Direct sequencing of Leishmania donovani from patients in Garissa County, Northern Kenya, reveals a newly emerging intra-specific hybrid genotype

IntroductionLeishmaniasis is endemic in many countries, including Kenya. Despite the rising frequency of visceral leishmaniasis (VL) outbreaks in Garissa County, Northeastern Kenya, there is limited data on the genetic structure and epidemiology of Leishmania parasites from this region. This study used molecular methods to characterize Leishmania parasites collected at Garissa County Referral Hospital during the 2019 - 2022 VL outbreak. Methods286 blood samples, collected from patients suspected of having VL at Garissa County Referral Hospital between 2019 and 2022 were used. Leishmania parasites were screened at genus level by a quantitative real-time PCR assay targeting the arginine permease gene AAP3 (AAP3-qRT-PCR). Species identification and targeted gene sequencing were made on Illumina MiSeq using PCR amplicons of Hsp70 gene and ITS regions. Whole genome sequencing (WGS) was performed directly on eight selected blood samples using a target enrichment method after which data was analyzed using phylogenomic tools. ResultsBy AAP3-qRT-PCR, 128/286 (45%) blood specimens were determined to have Leishmania parasites. We obtained 86 Hsp70 and 79 ITS sequences that phylogenetically clustered with the L. donovani species complex. By WGS, the eight selected samples had L. donovani s.s., and clustered in two separate groups: one similar to the previously reported L. donovani group 5 and the other constituted a new and intra-specific hybrid genetic variant not reported previously. In all the 8 Kenya samples, we found SNPs in genes previously shown to be involved in L. donovani resistance to Antimony, Amphotericine B and Miltefosine. ConclusionThis study reveals the complex nature of Leishmania genetic structure in Kenya and sheds light on the genomic polymorphism of L. donovani in the region, which in turn, may explain the evolving threat of VL in the region. As caveat, the genomic signatures of drug resistance genes that were identified should be interpreted with caution until their functional implication is clarified in future studies. Non-technical SummaryVisceral leishmaniasis (VL), or kala-azar, is a deadly disease if untreated. In Kenya, it is common in Garissa, Isiolo, Marsabit, Turkana, and Wajir. During the 2019-2022 outbreak, we collected samples from patients at Garissa County Referral Hospital to study the genetic structure of the parasites. To avoid biases from lab-grown parasites, we used advanced genetic methods on parasites directly from patients blood. We identified two parasite groups: one related to a known group 5 (Ld5) from Kenya and Ethiopia, and a new group with mixed ancestry from Sudan, Ethiopia (Ld3), and Iraq (Ld4). Notably, we found genes linked to drug resistance. These findings are crucial because they help in understanding how the parasites evolve and spread. As caveat, the presence of drug resistance genes should be interpreted with caution until their functional implication are clarified in future studies.