Leishmaniose cutanéomuqueuse au Maroc, témoin d’un changement dans l’écologie du parasite ?

Intra and peridomiciliary comparison of density, sex ratio and gonotrophic stage of Phlebotomus sergenti in an active anthroponotic cutaneous leishmaniasis focus in Morocco

Cutaneous leishmaniasis due to Leishmania tropica represents a major public health problem due to its ability to spread into non-endemic areas by means of its vectors, and the associated dramatic psychosocial impact. The objective of this work was to compare the intra and extradomiciliary density, sex ratio and gonotrophic stage of sand flies from a recent active focus in Morocco. This field study is based on the need to optimize the effectiveness of control programs. Two different capture methods, CDC light traps and sticky traps, were used at two different times of the year, corresponding with the peaks of sand fly abundance. 7,815 sand flies were captured and classified into 13 species belonging to genera Sergentomyia (50.8%) and Phlebotomus (49.2%). Phlebotomus sergenti was the most abundant and frequent species of the genus Phlebotomus both inside (49.3%) and outside houses (52.1%) and it showed the highest density in extradomiciliary captures in June. The proportion of blood-fed females was similar indoors and outdoors (21.5% and 26.3%, respectively). Females in the three gonotrophic stages were found in 26% houses and this was significantly associated with some factors related to housing conditions. Therefore, P. sergenti seems well adapted to both indoors and outdoors biotopes where these females coexist with males. These findings suggest that the adoption of additional measures could benefit the strategy of the Moroccan health authorities, currently consisting of indoor insecticide spraying, given that transmission may also occur outdoors.

[Cutaneous leishmaniasis of the vermilion border of the upper lip extending to the oral mucosa]

BACKGROUND

Cutaneous leishmaniasis is endemic in Morocco. Mucosal involvement is rare. We report a case in Morocco of cutaneous leishmaniasis of the vermilion border of the upper lip extending to the oral mucosa due to Leishmania tropica.

PATIENTS AND METHODS

A 15-year-old girl was seen with 2 ulcerated lesions, present for 4 months, situated on the left cheek and vermilion border and extending to the oral mucosa. The diagnosis of leishmaniasis was confirmed by direct examination revealing high numbers of Leishmania amastigotes. Culture of the offending organism in NNN medium and isoenzymatic characterization resulted in identification of L. tropica. Treatment with meglumine antimoniate (Glucantime) was ineffective. The outcome was good after treatment with fluconazole.

CONCLUSION

In Morocco, cutaneous leishmaniasis with mucosal involvement is rare, and usually develops as a complication of cutaneous leishmaniasis via direct extension.

Risk mapping of human HIV-Leishmaniasis co-infection in Morocco

Background

HIV/AIDS is frequently associated with opportunistic diseases such as leishmaniasis. Hence, the co-infection HIV-Leishmania spp. is the result of the geographical overlap between leishmaniasis and HIV/AIDS cases. To the best of our knowledge, this is the first report describing the spatial distribution of HIV-Leishmaniasis co-infection in Morocco where both infections are endemic.

Methods

In the current study, we discuss the HIV-Leishmania spp. co-infection vulnerability in Morocco by using the cartography tools. Thus, epidemiological data of both infections (Leishmaniasis and HIV/AIDS) in different administrative regions of Morocco were collected and co-registered for Digital maps making.

Results & conclusion

The results showed a high risk of HIV-Leishmania infantum co-infection in northern and central regions in Morocco. These results should be taken into account for efficient control strategies and epidemiological surveillance of HIV –Leishmania spp. co-infection in Morocco.

Distribution and Bionomic of Sand Flies in Five Ecologically Different Cutaneous Leishmaniasis Foci in Morocco

Cutaneous and visceral leishmaniases are endemic in Morocco. Their geographical distribution is well known. It has been related to bioclimatic factors. However, in 2008, two new cutaneous leishmaniasis foci appeared out of the known risk areas. Hence, we have undertaken this entomological survey in five foci situated in different bioclimatic areas to better understand the distribution and the epidemiology of this disease. Results of this study, undertaken during 2011, showed the predominance of Phlebotomus sergenti (55.8%) followed by Ph. perniciosus (12.9%), Ph. longicuspis (12.3%), and Ph. papatasi (12.0%). Ph. sergenti was active during 6 months in subhumid area and 8 months in arid, semiarid, and Saharan areas. Compared to previous studies, our results show a rise in Ph. sergenti abundance and an extension of its activity period. These results could explain the increase in anthroponotic cutaneous leishmaniasis incidence in Morocco and its extension to new nonendemic regions. Ph. perniciosus and Ph. longicuspis have also displayed a large distribution and a long activity period indicating a high potential risk of Leishmania infantum transmission in the studied areas.