When being asked to extract molecular immune signatures, at the preclinical stage of systemic lupus erythematosus (SLE), the analysts who received the subjects' blood, monitor the presence and titers of autoantibodies against a more or less extended panel of SLE associated autoantigens. Tunisian subjects are known to stably share habitats where zoo anthropophilic blood-feeding sand flies and Leishmania infantum co-perpetuate. We were curious to add three other antigenic sources depicted below.

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... wo serum biobanks were selected in the original publication. Analysis from the second shown, four sera containing high titers of mammalian histones autoantibodies as well as a range of ENA-binding autoantibodies. Combined tests that allow detecting antibodies signing [1] risks of developing SLE [2] as well as exposure to viscerotropic Leishmania species, whenever physicians addressed blood of healthy subjects inhabiting areas where perpetuate these species L. chagasi/infantum and L. donovani. L. donovani is the second species within the genus Leishmania to share these so-called viscerotropic features with L. chagasi/infantum. We were not in the position to disentangle the genetic and environmental components that could account for the multiple positive serologic tests in healthy subjects. It will be important to broaden the spectrum of differential diagnoses in healthy subjects at risk of developing auto immune diseases when they stably inhabit areas where sand flies and viscerotropic Leishmania species coperpetuate.