litter, in animal burrows, in termite mounds, and in
cracks and crevices. At nightfall they emerge to feed on sugary secretions and plant sap.
The female needs a blood meal before it can reproduce; some species feed on mammals

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including man, while others also feed on birds, reptiles and amphibians. The fly is a weak
flier and takes short flights to find a victim, adopting a "hopping" style of flight when
close to a host. Some sandflies are "exophagic", living entirely out of doors, while others
are "endophagic" and invade houses. In the tropics, adults may breed all year round, but
in temperate climates the adults die off in the autumn and new adults emerge in the
spring. The adults have short mouthparts and are unable to bite through clothing

Adult feeding behaviour

Both male and female sand flies feed on plant juices and sugary secretions. Females also
blood-feed to produce eggs. Sand flies use their mouthparts to probe exposed skin,
leading to the formation of a pool of blood from which they feed. Sand fly saliva contains
pharmacologically active components that aid in the feeding process [21]. Feeding
activity is influenced by temperature, humidity and air movement (sand flies are weak
fliers so even light wind can inhibit flight and reduce biting). Most species feed at dusk
and during the night, when temperature falls and humidity rises [22], although daytime
biting can occur indoors in darkened rooms or among shaded vegetation/trees, especially
if disturbed by human activity.

Reproduction and oviposition

Adult sand flies mate soon after emergence; males locate females at resting sites or on
vertebrate hosts, with the aid of pheromones [23]. Female sand flies usually lay 30-70
eggs during a single gonotrophic cycle, which are deposited in cracks and holes in the
ground or in buildings, animal burrows and among tree roots [20]. The eggs require a
microhabitat with high humidity in order to survive, but are not laid in water. Generally,
one blood meal results in the production of a single batch of eggs [22].

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Activity (incl. dispersal, seasonality, overwintering)

The extent to which sand fly population densities vary throughout the year depends on
the local climate, with significant seasonal changes in temperature and precipitation
resulting in fluctuations in sand fly numbers – i.e. lowest during the coldest and/or driest
seasons of the year [22]. In tropical areas, some species are common all year, whereas
others show marked changes in relation to wet and dry seasons. In temperate regions
adult sand flies are only present during the summer. In addition, the various species of
sand fly have different seasonal activity periods and daily peaks of biting activity. Adult
sand flies are weak fliers, travelling with a characteristic short hopping flight, and they
usually disperse no more than a few hundred metres from their breeding sites. Most
species fly horizontally near ground level. In temperate and arid regions, sand flies may
overwinter as diapausing mature larvae [20].

Habitat preference
Phlebotomus spp. occur predominantly in warm, humid, tropical climates and semi-
desert vegetation habitats, although a few species occur in temperate zones. They are
able to colonise rural, peri-urban and urban areas. Sand flies require a humid
microclimate in order for their eggs to develop and larvae need a cool, moist habitat with
decaying debris. Adult sand flies often inhabit rock crevices, caves, and rodent burrows,
and in peri-domestic settings rest in cool, dark and humid corners of animal shelters or
human dwellings [22] [24]. Both rodent burrows and peri-domestic areas provide ready
access to blood meals in addition to shelter from the elements.

Host preference
Female sand flies feed on a wide variety of vertebrate hosts, including humans, livestock,
dogs, urban and wild rodents, reptiles, amphibians, and birds [13] [20] [24]. Many species
of sand fly are opportunistic and feed on those animals to which they have easiest access,
as the same species collected from different biotopes often display different feeding
patterns [25]. A study of sand fly species from farms and kennels in Italy found that P.

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papatasi, P. perniciosus and P. perfiliewi fed primarily on the host species (livestock and
humans) that were present at the collection site [26]. If many different animals were
present, both P. perfiliewi and P. perniciosus were found to feed on all of them [26].
Similarly, at a wildlife park in Spain Phlebotomus perniciosus, P. ariasi and P. papatasi fed
on a wide range of species, however, there was evidence of preferential feeding on
certain host species [27]. Feeding probability was also positively associated with
increasing host census and decreasing movement costs of sand flies to the host [27]. As a
result, it is probable that in urban and peri-urban settings humans and domestic dogs are
the main targets for sand flies.

Epidemiology and transmission of pathogens

Vector status of different diseases in terms of public health and veterinary importance
Vectorial competence refers to the vectors’ ability to acquire, maintain and transmit the
pathogen Experimental transmission studies in animals have
implicated P. perniciosus and P. ariasi as competent vectors of L. infantum. A species may
otherwise be considered a vector if it is attracted to a particular Leishmania reservoir host
species and the same parasite strain is detected in the vector and the host in disease foci
Based on these criteria, species with confirmed vectorial competence for L.
infantum include P. ariasi P. balkanicus P. halepensis P. kandelakii P. langeroni P.
neglectus , P. perfilewi P. perniciosus and P. tobbi Suspected L. infantum vectors include P.
alexandri P. mascitti and P. major variants other than P. neglectus Confirmed vectors of L.
major and L. tropica are P. papatasi and P. sergenti, respectively Phlebotomus similis, a
sister species of P. sergenti, has been implicated as the vector for L. tropica in Crete [49]
[50]. Vectors of L. major and L. tropica are considered ‘specific vectors’ as they display
strong specificity for these Leishmania species. In contrast, other Phlebotomus spp.
support development of multiple Leishmania spp. and are termed ‘permissive vectors’
Competence of Leishmania spp. vectors varies between species and is not fixed for a
particular species as it depends on parasite-vector-host interactions as well as on the
ecological and epidemiological features of the infection
Traditionally P. papatasi was the implicated vector of phleboviruses. However, in the last
decade, viruses have been detected in P. perfiliewi, P. perniciosus, P. longicuspis, P.
papatasi, P. sergenti and Sergentomyia minuta, indicating sand flies have low specificity
for these viruses. Infection is found in males and females suggesting transovarial and
venereal transmission during mating [53] [5].
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Factors driving/having an impact on transmission cycles

Risk of sand fly-borne pathogens establishing transmission cycles in non-endemic
European regions
Vector-borne pathogens may not become established in a particular biotope if the vector
population size and the activity period are too small (50 vectors/m2 sticky trap is
considered the minimum density necessary for Leishmania transmission). This may explain
the absence or low prevalence of L. infantum infection in areas of central and eastern
Europe in spite of the presence of P. perniciosus, P. perfilewi and/or P. neglectus vectors
[54]. Conditions promoting vector spread, such as a warmer climate due to climate change
combined with the introduction of infected dogs, are considered the reasons for a
northward expansion of P. perniciosus, P. ariasi and P. neglectus and canine leishmaniasis
in northern Italy and Spain and southern France [55] [56] [57] [58] and for P.
perniciosus being reported at higher altitudes in southern Spain [59].
The introduction of infected dogs in Leishmania-free areas poses the risk that
leishmaniasis may become established in sand fly marginal areas, and there is an influx of
infected dogs into northern Europe as a result of dog adoption schemes and tourism [60]
[61] [62]. Furthermore, canine leishmaniasis due to congenital parasite transmission has
been reported in three generations of dogs living in the Czech Republic [63]. Congenital
transmission is considered an important infection route in the USA [64].
The absence of CL in southern Europe caused by L. major, despite the widespread
abundance of its vector P. papatasi, is due to the lack of a suitable rodent reservoir host
for these species [14]. Nevertheless, an L. infantum/L. major hybrid was detected in AIDS
patients in Portugal which was shown to develop and enable transmission in P.
papatasi [65] [66]. Leishmania major DNA was later detected in the sand
fly Sergentomyia minuta [67], the natural vector
of Leishmania (Sauroleishmania) tarentolae in reptiles. These findings highlight the risk
of L. major introduction from North Africa and the potential for hybrids forming and
spreading across the natural P. papatasi range, emphasising the need for continuing
surveillance [66].
The establishment of the L. tropica cycle in southern European countries where the
vector P. sergenti is widespread is a possibility since numerous cases are being diagnosed
among people migrating into Europe from endemic countries [68]. Leishmania tropica was
highly endemic on the island of Crete until the 1950s and cases have been continuously
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reported there and on the Ionian Islands since the early 2000s [69]. The suspected vector
in Crete is P. similis, a species found in Greece and Asia Minor [49]

Leishmania tropica also has a zoonotic cycle that relies on rodent species from North Africa
and the Middle East which are not present in Europe.
Cyprus is the only area in Europe where cases of anthroponotic VL caused by L.
donovani have been reported. This species has the largest public health impact worldwide,
being endemic in eastern Africa and on the Indian continent and present in Turkey
[70]. Leishmania donovani is closely related to L. infantum and an L. infantum/L.
donovani hybrid successfully developed in P. tobbi and P. perniciosus [71]. Preventing
further spread of L. donovani into Europe is considered a priority [69].
No studies are available on the risk of phlebovirus transmission cycles becoming
established in non-endemic European regions.

Factors driving sand fly-borne pathogen transmission in endemic areas

The transmission intensity level in endemic areas is strongly seasonal and varies on a small
and a large geographical scale, depending on environmental factors that affect vector and
reservoir host abundance. The incidence of clinical cases depends on the pathogen
incubation period which is at least two or three months for VL but only a few days for
phleboviruses. The incidence of sand fly fever with the Naples and Sicilian viruses begins
in April and reaches a maximum by September, closely mirroring the lifecycle of P.
papatasi [46]. Neurological infections by Toscana virus occur during the summer months.
In contrast, VL clinical cases in dogs and people in Europe often peak in the autumn and
winter. Sand fly infection rates with L. infantum in the Fuenlabrada outbreak were highest
at the end of the transmission period, indicating a higher risk of infection for people in late
summer [72].
The risk of Leishmania infection depends on the density of infected vertebrate hosts and,
apart from dogs, many domestic and sylvatic host species carry long-lasting subclinical
infections which can potentially be transmitted to the vector [73] [74]. Several host species
other than humans can become infected with phleboviruses but viremia is short-lived and
no vertebrate reservoir host has yet been recognised [53]. This is epidemiologically
puzzling because although viruses are transmitted congenitally in the vector, infection

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rates in subsequent generations gradually decrease, indicating that the vector alone is
unable to maintain the viruses in the population permanently [46].
An illustrative example of the small-scale heterogeneity in the spatial distribution of sand
fly-borne pathogens was the study of canine leishmaniasis in a 103 km2 highly endemic
and geographically diverse rural municipality in Spain on the south-east Mediterranean
coast [75]. Leishmania seroprevalence ranged from 0% in low (<100 m) irrigated colluvial
farmland to 47-100% in the highest (157-362 m) and driest part of the municipality where
the soil was predominantly conglomerate crust, favourable for the breeding and resting of
sand flies. Dogs sharing a home with other infected dogs were at much greater risk of being
infected than other dogs [75]. Elsewhere, a positive association between altitude and the
incidence of leishmaniasis and vector density has been shown to exist [76] [77] [78] [79]
[80]. Suitable altitude ranges differ, as they are an indirect measure of temperature,
humidity, predominant wind, terrain characteristics and land use, all of which are critical
factors affecting sand fly abundance and pathogen transmission.
Human intervention can strongly affect vector and parasite abundance. The recent L.
infantum VL and CL outbreak in Fuenlabrada was triggered by disturbance of the natural
habitat of P. perniciosus [81]. Vector density rose to >1000 vectors/m2 sticky trap in some
areas following a demographic explosion of hares (Lepus granatensis) on which the vectors
fed, with the hares acting as an atypical reservoir for L. infantum. Hares had found ideal
breeding grounds in green leisure parks built around a newly urbanised agricultural area,
occupied by a mostly urban human population, supposedly with a low level of acquired
immunity against the parasite. Comparable scenarios occur when non-immune people
enter CL and VL endemic areas, as was the case in situations with immigrant agricultural
workers in North Africa and the Arabian Peninsula, communities displaced by war in Sudan,
and American and European soldiers deployed in conflicts in Syria, Iraq and Afghanistan
[82]. Similarly, absence of acquired immunity against phlebovirus infections led to
thousands of clinical cases during World War II among soldiers stationed in the
Mediterranean and the Middle East [46].
Changes in vector density leading to an increase in transmission potential were also
associated with recent epidemics of VL, affecting hundreds of local adults and infants in
endemic regions in Italy [83]. The causes of these epidemics remain unclear and, as in the
Fuenlabrada outbreak, they were not associated with greater disease incidence in dogs.
They were characterised by a generalised expansion of transmission foci rather than a
few large case clusters, with P. perniciosus being the most common vector, followed
by P. perfiliewi and P. neglectus [83].
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Immunosuppression among HIV-positive patients was the determinant for

the Leishmania-HIV virus coinfection epidemic of the late 1980s and 1990s in
Mediterranean countries. There was no evidence of increased exposure to infected sand
fly vectors, rather the sharing of needles among HIV+ intravenous drug users was
established as a new L. infantum transmission route [84]. The Leishmania-HIV virus
coinfection epidemic was the first major epidemic of human leishmaniasis in Spain since
the 1960s. Prior to this, leishmaniasis was a common disease in humans in Spain,
particularly among infants lacking acquired immunity, and it was associated with
malnutrition, poor sanitation and the Spanish Civil War [85]. In western European
countries, leishmaniasis is no longer a disease which mainly affects children. In contrast,
this age group is still the most vulnerable in Albania [35]. Poverty and conflict are major
determinants for the emergence of CL and VL cases in war-ridden Iraq, Syria Afghanistan
and Sudan since the 1980s and 1990s, associated with population displacement into
endemic areas, destruction of healthcare infrastructure and increased incidence of other
diseases [82] [86].

Public health control measures

The suitability of leishmaniasis control strategies depends on the epidemiology of
infection and the ecological characteristics of the vector and reservoir hosts, differing
substantially for zoonotic and anthroponotic leishmaniasis. At present, there are no
nationwide surveillance and control schemes for sand flies in southern
Europe. Leishmania infantum control in Europe largely relies on preventing vector
infestation in dogs using pyrethroid insecticide-impregnated collars and spot-on
applications [87] [88]. The efficacy of these products under laboratory conditions is close
to 90% and experimental field studies in dogs have demonstrated their usefulness in
reducing leishmaniasis in people and dogs [89] [90] [91] [92] [93] [94] [95]. They require
strict adherence to the recommended application frequency, they must be used
throughout the entire vector season and their efficacy at a population level depends on
the proportion of treated dogs and the infection incidence, with collars being more useful
when incidence is high Common problems causing reduced efficacy include collar losses,
inappropriate mechanical application of topical solutions and product wash off when the
skin is soaked in water. For these reasons, the effectiveness of insecticide preventive
treatments in dogs may be very limited when left to dog owners in uncontrolled, non-
experimental conditions

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Public health interventions to control leishmaniasis outbreaks or foci require an

integrated strategy, combining vector surveillance and action against vector and reservoir
species
The Fuenlabrada human leishmaniosis outbreak of L. infantum transmitted by P.
perniciosus, represents the only recent example in Europe where this approach was used
There were four main aspects to the programme: vector surveillance; environmental
interventions to remove potential vector breeding and adult resting sites; large-scale
environmental application of insecticides, and drastic reduction of the population of
hares and rabbits, reservoirs of Leishmania.
Surveillance aims to assess the risk of parasite transmission and guiding vector control
activities. Due to the difficulty in locating sand fly breeding sites, it centres on monitoring
the distribution and abundance of the adult stages A variety of sampling methods are
available [24], the most common being sticky interception traps to capture a random
selection of the sand flies flying in the immediate surroundings, light traps (with/without
CO2 baiting) to catch host-seeking females attracted to light, and aspirator collection to
catch resting flies. Emergence traps can be used to catch flies as they leave resting sites
such as animal burrows. Animal-baited traps are another option useful for sampling host-
seeking flies [24]. Weather conditions such as temperature, humidity and wind speed can
affect sampling success. Selected sampling sites in Fuenlabrada were peri-urban parks
and the urban infrastructure close to the residences of leishmaniasis cases where
transmission was considered to be occurring.
Environmental interventions to eliminate sand fly breeding and resting sites in
Fuenlabrada included removing organic waste, unwanted vegetation, wood piles and
waste tips; cleaning drainpipes and watercourses; sealing sewage drains and electricity
meters; plastering holes and cracks in the walls of buildings; placing wire mesh in the
windows of sanitary basements and aeration tubes; eliminating rats and feral cat colonies
and destroying hare and rabbit nesting grounds. Pyrethroid insecticides were applied on
vegetation and water collection drainage systems in parks and urban areas close to
leishmaniasis cases, around subterranean electricity networks, on walls covered with
vegetation and in the sanitary basements of buildings.
Control activities in Fuenlabrada reduced the incidence of human leishmaniasis from
34.03 per 100 000 people in 2011 to 3.41 cases per 100 000 people in 2017 (incidence
was 0.81/100 000 people in 2001) [104]. Culling of hares was the single most effective
measure reducing incidence of leishmaniasis by 56% over two consecutive seasons.
Elimination of potential sand fly breeding and resting sites was also considered effective
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in reducing sand fly density. In contrast, widespread application of insecticides on the

environment was short-lived and unexpectedly, sand fly trap counts rose after the
insecticides were applied, presumably due to an increase in vector activity and vectors
evicting treated resting sites.
Eliminating reservoir hosts to control zoonotic leishmaniasis has been attempted
before. Leishmania major was successfully eliminated in areas of the former USSR in
Central Asia by destroying the natural habitat of rodent reservoirs and this approach is
now being applied in the Middle East and North Africa [82]. In contrast, the culling of
infected dogs in Brazil between 2008 and 2017 did not reduce zoonotic human VL from L.
chagasi (syn. L. infantum) due to low coverage and low sensitivity of diagnostic tests. The
measures also met with widespread criticism for ethical reasons [105] [106].
Insecticide spraying on sand fly resting sites has shown contrasting results in other
countries. Sand fly density in tropical rainforests was reduced by 30% in Panama using
the organophosphate malathion [107], whilst in Brazil no sand flies were observed for 21
days after the application of the organochlorine DDT [108]. Spraying cyfluthrin inside
termite mounds and animal burrows in Kenya decreased sand flies by 90% for two weeks
[109]. Continuous insecticide spraying against the malaria mosquito vector with DDT in
the mid-twentieth century significantly reduced the incidence of Leishmania and
phlebovirus infections in Europe and India [69] [110] [111]. Fipronil insecticide oral bait is
being considered as an alternative to mass fumigation of rodent burrows for L.
major control in Kazakhstan [112].
Attractive toxic sugar bait (ATSB) sprayed on vegetation or on sand fly barrier fences
[113] has been used to reduce adult sand fly populations in Israel [114], Morocco [115]
and Iran [116] where L. major is endemic. Common bait includes natural products such as
boric acid, Spinosad and sodium ascorbate [114] [117]. ATSB is considered useful in arid
areas where attractive flowering plants are scarce or absent, since it is more selective,
environmentally friendly and less expensive than the large-scale use of insecticides [114].
In Israel, Bacillus sphaericus was applied to sugar solutions close to sand fly habitats as a
means of biological control, causing significant larval mortality and reduction of the adult
population [118]. Bacillus sphaericus reduced the survival and fecundity of sand flies in
vitro [119] [120].
Ensuring the collaboration of the general public and medical and veterinary professionals
is a key factor for the correct management of leishmaniasis control programmes and to
reduce the risk of further outbreaks. Public health awareness and education initiatives
and materials provide information on the disease and the vector and on personal
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protection against sand fly bites. The latter includes using insecticide repellents, fitting
mosquito screens on windows at home, sleeping or resting in screened or air-conditioned
rooms and protecting pets with insect repellents.
The participation of well-informed communities, coupled with active case finding by
health authorities is critical to the success of integrated control strategies in areas
where L. major, L. tropica and L. donovani are endemic [86]. Vectors of these species are
also endophilic, and peri- and intra-domiciliary control measures are essential,
particularly indoor residual spraying (IRS) with insecticides and the use of insecticide-
treated bed nets (ITN) and linen IRS is recommended when transmission incidence is
high, but is operationally challenging and its efficacy must be assessed by observing the
performance of people conducting the spraying; evaluating the accuracy of IRS;
performing bioassays; monitoring knock-down catches of sand flies resting indoors, and
assessing people’s acceptance of the intervention [86]. ITNs represent a very effective,
low-hazard method for reducing human-sand fly contact and transmission of
leishmaniasis in the population, as shown in trials carried out in many CL and VL endemic
countries. However, achieving widespread coverage and enduring compliance in their use
can be a major limiting factor

Key areas of uncertainty

Environmental interventions to control vector populations need to be more clearly
defined, based on a better understanding of factors leading to the large and small-scale
spatial distribution of sand fly vectors, including breeding and resting sites. Further
research is needed to improve the efficacy and understanding of the implications of
insecticide treatment and to evaluate environmental persistence and application
techniques, potential associated health risks and the development of resistance which
may compromise the long-term effectiveness and sustainability of insecticide-based
interventions [103] [127]. Strategies targeting sugar-feeding adult sand flies require
wider knowledge of the vegetation flies feed on and to identify better attractants and
ways of delivering them. The use of insecticide-impregnated vertical barriers in foci
where sand flies reach human dwellings from the periphery could be further explored
and standardised. Personal protection against sand fly bites could be improved by
developing and testing novel sand fly repellents and ITN strategies With respect to the
pathogens themselves, TOSV is not listed in international surveillance programmes, and
this limits the timely availability of data on the incidence of this disease in the EU.
Furthermore, there is uncertainty on the clinical impact and epidemiological

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 Albasrah university
Science Department
Department of pathological analyzes

characteristics of newly described phleboviruses and their interaction

with Leishmania parasites in sand flies [46] [53]. Public health protocols to control the
epidemic foci of sand fly-borne pathogens in Europe could benefit from standardisation
and the results from interventions should be more widely communicated to the scientific
community.

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 Albasrah university
Science Department
Department of pathological analyzes

The References

Kznhealth
Wikipedia
animals.mom.me

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