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Medenica S, Miladinović-Tasić N, Stojanović NM, Lakićević N, Rakočević B. Climate Variables Related to the Incidence of Human Leishmaniosis in Montenegro in Southeastern Europe during Seven Decades (1945-2014). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1656. [PMID: 36767024 PMCID: PMC9914530 DOI: 10.3390/ijerph20031656] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/06/2023] [Accepted: 01/12/2023] [Indexed: 06/18/2023]
Abstract
Leishmaniosis (or leishmaniasis) is a neglected parasitosis most commonly transmitted by the sandfly bite. Changes in temperature, precipitation, and humidity can greatly affect the vectors and reservoir hosts. This study aimed to determine the association between temperature, air humidity, and weather conditions with the incidence of leishmaniasis in Montenegro during a seven-decade period (1945-2014) and to statistically compare and correlate the obtained data. In the studied period, there were 165 registered cases of leishmaniosis, 96.4%, in the coastal and central region of Montenegro, with an average incidence rate of 0.45/100.000. The visceral form of leishmaniosis predominated (99% of the cases), with only one case of cutaneous disease. Climate factors (average temperature, air humidity, and precipitation) had an impact on the occurrence of leishmaniosis in Montenegro. Air temperature elevated by 1 °C in all regions of Montenegro was significantly correlated with an increased incidence of leishmaniosis, by 0.150 (0.013 to 0.287; p < 0.05). In order to improve prevention and control of this disease, it is also necessary to investigate other factors with a possible impact on the number of cases of this neglected parasitosis.
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Affiliation(s)
- Sanja Medenica
- Public Health Institute Podgorica, 81110 Podgorica, Montenegro
| | - Nataša Miladinović-Tasić
- Department of Microbiology and Immunology, Faculty of Medicine, University of Niš, 18000 Niš, Serbia
- Center of Microbiology, Public Health Institute Niš, 18000 Niš, Serbia
| | - Nikola M. Stojanović
- Department of Physiology, Faculty of Medicine, University of Niš, 18000 Niš, Serbia
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Seasonal Patterns of Zoonotic Cutaneous Leishmaniasis Caused by L. major and Transmitted by Phlebotomus papatasi in the North Africa Region, a Systematic Review and a Meta-Analysis. Microorganisms 2022; 10:microorganisms10122391. [PMID: 36557644 PMCID: PMC9782821 DOI: 10.3390/microorganisms10122391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 11/29/2022] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND In North African countries, zoonotic cutaneous leishmaniasis (ZCL) is a seasonal disease linked to Phlebotomus papatasi, Scopoli, 1786, the primary proven vector of L. major dynamics. Even if the disease is of public health importance, studies of P. papatasi seasonal dynamics are often local and dispersed in space and time. Therefore, a detailed picture of the biology and behavior of the vector linked with climatic factors and the framework of ZCL outbreaks is still lacking at the North African countries' level. Our study aims to fill this gap via a systematic review and meta-analysis of the seasonal incidence of ZCL and the activity of P. papatasi in North African countries. We address the relationship between the seasonal number of declared ZCL cases, the seasonal dynamic of P. papatasi, and climatic variables at the North African region scale. METHODS We selected 585 publications, dissertations, and archives data published from 1990 to July 2022. The monthly incidence data of ZCL were extracted from 15 documents and those on the seasonal dynamic of P. papatasi from 11 publications from four North African countries. RESULTS Our analysis disclosed that for most studied sites, the highest ZCL incidence is recorded from October to February (the hibernal season of the vector), while the P. papatasi density peaks primarily during the hot season of June to September. Overall, at the North African region scale, two to four months laps are present before the apparition of the scars reminiscent of infection by L. major. CONCLUSIONS Such analysis is of interest to regional decision-makers for planning control of ZCL in North African countries. They can also be a rationale on which future field studies combining ZCL disease incidence, vector activity, and climatic data can be built.
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Imane S, Oumaima B, Kenza K, Laila I, Youssef EM, Zineb S, Mohamed EJ. A Review on Climate, Air Pollution, and Health in North Africa. Curr Environ Health Rep 2022; 9:276-298. [PMID: 35352307 PMCID: PMC8964241 DOI: 10.1007/s40572-022-00350-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2022] [Indexed: 12/04/2022]
Abstract
PURPOSE OF REVIEW The aim of this review is to summarize and provide clear insights into studies that evaluate the interaction between air pollution, climate, and health in North Africa. RECENT FINDINGS Few studies have estimated the effects of climate and air pollution on health in North Africa. Most of the studies highlighted the evidence of the link between climate and air pollution as driving factors and increased mortality and morbidity as health outcomes. Each North African country prioritized research on a specific health factor. It was observed that the health outcome from each driving factor depends on the studied area and data availability. The latter is a major challenge in the region. As such, more studies should be led in the future to cover more areas in North Africa and when more data are available. Data availability will help to explore the applicability of different tools and techniques new to the region. This review explores studies related to climate and air pollution, and their possible impacts on health in North Africa. On one hand, air quality studies have focused mainly on particulate matter exceedance levels and their long-term exposure impacts, namely, morbidity and mortality. The observed differences between the various studies are mainly due to the used exposure-response function, the studied population, background emissions, and natural emission from the Sahara Desert that characterize the region. On the other hand, climate studies have focused primarily on the impact of heat waves, vector-borne disease, and mental disorders. More than half of these studies have been on leishmaniasis disease. The review revealed unbalanced and insufficient research on health impacts from air pollution episodes and climate extremes across the region.
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Affiliation(s)
- Sekmoudi Imane
- Process and Environment Engineering Laboratory, Faculty of Sciences and Technologies, Mohammedia. Hassan II University, Casablanca, Morocco
| | - Bouakline Oumaima
- SETIME Laboratory, Department of Physics, Faculty of Science, Ibn Tofail University, B.P 133, Kenitra, 14000 Morocco
| | - Khomsi Kenza
- General Directorate of Meteorology, Casablanca, Morocco
- Laboratory of Chemistry-Biochemistry, Environment, Nutrition and Health, Faculty of Medicine and Pharmacy, Hassan II University, Ain Chock, Casablanca, P.O. Box 5696, Morocco
| | - Idrissi Laila
- Process and Environment Engineering Laboratory, Faculty of Sciences and Technologies, Mohammedia. Hassan II University, Casablanca, Morocco
| | - El merabet Youssef
- SETIME Laboratory, Department of Physics, Faculty of Science, Ibn Tofail University, B.P 133, Kenitra, 14000 Morocco
| | - Souhaili Zineb
- Laboratory of Chemistry-Biochemistry, Environment, Nutrition and Health, Faculty of Medicine and Pharmacy, Hassan II University, Ain Chock, Casablanca, P.O. Box 5696, Morocco
| | - El jarmouni Mohamed
- National School of Applied Sciences, Water and Environmental Engineering Team, Applied Sciences Laboratory, Abdelmalek Essaadi University, B.P03, Ajdir, Al-Hoceima, Morocco
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karmaoui A, Salem AB, Sereno D, El Jaafari S, Hajji L. Geographic distribution of Meriones shawi and Psammomys obesus, the main reservoirs and Phlebotomus papatasi vector of zoonotic cutaneous leishmaniasis in Middle East and North Africa. Parasite Epidemiol Control 2022; 17:e00247. [PMID: 35310083 PMCID: PMC8931442 DOI: 10.1016/j.parepi.2022.e00247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 02/28/2022] [Indexed: 11/02/2022] Open
Abstract
Rodents play a significant role in the balance of a terrestrial ecosystem; they are considered prey for many predators like owls and snakes. However, they present a high risk to agriculture (damaging crops) and health. These rodents are the main reservoirs of some vector-borne diseases like leishmaniasis. Meriones shawi (MS) and Psammomys obesus (PO) are the primary Zoonotic cutaneous leishmaniasis (ZCL) reservoirs in the Middle East and North Africa (MENA). A review on the MS and PO at the MENA scale was explored. A database of about 1500 papers was used. 38 sites were investigated as foci for MS and 36 sites for PO, and 83 sites of Phlebotomus papatasi (Pp) in the studied region. An updated map at the regional scale and the trend of the reservoir distribution was carried out using a performing proper density analysis. In this paper, climatic conditions and habitat characteristics of these two reservoirs were reviewed. The association of rodent density with some climatic variables is another aspect explored in a case study from Tunisia in the period 2009–2015 using Pearson correlation. Lastly, the protection and control measures of the reservoir were analyzed. The high concentration of the MS, PO, and Pp can be used as an indicator to identify the high-risk area of leishmaniasis infection.
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Benallal KE, Garni R, Harrat Z, Volf P, Dvorak V. Phlebotomine sand flies (Diptera: Psychodidae) of the Maghreb region: A systematic review of distribution, morphology, and role in the transmission of the pathogens. PLoS Negl Trop Dis 2022; 16:e0009952. [PMID: 34990451 PMCID: PMC8735671 DOI: 10.1371/journal.pntd.0009952] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Phlebotomine sand flies (Diptera: Psychodidae) are important vectors of various human and animal pathogens such as Bartonella bacilliformis, Phlebovirus, and parasitic protozoa of the genus Leishmania, causative agent of leishmaniases that account among most significant vector-borne diseases. The Maghreb countries Mauritania, Morocco, Algeria, Tunisia, and Libya occupy a vast area of North Africa and belong to most affected regions by these diseases. Locally varying climatic and ecological conditions support diverse sand fly fauna that includes many proven or suspected vectors. The aim of this review is to summarize often fragmented information and to provide an updated list of sand fly species of the Maghreb region with illustration of species-specific morphological features and maps of their reported distribution. MATERIALS AND METHODS The literature search focused on scholar databases to review information on the sand fly species distribution and their role in the disease transmissions in Mauritania, Morocco, Algeria, Tunisia, and Libya, surveying sources from the period between 1900 and 2020. Reported distribution of each species was collated using Google Earth, and distribution maps were drawn using ArcGIS software. Morphological illustrations were compiled from various published sources. RESULTS AND CONCLUSIONS In total, 32 species of the genera Phlebotomus (Ph.) and Sergentomyia (Se.) were reported in the Maghreb region (15 from Libya, 18 from Tunisia, 23 from Morocco, 24 from Algeria, and 9 from Mauritania). Phlebotomus mariae and Se. africana subsp. asiatica were recorded only in Morocco, Ph. mascitti, Se. hirtus, and Se. tiberiadis only in Algeria, whereas Ph. duboscqi, Se. dubia, Se. africana africana, Se. lesleyae, Se. magna, and Se. freetownensis were reported only from Mauritania. Our review has updated and summarized the geographic distribution of 26 species reported so far in Morocco, Algeria, Tunisia, and Libya, excluding Mauritania from a detailed analysis due to the unavailability of accurate distribution data. In addition, morphological differences important for species identification are summarized with particular attention to closely related species such as Ph. papatasi and Ph. bergeroti, Ph. chabaudi, and Ph. riouxi, and Se. christophersi and Se. clydei.
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Affiliation(s)
- Kamal Eddine Benallal
- Laboratory of Parasitic Eco-Epidemiology and Genetic of Populations, Institut Pasteur of Algiers, Algiers, Algeria
- Department of Parasitology, Faculty of Science, Charles University, Prague, Czech Republic
| | - Rafik Garni
- Laboratory of Parasitic Eco-Epidemiology and Genetic of Populations, Institut Pasteur of Algiers, Algiers, Algeria
| | - Zoubir Harrat
- Laboratory of Parasitic Eco-Epidemiology and Genetic of Populations, Institut Pasteur of Algiers, Algiers, Algeria
| | - Petr Volf
- Department of Parasitology, Faculty of Science, Charles University, Prague, Czech Republic
| | - Vít Dvorak
- Department of Parasitology, Faculty of Science, Charles University, Prague, Czech Republic
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Oliveira RS, Pimentel KBA, Moura ML, Aragão CF, Guimarães-E-Silva AS, Bezerra JMT, Melo MN, Pinheiro VCS. Clinical, epidemiological and climatic factors related to the occurrence of cutaneous leishmaniasis in an endemic area in northeastern Brazil. BRAZ J BIOL 2021; 81:557-565. [PMID: 32876165 DOI: 10.1590/1519-6984.224937] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/26/2020] [Indexed: 01/19/2023] Open
Abstract
Cutaneous leishmaniasis (CL) is a neglected tropical disease with a wide distribution in the Americas. Brazil is an endemic country and present cases in all states. This study aimed to describe the occurrence, the underlying clinical and epidemiological factors, and the correlation of climatic variables with the frequency of reported CL cases in the municipality of Caxias, state of Maranhão, Brazil. This is a retrospective and descriptive epidemiological study based on data extracted from the Brazilian Information System of Diseases Notification, from 2007 to 2017. Maximum and minimum temperature, precipitation, and relative air humidity data were provided by the Brazilian National Institute of Meteorology. A total of 201 reported autochthonous CL cases were analyzed. The predominance of cases was observed in males (70.1%). The age range between 31 and 60 years old was the most affected, with 96 cases (47.9%). Of the total number of registered cases, 38.8% of the affected individuals were engaged in agriculture-related activities. The georeferenced distribution revealed the heterogeneity of disease occurrence, with cases concentrated in the Western and Southern regions of the municipality. An association was detected between relative air humidity (monthly mean) and the number of CL cases per month (p = 0.04). CL continues to be a concerning public health issue in Caxias. In this context, there is a pressing need to strengthen measures of prevention and control of the disease through the network of health services of the municipality, considering local and regional particularities.
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Affiliation(s)
- R S Oliveira
- Curso de Medicina, Departamento de Ciências da Saúde, Universidade Estadual do Maranhão - UEMA, Campus Caxias - Anexo Saúde, Rua Quinhinha Pires, 746, Centro, CEP 65602-050, Caxias, MA, Brasil
| | - K B A Pimentel
- Programa de Pós-graduação Strictu Sensu em Saúde e Ambiente, Universidade Federal do Maranhão - UFMA, Praça Madre Deus, 02, Madre Deus, CEP 65025-560, São Luís, MA, Brasil
| | - M L Moura
- Curso de Medicina, Departamento de Ciências da Saúde, Universidade Estadual do Maranhão - UEMA, Campus Caxias - Anexo Saúde, Rua Quinhinha Pires, 746, Centro, CEP 65602-050, Caxias, MA, Brasil
| | - C F Aragão
- Programa de Pós-graduação Strictu Sensu em Virologia, Instituto Evandro Chagas - IEC, Rodovia BR 316, Km 07, s/n, Levilândia, CEP 67030-000, Ananideua, PA, Brasil
| | - A S Guimarães-E-Silva
- Programa de Pós-graduação Strictu Sensu em Biodiversidade, Ambiente e Saúde, Laboratório de Entomologia Médica, Universidade Estadual do Maranhão - UEMA, Campus Caxias, Praça Duque de Caxias, s/n, Morro do Alecrim, CEP 65604-380, Caxias, MA, Brasil
| | - J M T Bezerra
- Curso de Ciências Biológicas, Universidade Estadual do Maranhão - UEMA, Campus Lago da Pedra, Avenida Roseana Sarney, s/n, Vila Rocha, CEP 65715-000, Lago da Pedra, MA, Brasil
| | - M N Melo
- Laboratório de Biologia de Leishmania, Departamento de Parasitologia, Universidade Federal de Minas Gerais - UFMG, Av. Presidente Antônio Carlos, 6627, Pampulha, CEP 31270-901, Belo Horizonte, MG, Brasil
| | - V C S Pinheiro
- Programa de Pós-graduação Strictu Sensu em Biodiversidade, Ambiente e Saúde, Laboratório de Entomologia Médica, Universidade Estadual do Maranhão - UEMA, Campus Caxias, Praça Duque de Caxias, s/n, Morro do Alecrim, CEP 65604-380, Caxias, MA, Brasil
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Seasonal Distribution of Phlebotomus papatasi, Vector of Zoonotic Cutaneous Leishmaniasis. Acta Parasitol 2020; 65:585-598. [PMID: 32347533 DOI: 10.2478/s11686-020-00201-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 03/18/2020] [Indexed: 01/18/2023]
Abstract
PURPOSE The activity of Phlebotomus papatasi Scopoli, a vector of cutaneous leishmaniasis, is known to be seasonal, but the information describing these patterns is sparse in time and space. The purpose of his paper is to conduct a meta-analysis to depict the seasonality of P. papatasi at the global scale. METHODS The current paper uses data from a collection of 1200 scientific papers, where 300 are about the vector and 36 include monthly data (of 61 sites) of the P. papatasi from 15 countries published from 1994 to 2017. RESULTS The activity peaked mainly in dry periods in all explored sites. A map of seasonal distribution depicted a peak activity in August, followed by September. Geographically (geographic preference), August and September at the latitude 33° showed the highest abundance at a global scale. Concerning the latitude P. papatasi distribution, the high number is localized between 27° and 35°. However, the high number of this species according to the longitude is localized between - 4° and 58°, which shows a high interval of activity. Locally, for the habitat preference, the findings show a preference of this vector to indoor than to outdoor. CONCLUSIONS All these results can be helpful in identifying the period and sites of a future potential risk of leishmaniasis. This is the first attempt at the update of the vector activity both at global and local scale.
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Calderon-Anyosa R, Galvez-Petzoldt C, Garcia PJ, Carcamo CP. Housing Characteristics and Leishmaniasis: A Systematic Review. Am J Trop Med Hyg 2019; 99:1547-1554. [PMID: 30382013 DOI: 10.4269/ajtmh.18-0037] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Leishmaniasis is a major neglected tropical disease associated with high rates of disability and death. This disease is associated with poverty, which can be reflected in housing quality, especially in rural areas. This systematic review found that mud walls with cracks and holes, damp, and dark houses were risk factors for transmission of leishmaniasis. These characteristics create favorable conditions for sand fly breeding and resting as sand flies prefer humidity, warmth, and protection from sunlight during the day. Housing interventions might be a promising research area with a special focus on education as individual and collective protection for the effective control of leishmaniasis.
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Affiliation(s)
- Renzo Calderon-Anyosa
- Kuskaya Program, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Camila Galvez-Petzoldt
- Kuskaya Program, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Patricia J Garcia
- Kuskaya Program, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Cesar P Carcamo
- Kuskaya Program, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
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Dokhan MR, Jaouadi K, Salem S, Zenbil O, Gonzalez JP, Ben Salah A, Annajar BB. Natural Infection of Phlebotomus sergenti by Leishmania tropica in Libya. Am J Trop Med Hyg 2018. [PMID: 29532769 DOI: 10.4269/ajtmh.17-0814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Cutaneous Leishmaniasis (CL) is a public health concern caused by Leishmania (L.) major and L.tropica in Libya. Information on sandfly vectors, as well as their associated Leishmania species, is of paramount importance because vector dispersion is one of the major factors responsible for pathogen dissemination. A number of 515 sandflies (275 males and 240 females) were collected during June-November 2012 using the Centers for Disease Control miniature light traps from Al Rabta, northwest of Libya. Two hundred and forty unfed females were identified; Phlebotomus (Ph.) papatasi (N = 97), Ph. sergenti (N = 27), Ph. longicuspis (N = 32), Sergentomyia (Se.) minuta (N = 38), and Se. fallax (N = 46). These flies were screened for Leishmania DNA using the polymerase chain reaction-restriction fragment length polymorphism analysis of the internal transcribed spacer 1 and sequencing. Two Ph. sergenti were found positive to L. tropica DNA. This finding should be considered for any further vector surveillance and epidemiological studies of CL in endemic areas across Libya.
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Affiliation(s)
- Mostafa Ramadhan Dokhan
- Department of Zoology, Faculty of Science, University of Sabratha, Sabratha, Libya.,Libyan National Centre for Disease Control (NCDC), Tripoli, Libya
| | - Kaouther Jaouadi
- Laboratory of Medical Epidemiology, Institut Pasteur de Tunis, Tunis, Tunisia.,Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Institut Pasteur de Tunis, Tunis, Tunisia
| | - Sadok Salem
- Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Institut Pasteur de Tunis, Tunis, Tunisia.,Laboratory of Medical Epidemiology, Institut Pasteur de Tunis, Tunis, Tunisia
| | - Osama Zenbil
- Libyan National Centre for Disease Control (NCDC), Tripoli, Libya
| | - Jean Paul Gonzalez
- Center of Excellence for Emerging and Zoonotic Animal Disease, Kansas State University, Manhattan, Kansas
| | - Afif Ben Salah
- Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Institut Pasteur de Tunis, Tunis, Tunisia.,Department of Family and Community Medicine, College of Medicine and Medical Sciences (CMMS), Arabian Gulf University (AGU), Manama, Bahrain.,Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia.,Laboratory of Medical Epidemiology, Institut Pasteur de Tunis, Tunis, Tunisia
| | - Badreddin Bashir Annajar
- Public Health Department, Faculty of Medical Technology, University of Tripoli, Tripoli, Libya.,Libyan National Centre for Disease Control (NCDC), Tripoli, Libya
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Kassem HA, Beier JC, El Sawaf BM. Historical overview of infantile visceral leishmaniasis in El Agamy, Alexandria, Egypt. Acta Trop 2017; 176:335-339. [PMID: 28870535 DOI: 10.1016/j.actatropica.2017.08.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 08/17/2017] [Accepted: 08/31/2017] [Indexed: 11/26/2022]
Abstract
Infantile visceral leishmaniasis (IVL) is considered a rare and neglected disease in Egypt. An outbreak of the disease in El Agamy, Alexandria occurred in 1982 although the disease was previously reported 80 years before. Epidemiological and entomological studies were conducted ever since the 1982 outbreak to identify human cases, the parasite, reservoir host and the sand fly vector. Leishmania infantum MON-98, a new and unique zymodeme, was responsible of the disease. Stray dogs acted as the reservoir host and Phlebotomus langeroni was the proven vector. The parasite isolates from human cases were identical to the parasite isolates from the reservoir host and the sand fly vector. The El Agamy focus in 1982 was basically a rural Bedouin setting of recently built cement houses surrounded by lime stone fences. The numbers of human cases of IVL in this area have been declining, with the last reported case in 2005. This coincides with the completion of irregular urbanization of El Agamy which resulted in the disappearance of P. langeroni. In this review, we characterize the old focus of IVL in El Agamy based on published literature to identify factors underlying the appearance and disappearance of the disease.
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