[Leishmania tropica in Morocco. III--The vector of Phlebotomus sergenti. Apropos of 89 isolates]

Genetic diversity in Leishmania infantum and Leishmania tropica isolates from human and canine hosts in northern Morocco

This study investigated nine provinces in northern Morocco and collected 275 skin scraping, 22 bone marrow aspirates, and 89 fine needle aspirations from suspected cutaneous leishmaniasis (CL) and visceral leishmaniasis (VL) patients and potentially infected dogs. Molecular analysis using ITS1 RFLP PCR and RT-PCR revealed a higher prevalence of L. infantum (66.18 %; χ2 = 28.804; df = 1; P-value = 8.01e-08) than L. tropica in skin scraping, with L. infantum being the sole causative agent for both VL and canine leishmaniasis. L. infantum was predominantly found in most provinces, while L. tropica was relatively more dominant in Taza Province. Discriminant Analysis of Principal Components (DAPC) revealed distinct clustering between L. tropica and the other three species. However, no small subset of SNPs could clearly differentiate between Infantum_CL, Infantum_VL, and CanL, as they likely share a significant genetic background. The high rate of L. infantum could be attributed to the abundance of sand fly species transmitting VL. In Taza Province, Phlebotomus sergenti, responsible for anthroponotic CL, is the most abundant species. DNA sequencing demonstrated sequence heterogeneity in L. infantum (variants 1-9) and L. tropica (variants 1-7). Phylogenetic analysis showed a distinct separation between L. tropica and L. infantum strains, with an overlap among L. infantum strains isolated from cutaneous, visceral, and canine cases, and dogs serving as the central population for L. infantum.

A comparative genomics approach reveals a local genetic signature of Leishmania tropica in Morocco

In Morocco, cutaneous leishmaniasis (CL) caused by Leishmania (L.) tropica is an important health problem. Despite the high incidence of CL in the country, the genomic heterogeneity of these parasites is still incompletely understood. In this study, we sequenced the genomes of 14 Moroccan isolates of L. tropica collected from confirmed cases of CL to investigate their genomic heterogeneity. Comparative genomics analyses were conducted by applying the recently established Genome Instability Pipeline (GIP), which allowed us to conduct phylogenomic and principal components analyses (PCA), and to assess genomic variations at the levels of the karyotype, gene copy number, single nucleotide polymorphisms (SNPs) and small insertions/deletions (INDELs) variants. Read-depth analyses revealed a mostly disomic karyotype, with the exception of the stable tetrasomy of chromosome 31. In contrast, we identified important gene copy number variations across all isolates, which affect known virulence genes and thus were probably selected in the field. SNP-based cluster analysis of the 14 isolates revealed a core group of 12 strains that formed a tight cluster and shared 45.1 % (87 751) of SNPs, as well as two strains (M3015, Ltr_16) that clustered separately from each other and the core group, suggesting the circulation of genetically highly diverse strains in Morocco. Phylogenetic analysis, which compared our 14 L. tropica isolates against 40 published genomes of L. tropica from a diverse array of locations, confirmed the genetic difference of our Moroccan isolates from all other isolates examined. In conclusion, our results indicate potential regional variations in SNP profiles that may differentiate Moroccan L. tropica from other L. tropica strains circulating in endemic countries in the Middle East. Our report paves the way for future research with a larger number of strains that will allow correlation of diverse phenotypes (resistance to treatments, virulence) and origins (geography, host species, year of isolation) to defined genomic signals such as gene copy number variations or SNP profiles that may represent interesting biomarker candidates.

Population Genetic Structure of Phlebotomus sergenti (Diptera: Psychodidae) Collected in Four Regions of Morocco Based on the Analysis of Cyt b and EF-1α Genes

Phlebotomus (Ph.) sergenti is the main vector of Leishmania (L.) tropica (Trypanosomatida: Trypanosomatidae), the causative agent of anthroponotic cutaneous leishmaniasis in Morocco. This species has an extended geographical distribution, wider than that of the parasite. The main objective of our study was to analyze the genetic diversity of Ph. sergenti collected in four foci in Morocco: Taza, Foum Jemâa, El Hanchane, and Ouarzazate. We studied a set of diversity and population structure indices by sequencing two markers; nuclear EF-1α and mitochondrial Cyt b from 175 individual sand flies. Our results showed a considerable degree of intraspecific polymorphism with a high number of haplotypes identified in both genes. Many polymorphic sites detected in the Cyt b sequences (SCyt b = 45) indicate that it is the most polymorphic marker showing a distinct distribution of haplotypes according to their geographical origin, whereas the EF-1α marker showed no geographical isolation. Analysis by Tajima's D and Fu's Fs tests revealed a possible recent expansion of the populations, especially with the EF-1α marker, showing significant values in Taza and Ouarzazate sequences. The present study revealed significant genetic diversity within Ph. sergenti populations in Morocco. The results warrant further research using a combination of more than two markers including mitochondrial and non-mitochondrial markers, which may provide more information to clarify the genetic status of Ph. sergenti.

Entomological Survey and Impact of Climatic Factors on the Dynamics of Sandflies in Central Morocco

Sandflies are small insects belonging to the order Diptera, which make up the Phlebotominae subfamily within the Psychodidae family. In the fight against leishmaniasis in the prefecture of Meknes, Morocco, a study of the phlebotomist population was carried out during the period of activity of sandflies while studying the link between the abundance of these insects and climatic factors, namely, temperature, moisture, rainfall, and wind speed. A total of 958 phlebotomus were captured, 73% of which belong to Phlebotomus sergenti, a vector of Leishmania species causing human cutaneous leishmaniasis. This study also showed the existence of two months of risk in July and September with a positive correlation between temperature and abundance of sandflies and a negative correlation between abundance of sandflies and rainfall and moisture. Indeed, it is necessary to strengthen the means to fight this disease during periods of activity and to use medium-term climatological forecasts to develop an alert system for leishmaniasis.

Distribution and Ecology of Phlebotomine Sand Flies (Diptera: Psychodidae) in Endemic and Nonendemic Area of Leishmaniasis in Northern Morocco

Northern Morocco is endemic for cutaneous and visceral leishmaniasis. Our entomological investigations aim to evaluate the risk of Leishmania transmission by determining the species composition, the density, and seasonal fluctuation of sand fly populations in endemic and nonendemic areas of leishmaniasis in Tetouan province (North-Western Morocco). Using Sticky-paper traps, 8,370 specimens were collected between May and November 2015 in two localities: peri-urban area of Tetouan city, where leishmaniasis is endemic and that of the Oued Laou village where no cases of leishmaniasis have been recorded. Six sand fly species were identified. The genus Phebotomus was represented by five species: Phlebotomus ariasi, Phlebotomus. longicuspis, Phlebotomus perniciosus, Phlebotomus kazeruni, and Phlebotomus sergenti, while the genus Sergentomyia was represented by only one species Sergentomyia minuta. Phlebotomus perniciosus was dominant in the nonendemic area (47%) while Phlebotomus sergenti was dominant in the endemic area (51%). The spatio-temporal distribution of sand fly populations is discussed according to biotic and abiotic variables. Seasonal fluctuation in sand fly density showed a bimodal pattern for the subgenus Larroussius and a unimodal pattern for the subgenus Paraphlebotomus in Tetouan city. But, in Oued Laou village, a unimodal density distribution for species of the Larroussius subgenus and a bimodal seasonal distribution for species of the subgenus Paraphlebotomus were identified. We affirm the coexistence, in the study area, of vectors of both cutaneous and visceral leishmaniasis, namely P. ariasi, P. longicuspis and P. perniciosus vectors of Leishmania infantum and P. sergenti vector of L. tropica. However, the geographic distribution, the specific abundance, and the activity reveal significant differences between endemic and nonendemic areas in the region.

Ecological Survey of the Peridomestic Sand Flies of an Endemic Focus of Zoonotic Cutaneous Leishmaniasis in the South-East of Morocco

Leishmaniasis is a parasitosis caused by parasites of the genus Leishmania and is transmitted by Phlebotominae sand flies. An entomological survey was carried out in different localities of Zagora Province. Our work allowed us to establish an inventory of sand flies to study potential vectors of leishmaniasis and to compare the composition and the specific abundance of different endemic stations. The sand flies were collected using CDC miniature light traps during the month of July 2019 in the ten studied villages. The results indicate the presence of thirteen species, belonging to the genera Phlebotomus and Sergentomyia. Phlebotomus papatasi was the predominant species (46.65%) followed by Ph. alexandri (17%), Ph. longicuspis (11.55%), Ph. bergeroti (1.53%) and Ph. sergenti (1.27%). Phlebotomus kazeruni (0.03%) was rare, and only one female was captured in Ifred. Sergentomyia schwetzi (8.69%) was the most prevalent species in the Sergentomyia genus followed closely by Se. fallax (6.84%). Sergentomyia africana was present with a proportion of (3.86%) followed by Se. clydei (1.96%). Sergentomyia dreifussi (0.46%), Se. antennata (0.08%), and Se. minuta (0.08%) were very limited. Phlebotomus papatasi, Ph. alexandri, Ph. bergeroti, Ph. longicuspis, Ph. sergenti, Se. schwetzi, Se. clydei, and Se. fallax are constant species, being present at least in 50% of the stations (occurrence> 50%). Common species (25%–49%) were Se. minuta and Se. africana and rare species were Ph. kazeruni and Se. antennata with a very limited distribution (occurrence <12%). The greatest species richness was found in Ksar Mougni and Ifred with the occurrence of 11 species, but overall, it was high (>9 species) in most of the villages. The Shannon–Wiener index was high (H′ > 1) in eight localities (Ksar Mougni, Tassaouante, Bleida, ZaouiteLeftah, Ifred, Timarighine, Ait Oulahyane, and Ait Ali Ouhassou). The high value of this index is in favor of the ZaouiteLeftah locality (Shannon–Wiener index = 1.679) which is explained by the presence of a stand dominated by Ph. papatasi. In order to avoid exposure to infections, a good epidemiological surveillance and vector with rodent control measures must be well maintained. Awareness campaigns are also required and must be conducted for better knowledge of the disease.

Seasonal Dynamics of Sand Flies (Diptera, Pshycodidae), Vectors of Cutaneous Leishmaniasis, in the City of Fez, Northern Morocco

The infections transmitted by sand flies (Diptera, Psychodidae) pose always a real health problem due to the increasing number of cases detected each year and the annual emergence of new leishmaniasis outbreaks. This study evaluated the temporal evolution of six species of sand flies in five stations inventoried between May 2017 and April 2018, in order to determine for the first time the extent of cutaneous leishmaniasis (CL) transmission in the city of Fez. The monthly impact of Fez sand fly density has been studied using all multivariate statistical analyses, including multiple factor correspondence analysis (MCA), which were performed using XLSTAT and the version of SPSS 20.0 test. Differences between concentrations were considered significant if P < 0.05. To better study the results obtained, different ecological indices have been studied. This study showed that these vectors developed in different sectors of the city of Fez. A total of 816 sand flies were collected from five stations in the city, belonging to three species of the genus Phlebotomus (46.82%) and three species of the genus Sergentomyia (53.18%). The seasonal fluctuation of the average density followed a bimodal evolution for the three stations Dhar Richa, Ain Nokbi, and Boujloud. The stations of Ain Nokbi (0.87 ph/m²) and Dhar Richa (0.467 ph/m²) exposed the sites to a high average density with a maximum peak during August (1.965 ph/m²) and July (1.87 Ph/m²), respectively. S. minuta (44.24%), Ph. sergenti (26.96%), Ph. perniciosus (10.78%), and Ph. papatasi (9.07%) were the most qualified species. The calculated P value is above the 5% significance level, so the relative abundance of these species between study sites shows no significant difference. The period of phlebotomy activity of the genus Phlebotomus in Fez lasts seven months from May to November with a bimodal or trimodal evolution and varies according to the species or the surveyed station. The seasonal fluctuation of sand flies could be conditioned by climatic factors where the period of activity of the species coincides with the hot months (May, June, July, and August). We have observed that the temperature factor favors the prevalence of sand flies, while the difference in the relative abundance of species between the sites is related to the difference in the bioecological conditions of each site.

Leishmania tropica and Leishmania infantum infection in dogs and cats in central Israel

Background

Three species of Leishmania cause disease in humans in Israel and are endemic in the Middle East: Leishmania infantum, Leishmania tropica and Leishmania major. These species infect dogs and cats, but little is known about their prevalence in pet populations and their clinical manifestations. A study on dog and cat Leishmania infection was conducted in a focus of human L. tropica infection in central Israel with the aim of getting insight on leishmaniosis in pets in an area where human infection is highly prevalent.

Methods

Blood, demographic and clinical data were collected from dogs and cats brought for veterinary care in a focus of human L. tropica infection during 2018–2020. kDNA PCR and internal transcribed spacer1 high-resolution melt analysis PCR (ITS1 HRM PCR) with DNA sequencing were performed for the detection of Leishmania and species determination.

Results

Forty-three of 189 dogs (22.8%) and 44 of 152 cats (28.9%) were positive for Leishmania spp. infection by kDNA PCR. The ITS1 HRM PCR detected six dogs (3.3%) infected with L. infantum and one (0.5%) with L. tropica, whereas six cats (3.9%) were found infected by L. infantum and five (3.3%) by L. tropica. Four of the five L. tropica-positive cats suffered from weight loss, four had azotemia, two with mild and two with severe azotemia and progressive renal disease. Three cats had gingivostomatitis; three had skin lesions with abscess and ulcers in two and scales and hair loss in another cat, which was also FIV +. This is the first report of feline L. tropica infection in Israel. Clinical information on cats with this infection from previous studies elsewhere is scarce.

Conclusions

A high rate of Leishmania spp. infection, mostly estimated as sub-clinical, was found in dogs and cats admitted for veterinary care in an L. tropica focus. Among the animals in which infection could be characterized to the species level, more dogs were infected with L. infantum than with L. tropica while 5 of 11 cats were infected with L. tropica and had signs of systemic and skin disease not described before in feline L. tropica infection.

Graphical Abstract

Supplementary Information

The online version contains supplementary material available at 10.1186/s13071-022-05272-0.

Transmission patterns of Leishmania tropica around the Mediterranean basin: Could Morocco be impacted by a zoonotic spillover?

Cutaneous leishmaniasis (CL) due to Leishmania tropica is a neglected tropical disease characterized by a wide geographical distribution in the Mediterranean basin and is endemic in several of its countries. In addition, the vector Phlebotomus sergenti is abundantly present all around the basin. Its transmission cycle is still subject to debate. In some countries, the presence of an animal reservoir has been confirmed. In Morocco, CL due to L. tropica has risen since the 1980s and has spread widely to become the most abundant form of leishmaniasis in the territory. However, the anthroponotic transmission is so far the only recognized mode, despite recordings of L. tropica infection in animal hosts. In this review article, we assess the situation of CL due to L. tropica in the Mediterranean basin with a focus on Morocco and gather knowledge about any potential zoonotic transmission in the country. A concomitant zoonotic transmission could explain the persistence of the disease in areas where human protective measures combined with vector management did not help reduce the disease burden.

Cutaneous leishmaniasis (CL) due to Leishmania tropica is a neglected tropical disease still considered to be anthroponotic in Morocco despite evidence of zoonotic transmission in other endemic countries of the Mediterranean basin. Its high incidence in the country makes it necessary to investigate whether or not a potential concomitant zoonotic transmission exists alongside the anthroponotic one. Moreover, several reports of natural animal infection have been noted in the country. In this paper, we review how CL due to L. tropica is present around the Mediterranean basin, with a particular focus on the Moroccan foci, and try to unveil the existence of a zoonotic transmission in the area. A deep understanding of the transmission patterns of L. tropica in the region is necessary for the implementation of effective control measures and a better assessment of the disease burden. In addition, the complexity of this neglected disease requires more fundamental and applied research to unveil potential factors involved in its spread.

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.

Evolution, systematics and historical biogeography of sand flies of the subgenus Paraphlebotomus (Diptera, Psychodidae, Phlebotomus) inferred using restriction-site associated DNA markers

Phlebotomine sand flies are the main natural vectors of Leishmania, which cause visceral and tegumentary tropical diseases worldwide. However, their taxonomy and evolutionary history remain poorly studied. Indeed, as for many human disease vectors, their small size is a challenge for morphological and molecular works. Here, we successfully amplified unbiased copies of whole genome to sequence thousands of restriction-site associated DNA (RAD) markers from single specimens of phlebotomines. RAD markers were used to infer a fully resolved phylogeny of the subgenus Paraphlebotomus (11 species + 5 outgroups, 32 specimens). The subgenus was not recovered as monophyletic and we describe a new subgenus Artemievus subg. nov. Depaquit for Phlebotomus alexandri. We also confirm the validity of Ph. riouxi which is reinstated as valid species. Our analyses suggest that Paraphlebotomus sensu nov. originated ca 12.9-8.5 Ma and was possibly largely distributed from peri-Mediterranean to Irano-Turanian regions. Its biogeographical history can be summarized into three phases: i) a first split between Ph. riouxi + Ph. chabaudi and other species that may have resulted from the rise of the Saharan belt ca 8.5 Ma; ii) a Messinian vicariant event (7.3-5.3 Ma) during which the prolonged drought could have resulted in the divergence of main lineages; iii) a recent radiation event (3-2 Ma) that correspond to cycles of wet and dry periods in the Middle East and the East African subregions during the Pleistocene. Interestingly these cycles are also hypothetical drivers of the diversification of rodents, in the burrows of which Paraphlebotomus larvae develop. By meeting the challenge of sequencing pangenomics markers from single, minute phlebotomines, this work opens new avenues for improving our understanding of the epidemiology of leishmaniases and possibly other human diseases transmitted by arthropod vectors.

Understanding the factors that determine the emergence of anthroponotic cutaneous leishmaniasis due to Leishmania tropica in Morocco: Density and mitochondrial lineage of Phlebotomus sergenti in endemic and free areas of leishmaniasis

Anthroponotic cutaneous leishmaniasis (ACL) due to Leishmania tropica is spreading to new areas in Morocco. Exposure to the vector, Phlebotomus sergenti, is the only proven risk factor. Our objective was to compare the densities and genetic characteristics of P. sergenti populations in two nearby localities in Morocco, one in an ACL endemic area (El Borouj) and another in a nonendemic area (Sidi Hajjaj). P. sergenti density was significantly higher in the endemic area than in the nonendemic town (p = 0.032). A different predominant P. sergenti mitochondrial lineage was evidenced in each one of the two localities, and for the first time, the P. sergenti lineage acting as a vector of L. tropica has been identified. Bioclimatic differences were detected between both localities. In conclusion we found differences in both the density and the mitochondrial lineage of P. sergenti populations that may explain the different epidemiological situation. Given that the density of P. sergenti in the locality without ACL cases seems sufficient to allow transmission, the main factor that would justify its nonendemic character could be the absence of P. sergenti Lineage IV, which seems to prefer warmer and drier climates.

Multilocus sequence analysis provides new insight into population structure and genetic diversity of Leishmania tropica in Morocco

Cutaneous leishmaniasis (CL) is one of the most neglected tropical diseases, caused by different Leishmania species. Despite its high incidence in Morocco, CL due to Leishmania tropica is poorly understood in terms of its epidemiological status and population structure. In this study, we used multilocus sequence typing (MLST) in order to explore the genetic heterogeneity of L. tropica strains. Samples (N = 48) were collected from CL patients in two localities in Morocco (Foum Jamaa in the Azilal province and Imintanoute in Chichaoua province). PCR-sequencing of 18 strains was carried out for six housekeeping genes (cytb, me, fh, g6pd, pgd and gpi), Genetic diversity indices showed a high population genetic differentiation between and among populations. There was no shared haplotypes between the two localities studied. Our results reveal a considerable degree of differentiation through the relatively high FST value (> 0.4) and remarkable intraspecific polymorphism (S = 29). Imintanoute strains have more polymorphisms (S = 22) than the Foum Jamaa strains despite their small sample size. These results provide crucial background information of epidemiology in Imintanoute which raises questions about animal involvement in L. tropica transmission cycle.

Comparative Testing of Susceptibility Levels of Phlebotomus sergenti, the Main Vector of Anthroponotic Cutaneous Leishmaniasis, to Conventional Insecticides Using Two Capture Methods in Kerman City, Southeastern Iran

Background:

Collecting live sand flies from indoor sites is a major challenge for researchers in large cities due to the reluctance of families to survey their homes. This study was conducted to assess the efficacy of two methods for collecting sand flies for use in susceptibility tests in the urban area of Kerman, southeastern Iran.

Methods:

Sandflies were mainly collected using both baited traps and hand catch methods from outdoor and indoor sites. Susceptibility tests were separately done according to the standard World Health Organization testing protocol on Phlebotomus sergenti, including 60-minute exposure to DDT 4.0%, propoxur 0.1%, deltamethrin 0.05%, and malathion 5.0%.

Results:

During this research, the natural habitats and suitable indoor sites were selected to predict the density of live sand fly with perfect accuracy. The number of live Ph. sergenti caught by hand catch and baited traps methods was 42 and 361 in indoor and outdoor sites, respectively. The mortality rate of Ph. sergenti exposed to DDT 4%, deltamethrin 0.05, malathion 5%, and propoxur was 100%.

Conclusion

The baited traps showed a significant efficiency compared to hand catch for collecting live Ph. sergenti for use in susceptibility tests in urban areas. The Ph. sergenti collected from both indoor and outdoor sites were susceptible to all insecticides.

Entomological study in an anthroponotic cutaneous leishmaniasis focus in Morocco: Fauna survey, Leishmania infection screening, molecular characterization and MALDI-TOF MS protein profiling of relevant Phlebotomus species

In Morocco, leishmaniases are a major public health problem due to their genetic diversity and geographical distribution. Cutaneous leishmaniasis (CL) is an infectious disease caused by various species of Leishmania and transmitted typically by bite of phlebotomine sand flies. This study identifies sand fly fauna in Ibaraghen village, province of Azilal, which is a focus of CL, by combination of morphological and molecular methods (sequencing of COI gene, MALDI-TOF MS protein profiling). Nested-kDNA PCR was used to detect and identify Leishmania species within potential vector species. 432 CDC light traps were placed at different heights above ground level at four capture sites during a whole year. Traps at 1.5 m above the ground yielded capture of sand flies almost double compared to above ground level (29.33%), while the collection reached 55.09% when the traps were placed 2.5 m above ground. A total of 2,830 sand flies were collected, 2,213 unfed specimens were morphologically identified, 990 males (44.73%) and 1,223 females (55.26%) of 13 species; ten Phlebotomus species and three Sergentomyia species. Six species were analysed by MALDI-TOF MS protein profiling (4 Phlebotomus and 2 Sergentomiya species), and their identification was confirmed by COI sequencing. 1,375 unfed females were screened for the presence of Leishmania by nested-kDNA PCR in pools, 11/30 pools of P. sergenti showing a single band of 750 bp corresponding to L. tropica. Our results confirm the role of P. sergenti as a proven vector in Azilal focus of cutaneous leishmaniasis; however, the relative abundance of other species known as vectors of Leishmania species emphasizes the risk of introduction of L. infantum and L. major in this province. For the first time in Morocco, a combined approach to identify sand flies by both morphology and molecular methods based on DNA barcoding and MALDI-TOF MS protein profiling was applied.

Impact of Climatic Factors on the Seasonal Fluctuation of Leishmaniasis Vectors in Central Morocco (Meknes Prefecture)

The impact of climate factors on the epidemiology of diseases in general and leishmaniasis in particular continues to be a subject of research and analysis. Changes in climatic parameters contribute to the creation of ecological conditions favorable to the multiplication of the vectors of certain diseases. With this in mind, this study presents an entomological survey conducted in Meknes prefecture and the study of the link between the abundance of sandflies, an indicator of the risk of leishmaniasis in a given area, and the climatic factors. Monthly trapping of this fauna was carried out during a year from March 2016 until April 2017 using adhesive traps. Climatic data from the region were used to determine the effect of climate on the distribution of sandflies. A total of 941 leishmaniasis vector specimens were captured. The dominant species is Ph. sergenti (73.32), followed by Ph. longicuspis (8.25%), then Ph. perniciosus (7.94%) and Ph. papatasi (6.31%). The sex ratio study showed that males are more abundant than females for all species. The seasonal fluctuation is bimodal with two peaks, the first in July and the second in September. The results show a positive correlation between temperature and abundance of sandflies (r = 0.99) and a negative correlation with humidity and precipitation with a correlation coefficient of r = −0.87 and r = −0.72. Indeed, the medium-term climatological forecasts are essential tools to develop a warning system for leishmaniasis.

Leishmaniasis and phlebotomine sand flies in Oman Sultanate

There are few data on leishmaniases and sandflies in Oman Sultanate. We carried out an eco-epidemiological study in 1998 in the two main mountains of the country, the Sharqiyah and the Dhofar. This study allowed us to isolate and identify three Leishmania strains from patients exhibiting cutaneous leishmaniasis. The typing carried out by isoenzymatic study and by molecular biology were congruent: two strains of Leishmania donovani zymodeme (Z) MON-31 isolated in the Sharqiyah and one L. tropica ZROM102 (ZMON-39 variant for 4 isoenzymes) from the Dhofar. No strain was isolated from canids. The study of sandflies identified 14 species distributed in the genera Phlebotomus, Sergentomyia and Grassomyia: Ph. papatasi, Ph. bergeroti, Ph. duboscqi, Ph. alexandri, Ph. saevus, Ph. sergenti, Se. fallax, Se. baghdadis, Se. cincta, Se. christophersi, Se. clydei, Se. tiberiadis, Se. africana, and Gr. dreyfussi. In Sharqiyah, the only candidate for the transmission of L. donovani was Ph. alexandri, but the low densities observed of this species do not argue in favor of any role. In Dhofar, Ph. sergenti is the most important proven vector of L. tropica, but Ph. saevus, a locally much more abundant species, constitutes a good candidate for transmission.

Specification of blood meals ingested by female sand flies caught in Palestinian foci and identification of their concomitant leishmanial infections

Since leishmaniases are zoonotic vector-borne diseases transmitted through the bites of infected female sand flies, identification of the sources of imbibed blood meals and the detection and identification of leishmanial DNA in them are important in discerning animal reservoirs, clarifying the epidemiology and facilitating control of local leishmaniases. CDC light traps, aspirators and sticky paper traps were used to collect sand flies in four Palestinian foci of both, CL and VL. Phlebotomine species identification was based on morphological keys. Female specimens were screened to detect and identify leishmanial infections, using kDNA-PCR and ITS1-PCR, and engorged female specimens were analyzed to identify the origin of their blood meals, using an RDB blood meal assay based on the amplification of the cytochrome b gene (cytb) of vertebrate mitochondrial DNA (mtDNA). Twenty sand fly species, 11 of the genus Phlebotomus and nine the genus Sergentomyia, were identified. The most abundant species was Ph. papatasi (33.7%), followed by Ph. sergenti (21%). Among the 691 female sand fly specimens, 18.5% (128/691) were positive for leishmanial DNA, using the kDNA-PCR and 6.4% (44/691) were positive using the ITS1-PCR. DNA from parasites of the genus Leishmania was identified in only 1.5% of the infected sand flies. That of Leishmania tropica parasites was detected in six female specimens of Ph. sergenti and that of L. major parasites in two female specimens of Ph. papatasi. Interestingly, two engorged females of the species Se. (Neophlebotomus) sp. were positive for L. tropica DNA. Ninety engorged female sand flies of Ph. papatasi and 104 of Ph. sergenti had fed on a large variety of vertebrate hosts such as humans, hyraxes, rats, cows, goats and birds. Regarding blood-meals showing a mixture from different species of animal host, hyrax and rat blood was revealed in 8/104 (7.7%) females of Ph. sergenti. Detection of hyrax blood in engorged female sand flies of the species Ph. sergenti supports the role of hyraxes being a potential reservoir of L. tropica in Palestinian regions. Rat blood meals might be significant since a few strains L. tropica and L. infantum were isolated from rats. Further studies must be undertaken before conclusions could be drawn.

Emerging and Re-Emerging Leishmaniases in the Mediterranean Area: What Can Be Learned from a Retrospective Review Analysis of the Situation in Morocco during 1990 to 2010?

In Morocco, cutaneous and visceral leishmaniases represent a public health concern. In this opinion paper, we propose to highlight chosen elements that have governed the drastic increase in the incidence of leishmaniases recorded in Morocco during the period between 1990 to 2010 in order to guide the prediction of the expansion of diseases and epidemic events. We highlight that the dispersion of the zoonotic cutaneous leishmaniasis (ZCL) form, caused by the Leishmania major parasite, appears to be closely related to that of its arthropod vector density, which is sensitive to changes in climate. The dissemination of anthroponotic cutaneous leishmaniasis (ACL) was related to an increase in human travel and local tourism during the studied decades. These are linked to economic expansion and infrastructure development. Interestingly, the main ACL foci are spatially aligned with the highways, and their occurrence was synchronized with the building of transportation infrastructure. During the above-mentioned decades, the zoonotic visceral leishmaniasis (ZVL) caused by Leishmania infantum has expanded from its historical northern territories, dispersing outwards in all directions. This spread follows the emergence of hamlets and villages connecting with major cities.

Entomological Investigations, Seasonal Fluctuations and Impact of Bioclimate Factors of Phlebotomines Sand Flies (Diptera: Psychodidae) of an Emerging Focus of Cutaneous Leishmaniasis in Aichoun, Central Morocco

Leishmaniasis diseases are endemic in Morocco. An entomological survey was conducted in Aichoun locality for 1 year from September 2013 to August 2014. The objective of this study was to investigate the sand fly fauna, mainly the species composition and the monthly species prevalence in accordance with bioclimate factors. Sand flies were collected twice a month, using sticky traps and CDC light traps. During a one-year study, 4472 specimens of sand fly were caught (72.56% male/22.44% female) that were composed of seven species divided into two genera: Phlebotomus (99.46%) and Sergentomyia (0.53%). Ph. sergenti was the most prevalent species (46.64%), followed by Ph. perniciosus (38.19%), Ph. longicuspis (9.32%), Ph. papatasi (5.23%), and Ph. ariasi (0.06%). The genus Sergentomyia was even less frequent. The population dynamics showed a bimodal trend with two peaks: the first one in October (12.03% of specimens) and the second in June (27.92% of specimens). The study of the effects of climatic factors in the study area showed a link between the dynamics of sand flies and the variation of these parameters (temperature and relative humidity). During the period between November and March, the sand flies were absent. The highest prevalence of sand flies was recorded in June when the temperature and relative humidity values reached, respectively, 25.8°C and 42%. The minimum number of specimens was collected in September with an average temperature of 23.19°C and relative humidity of 57.4%. Statistical analysis with principal component analysis has shown a strong positive correlation between temperature parameters and the seasonal distribution of sand flies. The climatic factor of relative humidity has been judged of being negatively correlated. The wind speed does not have any impact on the relative abundance of all species. Within this context, the results will be useful for the development of a monitoring program to better manage the operations and evaluate their effectiveness.

Cartography and Epidemiological Study of Leishmaniasis Disease in Sefrou Province (2007-2010), Central North of Morocco

Increasing cases of leishmaniasis disease have been reported during recent years in Sefrou Province, Central North of Morocco. This study presents the epidemiological profile of the provincial population, aims at analyzing the epidemiological profile, and in particular, spatiotemporal follow-up of all cases of leishmaniasis. It is a retrospective analysis of leishmaniasis cases recorded between 2007 and 2010. The data were analyzed by SPSS software (version 20). Over a four-year period, from 2007 to 2010, there were 62 cases of leishmaniasis, 93.12% of cases of cutaneous leishmaniasis and 6.87% of visceral leishmaniasis. The case number of leishmaniasis in the Province of Sefrou varies between 0.165% and 0.0018%. For each type of leishmaniasis, the female sex was the most affected compared to the male sex. This difference cannot be considered statistically significant (χ2 = 0.083, p value = 0.77). For cutaneous leishmaniasis, all age groups were affected with a large percentage: patients aged 0–9 years with 63.11% followed by the age group [10–19] with 24.18%. Visceral leishmaniasis mainly has affected the infant population [0–9] with 83.33%. We have not observed any association between the age classes and the leishmaniasis type (χ2 = 6.20, p value = 0.4). From a spatial point of view, the majority of cases of leishmaniasis was reported in El Menzel region (67 cases) followed by Sefrou (64 cases) and Tazouta (38 cases). There is a statistically significant relationship between the type of leishmaniasis and the studied regions (χ2 = 52; p value <0.001). The study of the epidemiological profile of leishmaniasis cases may be useful in enlightening health authorities to develop screening, treatment, and control strategies to reduce the incidence rate of the disease. Other research studies can be conducted to the dynamics of the vectors of sandflies and their ecology.

Impact of Urbanization and Socioeconomic Factors on the Distribution of Cutaneous Leishmaniasis in the Center of Morocco

Background

Parasitic diseases, in particular leishmaniasis, are still a public health problem in several countries and in Morocco.

Methods

The data used are those of epidemiological surveillance collected in the registers of the prefectural epidemiology cell (PEC); however, the socioeconomic data were obtained from the High Commissioner for Planning. The Pearson correlation test was used to determine the correlation between the different variables.

Results

In total, 70 cases were recorded by the prefectural epidemiology cell (PEC) during the period from 2009 to 2015. 46% of the cases come from rural areas while 54% of the cases come from urban areas. The Pearson test shows the existence of a significant relationship between the number of cases recorded and the type of environment (r = 0.49, p value = 0.02), and population rate (R = 0.849 and p ≤ 0.001). However, in our case, the poverty rate does not influence CL's distribution.

Conclusion

Our results show that the CL affects the majority of the municipalities with predominance of the urban environment, so the distribution of cases of this pathology is not influenced by the poverty; however, the urbanization and the number of inhabitants have a positive impact on the distribution of this scourge.

Leishmaniasis in Northern Morocco: Predominance of Leishmania infantum Compared to Leishmania tropica

In Morocco, Leishmania infantum species is the main causative agents of visceral leishmaniasis (VL). However, cutaneous leishmaniasis (CL) due to L. infantum has been reported sporadically. Moreover, the recent geographical expansion of L. infantum in the Mediterranean subregion leads us to suggest whether the nonsporadic cases of CL due to this species are present. In this context, this review is written to establish a retrospective study of cutaneous and visceral leishmaniasis in northern Morocco between 1997 and 2018 and also to conduct a molecular study to identify the circulating species responsible for the recent cases of leishmaniases in this region. Data concerning leishmaniases cases were collected from the Epidemiology and Disease Control Directorate from 1997 to 2018. Human samples obtained from peripheral laboratories were examined using PCR-ITS1 method. The ITS1 products were subjected to digestion with the restriction endonuclease Mn1-I. Between 1997 and 2018, a total of 1,255 cases of cutaneous and visceral leishmaniasis were recorded in Tangier-Tetouan-Al Hoceima Region, i.e., 1.56% of the reported cases in Morocco (1,255/80,299). Concerning the geographical study covering the period 2007-2018, 79.5% (105/132) of the sectors were affected by leishmaniases. The molecular results showed that Humans were found to be infected with the L. infantum species with a high infection rate compared to L. tropica infection. Moreover, molecular characterization using ITS1 PCR-RFLP showed that the density of L. infantum was significantly higher (n = 68/81; 84%) than that of L. tropica (n = 13/81; 16%) (P-value 9.894e-10). While regarding visceral leishmaniasis, L. infantum was the only species responsible of this form. These findings of this study showed the emergence of L. infantum in Morocco and suggest that this species might be more prevalent than previously thought. Furthermore, the molecular determination of L. infantum will be helpful for control strategies by taking into consideration the reservoir of this species.

Review of Leishmaniasis in the Middle East and North Africa

Background

Cutaneous and visceral forms of leishmaniasis are the most important protozoan infection in the Middle East and North Africa (MENA).

Objectives

Review the current knowledge on leishmaniasis in the MENA.

Methods

The data presented in this review are gathered primarily from WHO reports and from an extensive literature search on PubMed.

Results

There are four cycles of transmission of leishmaniasis: zoonotic cutaneous leishmaniasis (ZCL), induce by Leishmania (L.) major, transmitted by Phlebotomus (P.) papatasi, with rodent species of Psammomys obesus, Meriones libycus, Nesokia indica, and Rhombomys opimus are considered as host reservoirs. Zoonotic visceral leishmaniasis (ZVL) is inducing by L. infantum, transmitted by several Phlebotomus spp. of the sub-genus Larroussius and mainly P. perniciosus in more than one-half of the MENA countries and the dog species of Canis familiaris are considered as the main reservoirs. Anthroponotic cutaneous leishmaniasis (ACL), induce by L. tropica and transmitted by P. sergenti, without any non-human reservoir in most cases. Anthroponotic visceral leishmaniasis (AVL) induces by L. donovani spreads through P. alexandri, circulates exclusively in humans.

Conclusion

There are many challenges facing the successful control of leishmaniasis. However, there is continuing research into the treatment of leishmaniasis and potentially vaccinations for the disease.

Thirty years of cutaneous leishmaniasis in Tadla-Azilal focus, Morocco

Cutaneous leishmaniasis (CL) due to Leishmania tropica is a major health problem in Tadla-Azilal focus, Morocco, where the first case was registered, here, in one locality named Tanant in 1987. So far, CL remains endemic and largely widespread. The objective of this study was to analyze the current eco-epidemiological situation after thirty years of active transmission. Data used are the official ones, obtained from the Moroccan Ministry of Health. Between 1998 and 2015, 5518 CL cases were registered in three provinces; Azilal, Béni Mellal and Fquih Ben Salah. CL has spread, from the historical focus in Azilal along two axes; one to the Northeastern Mountains and the other to the Northwestern plains. CL infected both genders and all ages, with large number of women (53%) and children (75% had <9 years old). More interestingly, age range at risk was larger within females than males, and this difference was more pronounced in Fquih Ben Salah where the disease had newly emerged. Similarly, age ranges at risk were larger and fluctuated significantly each year particularly in new emerging areas in Béni Mellal and Fquih Ben Salah. All these variations may testify, at least in part, to the process of acquiring immunity. Altitude structured CL spatiotemporal distribution. CL was more prevalent in two altitudes ranges; 400-500 m and 800-900 m. The situation and duration of period of diagnostic of CL varied largely according to the altitude. These different scenarios could be related to the seasonal dynamics of vector populations.

A review of cutaneous leishmaniasis in Morocco: A vertical analysisto determine appropriate interventions for control and prevention

Leishmaniasis is considered one of the most neglected diseases worldwide. In Morocco, cutaneous leishmaniasis is an important public health problem. Leishmania major and Leishmania tropica are the two major species in this country. Despite all efforts, monitoring and control of the cutaneous leishmaniasis is still challenging. We used for the first time a vertical analysis of the control of cutaneous leishmaniasis in Morocco from the document review and publications. This analysis allowed us to develop an epidemiological model that emphasized key possible interventions. No evaluation studies of these interventions in Morocco were done. Global Evidence underline the effectiveness of preventive interventions produced in integrate inter-sectorial strategy framework (e.g use of insecticide-treated bednets, indoor residual spraying and rodents' control) rather than treatments such as based thermotherapy, cryotherapy, photodynamic therapy, CO2 laser and paromomycin. Therefore, integrated vector management control (IVMC) with communityc participation is recommended as effective strategy. Strengthening of the IVMC with community involvement are necessary conditions to improve the program of cutaneous leishmaniasis and prevent epidemic foci appearance.

Management of Leishmaniases in the Era of Climate Change in Morocco

The proliferation of vector-borne diseases are predicted to increase in a changing climate and Leishmaniases, as a vector-borne diseases, are re-emerging diseases in several regions of the world. In Morocco, during the last decade, a sharp increase in cutaneous leishmaniases cases has been reported. Nevertheless, in Morocco, leishmaniases are a major public health problem, and little interest was given to climate change impacts on the distribution and spread of these diseases. As insect-borne diseases, the incidence and distribution of leishmaniases are influenced by environmental changes, but also by several socio-economic and cultural factors. From a biological point of view, environmental variables have effects on the survival of insect vectors and mammalian reservoirs, which, in turn, affects transmission. Here, we highlight the effects of climate change in Morocco and discuss its consequences on the epidemiology of leishmaniases to identify challenges and define targeted recommendations to fight this disease.

Risk factors for the expansion of cutaneous leishmaniasis by Leishmania tropica: Possible implications for control programmes

Cutaneous leishmaniasis (CL) caused by Leishmania tropica is emerging in new areas, initially as outbreaks and then establishing endemic foci. There is little evidence of the risk factors and effectiveness of existing control measures, what limits our ability to generalize in different epidemiological settings. The disease is described as anthroponotic; however, zoonotic outbreaks have been reported in some countries. Our aim was to identify risk factors in a recently reported endemic focus in Morocco in order to design more effective control programmes. A case-control study was conducted from September 2014 to October 2015 for epidemiological data collection from families with and without CL cases. Sandflies were captured and L. tropica infection determined. The presence of potential animal reservoirs was evaluated. 71 CL cases (44 diagnosed between 2013 and 2015) and 137 healthy people were surveyed. The average age of the new cases was 33.1 ± 22.3 years, and 69.0% were women. Phlebotomus sergenti was the most abundant species with a density of 4.27 sandflies/trap/night and differences between houses with and without CL cases were detected (p-value = 0.014). Overall, 2.7% female P. sergenti and 3.0% dogs were positive for L. tropica. Human, cat, rabbit and bird blood was detected in blood-fed P. sergenti females. 45% people used preventive measures that were not translated into a reduction in the individual risk of acquiring CL. Exposure to P. sergenti was the only risk factor found, and the reduction in its density could be achieved through the improvement of water wells management, organic fertilizers' disposal and dogs control. The lack of effectiveness of indoor residual spraying and treated nets are attributable to poor compliance and misuse of them. In addition, result optimization of the awareness campaigns on the public is possible by involving patients with CL to explain their own experience.

Natural Infection of Phlebotomus sergenti by Leishmania tropica in Libya

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.

Molecular identification of Leishmania infection in the most relevant sand fly species and in patient skin samples from a cutaneous leishmaniasis focus, in Morocco

BACKGROUND

Cutaneous leishmaniasis (CL) is an infectious disease caused by various species of Leishmania and transmitted by several species of sand flies. CL is among the most neglected tropical diseases, and it has represented a major health threat over the past 20 years in Morocco. The main objectives of this study were to identify relevant sand fly species and detect Leishmania infection in the most prevalent species and patient skin samples in Taza, a focus of CL in North-eastern Morocco.

METHODOLOGY AND FINDING

A total of 3672 sand flies were collected by CDC miniature light traps. Morphological identification permitted the identification of 13 species, namely 10 Phlebotomus species and 3 Sergentomyia species. P. longicuspis was the most abundant species, comprising 64.08% of the total collected sand flies, followed by P. sergenti (20.1%) and P. perniciosus (8.45%). Using nested-kDNA PCR, seven pools of P. sergenti were positive to Leishmania tropica DNA, whereas 23 pools of P. longicuspis and 4 pools of P. perniciosus tested positive for Leishmania infantum DNA. The rates of P. longicuspis and P. perniciosus Leishmania infection were 2.51% (23/915) and 7.27% (4/55), respectively, whereas the infection prevalence of P. sergenti was 3.24%. We also extracted DNA from lesion smears of 12 patients suspected of CL, among them nine patients were positive with enzymatic digestion of ITS1 by HaeIII revealing two profiles. The most abundant profile, present in eight patients, was identical to L. infantum, whereas L. tropica was found in one patient. The results of RFLP were confirmed by sequencing of the ITS1 DNA region.

CONCLUSION

This is the first molecular detection of L. tropica and L. infantum in P. sergenti and P. longicuspis, respectively, in this CL focus. Infection of P. perniciosus by L. infantum was identified for the first time in Morocco. This study also underlined the predominance of L. infantum and its vector in this region, in which L. tropica has been considered the causative agent of CL for more than 20 years.

Phlebotomus (Paraphlebotomus) chabaudi and Phlebotomus riouxi: closely related species or synonyms?

Phlebotomus riouxi Depaquit, Killick-Kendrick & Léger 1998 was described as a species closely related to Phlebotomus chabaudi Croset, Abonnenc & Rioux 1970, differing mainly by the size and number of setae of the coxite basal lobe. Molecular studies carried out on several populations from Algeria and Tunisia and based on mitochondrial genes cytochrome b (Cytb) and cytochrome oxidase I (COI) supported the typological validity of these two species. Recently, specimens from a single population in southern Tunisia were morphologically identified as Ph. riouxi, Ph. chabaudi and intermediates, but were clustered in the same clade according to their Cytb and nuclear gene elongation factor-1 α (EF-1α) sequences. These species were thus synonymized. To further explore this synonymy, we carried out a molecular study on specimens from Algeria and Tunisia using the same molecular markers and a part of 28S rDNA. We did not find any morphologically intermediate specimens in our sampling. We highlighted differences between the genetic divergence rates within and between the two species for the three markers and we identified new haplotypes. The sequence analysis did not reveal any signature of introgression in allopatric nor in sympatric populations such as in the Ghomrassen population. Phylogenetic analyses based on our specimens revealed that the two main clades are Ph. chabaudi and Ph. riouxi, in agreement with the morphological identification. These results support the validity of Ph. riouxi and Ph. chabaudi as typological species.

New epidemiological aspects of visceral and cutaneous leishmaniasis in Taza, Morocco

Background

Leishmaniasis is considered among the main endemic diseases in Morocco. However, further knowledge about epidemiological aspects of this disease is needed in several provinces to plan control and preventive strategies to tackle the disease. The present study aims to determine the epidemiological aspect of cutaneous and visceral leishmaniasis in Taza Province from 2007–2014 and to identify the circulating species in this province.

Results

The temporal study from 2007 to 2014 showed that the number of cutaneous leishmaniasis cases increased since 2010. During the period of study, most leishmaniasis cases were detected in both urban and rural areas with 34% of cases detected in two urban localities, Bab Zitouna and Bab tété with 297 and 106 cases, respectively. The molecular study of cutaneous leishmaniasis showed the presence of non-sporadic Leishmania infantum and Leishmania tropica in this province. Regarding visceral leishmaniasis, Leishmania infantum is the species that has been identified.

Conclusions

The epidemio-molecular study of leishmaniasis in Taza Province showed the coexistence of two species of Leishmania in the same foci. They also indicated that CL due to Leishmania infantum is more prevalent than reported in the literature. These results will be helpful for the implementation of control strategies by targeting dogs that constitute a reservoir of Leishmania infantum.

Electronic supplementary material

The online version of this article (doi:10.1186/s13071-016-1910-x) contains supplementary material, which is available to authorized users.

The Montpellier Leishmania Collection, from a Laboratory Collection to a Biological Resource Center: A 39-Year-Long Story

We report the development of a laboratory collection of Leishmania that was initiated in 1975 and, after 39 years, has become an international Biological Resource Center (BRC-Leish, Montpellier, France, BioBank No. BB-0033-00052), which includes 6353 strains belonging to 36 Leishmania taxa. This is a retrospective analysis of the technical and organizational changes that have been adopted over time to take into account the technological advances and related modifications in the collection management and quality system. The technical improvements concerned the culture and cryopreservation techniques, strain identification by isoenzymatic and molecular techniques, data computerization and quality management to meet the changes in international standards, and in the cryogenic and microbiological safety procedures. The BRC is working toward obtaining the NF-S 96-900 certification in the coming years. Our long-term expertise in Leishmania storage and typing and collection maintenance should encourage field epidemiologists and clinical practitioners in endemic countries to secure their own strain collection with the help of the French BRC-Leish.

Differential ecological traits of two Phlebotomus sergenti mitochondrial lineages in southwestern Europe and their epidemiological implications

OBJECTIVES

The introduction of leishmaniasis in a new area requires a well-established population of the sandfly vector species of the parasite. No autochthonous cases of anthroponotic cutaneous leishmaniasis have been detected in southwestern Europe, and Leishmania infantum is the only causative agent of leishmaniasis in this area. Phlebotomus sergenti, the main vector of Leishmania tropica, is commonly found in the Iberian Peninsula at sufficient densities to be able to act as a vector. It is characterised by high genetic diversity and classified in four mitochondrial lineages. Our aim was to analyse the composition and distribution of P. sergenti mitochondrial lineages in southwestern Europe given the possibility of phenotypic differences of biomedical importance between them.

METHODS

Sandflies were captured in the Iberian Peninsula and on the Canary and Balearic Islands. Mitochondrial lineage identification of 137 P. sergenti was performed using a novel PCR-RFLP that avoids the necessity of gene sequencing.

RESULTS

Two lineages were evidenced, the typical Iberian one (lineage I) and another, held in common with North Africa (lineage III), that show a distinctive distribution. P. sergenti lineage I shows a better correlation to the bioclimatic diversity in southwestern Europe. Conversely, P. sergenti lineage III prefers warmer temperatures and less precipitation, which are typical of the Mediterranean.

CONCLUSION

Lineage I seems to have adaptive advantages given its wider tolerance to temperature and altitude than lineage III, and it would seem more suitable to lead a potential geographical expansion towards the rest of Europe.

Entomological studies of phlebotomine sand flies (Diptera: Psychodidae) in relation to cutaneous leishmaniasis transmission in Al Rabta, North West of Libya

Al Rabta in the North-West of Libya is a rural area where cutaneous leishmaniasis (CL) is endemic for long time. Few reports are available on sand flies in this area which is an important focus of CL. Therefore, this study aimed at updating the species composition, and monthly fluctuation of sand flies in this area. Sand flies were biweekly collected by CDC light traps from June to November 2012 and April to November 2013 in two villages, Al Rabta East (RE) and Al Rabta West (RW). Nine species (6 Phlebotomus and 3 Sergentomyia) were reported in the two villages. A total of 5605 and 5446 flies were collected of which Phlebotomus represented 59.30 and 56.63% in RE and RW, respectively. Sergentomyia minuta and Phlebotomus papatasi were the abundant species. Generally, more males were collected than females for all species. The overall ratios (males: females) for most of species were not deviated from the expected 1:1 ratio (Chi-squared, P>0.05). Sand fly abundance (fly/trap) is directly related to the temperature and RH (P<0. 01) while it inversely related to wind velocity (P>0.05). Flies were active from April to November with increased activity from June to October. Prominent peaks were in September and June. The abundance of P. papatasi and Phlebotomus sergenti, vectors of CL (August-October) coincided with the reported higher numbers of CL cases (August- November). The obtained results could be important for the successful planning and implementation of leishmaniasis control programs.

Spatial relations among environmental factors and phlebotomine sand fly populations (Diptera: Psychodidae) in central and southern Morocco

Phlebotomine sand flies (Diptera: Psychodidae, Phlebotominae) are of considerable public health importance because of their ability to transmit several human parasites, mainly as vectors of Leishmania spp. Over the past decade, the epidemiological situation of cutaneous leishmaniasis (CL) has significantly increased with its geographic expansion to previously free areas and the emergence of overlapping foci of cutaneous leishmaniasis and visceral leishmaniasis (VL) in several provinces of Morocco. A total of 15,313 specimens was collected during this entomological survey. The genera Phlebotomus (57.38%) and Sergentomyia (42.62%) were identified. Sergentomyia minuta (22.01%) was the most prevalent species, followed by S. fallax (18.21%), Phlebotomus perniciosus (14.35%), P. papatasi (14.06%), P. sergenti (12.85%), P. longicuspis (10.74%), P. ariasi (2.68%), S. dreyfussi (1.53%), P. alexandri (1.31%), P. bergeroti (1.14%), S. christophersi (0.62%), S. africana (0.25%), P. chabaudi (0.14%), P. chadlii (0.05%), and P. kazeruni (0.04%). We aimed to determine current distribution of leishmaniases vectors, their ecological characteristics, and the significance of the predominant species at any bioclimate stage, altitude range, and soil texture in terms of the risk of leishmaniasis transmission.

Natural Leishmania infection of Phlebotomus sergenti (Diptera: Phlebotominae) in an endemic focus of cutaneous leishmaniasis in Şanlıurfa, Turkey

Sand flies (Diptera: Phlebotominae) were surveyed for Leishmania in various villages of Şanlıurfa in southeast Turkey. A total of 474 sand flies were collected by CDC light traps. Phlebotomus sergenti Parrot (49.6%) and Phlebotomus papatasi (Scopoli) (48.1%) were the most abundant species, followed by Phlebotomus alexandri Sinton (1.05%), Phlebotomus perfiliewi Parrot (0.4%), Phlebotomus (Adlerius) sp. (0.2%) and Sergentomyia theodori Parrot (0.4%). 196 female sand flies were grouped in 34 pools of max 10 specimens each and 4 pools of P. sergenti were found positive for Leishmania DNA, detected by using ITS-1 primer set. This is the first molecular detection and identification of Leishmania tropica within naturally infected P. sergenti from the most important focus of anthroponotic cutaneous leishmaniasis in Turkey. The high frequency of P. sergenti together with natural infection by the parasite makes this species the probable vector of L. tropica in Şanlıurfa. The data obtained from this study could be used in strategic planning for the control of leishmaniasis in the region.

Molecular epidemiological study of cutaneous leishmaniasis in Beni Mellal and Fquih Ben Saleh provinces in Morocco

Leishmaniases are parasitic diseases frequent in the Mediterranean Basin. Cutaneous leishmaniasis (CL) has been recently emerged in several new foci, causing a public health problem in Morocco. This study was performed to evaluate the epidemiological status of cutaneous leishmaniasis (CL) in Beni Mellal and Fquih Ben Saleh Provinces and to identify the causative agent. A total of 584 (56% female, 44% male) confirmed cases of CL were enrolled during the study period 2000-2012. Majority of cases (56%) were recorded in three sectors: Zaouiat Cheikh, Beni Mellal and Oulad Ayad. Fisher statistical test showed that there is a significant effect of the total cases of CL affected in the 185 localities. The age distribution of CL cases was relatively stable, with the majority of patients (62.34%) aged less than 9 years old with significant differences (p-value<2.2e-16). CL lesions were mostly located on the face (89%). The average number of lesions per patient was 1.38. Leishmania tropica was identified as the causative agent based on species-specific ITS1-PCR-RFLP assay.

Phlebotomus sergenti in a cutaneous leishmaniasis focus in Azilal province (High Atlas, Morocco): molecular detection and genotyping of Leishmania tropica, and feeding behavior

Background

Phlebotomus (Paraphlebotomus) sergenti is at least one of the confirmed vectors for the transmission of cutaneous leishmaniasis caused by Leishmania tropica and distributed widely in Morocco. This form of leishmaniasis is considered largely as anthroponotic, although dogs were found infected with Leishmania tropica, suggestive of zoonosis in some rural areas.

Methodology and Findings

This survey aimed at (i) studying the presence of Leishmania in field caught Phlebotomus sergenti, (ii) investigating genetic diversity within Leishmania tropica and (iii) identifying the host-blood feeding preferences of Phlebotomus sergenti. A total of 4,407 sand flies were collected in three rural areas of Azilal province, using CDC miniature light traps. Samples collected were found to consist of 13 species: Phlebotomus spp. and 3 Sergentomyia spp. The most abundant species was Phlebotomus sergenti, accounting for 45.75 % of the total. 965 female Phlebotomus sergenti were screened for the presence of Leishmania by ITS1-PCR-RFLP, giving a positive rate of 5.7% (55/965), all being identified as Leishmania tropica. Nucleotide heterogeneity of PCR-amplified ITS1-5.8S rRNA gene-ITS2 was noted. Analyses of 31 sequences obtained segregated them into 16 haplotypes, of which 7 contain superimposed peaks at certain nucleotide positions, suggestive of heterozygosity. Phlebotomus sergenti collected were found to feed on a large variety of vertebrate hosts, as determined by Cytochrome b sequencing of the DNA from the blood meals of 64 engorged females.

Conclusion

Our findings supported the notion that Phlebotomus sergenti is the primary vector of Leishmania tropica in this focus, and that the latter is genetically very heterogeneous. Furthermore, our results might be suggestive of a certain level of heterozygosity in Leishmania tropica population. This finding, as well as the feeding of the vectors on different animals are of interest for further investigation.

In Morocco three Leishmania species have been reported to cause cutaneous leishmaniasis: Leishmania major, Leishmania tropica and less frequently Leishmania infantum. Amongst these clinically important Leishmania species, Leishmania tropica is considered as a public health problem by the Ministry of Health in Morocco and other endemic countries. Phlebotomus sergenti is the known vector, which is thought to take blood meals mainly from humans, since they appear to be the sole reservoir, considering anthroponosis of the cutaneous leishmaniasis caused by L. tropica in many endemic areas. In the present study, we investigated by molecular tools the presence of Leishmania in field caught Phlebotomus, as well as the heterogeneity of Leishmania tropica in a cutaneous leishmaniasis focus in High Atlas of Morocco. Our results showed a high infection rate of Phlebotomus sergenti, which may be a consequence of high level of the parasite circulating in this region; and underlined the important genetic heterogeneity of Leishmania tropica in Morocco. Analysis of the blood meals of the vectors showed that Phlebotomus sergenti fed on a variety of vertebrates, including wild animals, such as rodent, monkey and bat. Whether these animals play any role in the maintenance of Leishmania tropica in this focus awaits further investigation.

Leishmaniasis in central morocco: seasonal fluctuations of phlebotomine sand fly in aichoun locality, from sefrou province

Cutaneous leishmaniases (CL) are endemic in Morocco. They are common in the human population in different localities such as Aichoun in Sefrou province, Morocco. This study was carried out in Aichoun locality from April to October 2012 in order to study the spatiotemporal trends of the main Leishmania phlebotomine vectors in this focus. Overall, 1171 sand flies, belonging to four species, were collected by sticky traps. Phlebotomus sergenti was the predominant species (78.4%) followed by Ph. perniciosus (10.5%), Ph. papatasi (7.94%), and Ph. longicuspis (3.16%). Sandflies were active during 6 months (May-October). Ph. sergenti, Ph. perniciosus, and Ph. papatasi displayed a bimodal distribution with a first peak in July and a second peak in September, while Ph. longicuspis showed a monophasic trend with a peak in August. The high abundance and the lengthy period of activity of Ph. sergenti and Ph. perniciosus, vectors of L. tropica and L. infantum, respectively, are a cause for concern as they indicate the high potential risk of Leishmania transmission in the studied areas.

Epidemiological study on sand flies in an endemic focus of cutaneous leishmaniasis, bushehr city, southwestern iran

Cutaneous leishmaniasis is the most important health problem in the city of Bushehr, southwestern Iran. The objective of the study was to determine some ecological aspects of sand flies in the city during 2010–2011. Sand flies were collected monthly from outdoors and indoors by sticky traps at four selected districts of the city. They were also dissected and examined by nested-PCR for identification of the parasite during August–September of 2011. A total of 1234 adult sand flies were collected and 6 species including 3 of Genus Phlebotomus and 3 of Genus Sergentomyia were identified. Four species including P. papatasi (3.98%), P. sergenti (1.14%), S. tiberiadis (87.18%), and S. baghdadis (7.7%) were found indoors. Six species including P. papatasi (3.47%), P. sergenti (3.17%), P. alexandri (0.1%), S. tiberiadis (77.74%), S. baghdadis (15.41%), and one female of S. clydei (0.11%) were collected from outdoors. Sand flies started to appear from March and disappear at the end of January. There was only one peak in the density curve in July. The study revealed that S. tiberiadis and S. baghdadis could enter indoors which 89 and 81.8% of them were found blood-fed, respectively. Moreover, P. papatasi, S. tiberiadis, and S. baghdadis were active indoors and outdoors in most months of the year. Nested-PCR of P. papatasi females was positive against kinetoplast DNA of L. major and L. turanica and also mixed natural infections were found by L. gerbilli and L. turanica. Moreover, mixed infections by L. major and L. turanica were observed in this species. Sergentomyia clydei and S. tiberiadis were found to be negative to any DNA of Leishmania species. Phlebotomus sergenti females were found infected with DNA of L. turanica and this is the first report of natural infection and detection of the parasite from this sand fly species in worldwide.

[Cutaneous leishmaniasis by Leishmania major and Leishmania tropica in Morocco: comparative epidemioclinical aspects of 268 cases]

Introduction

Depuis 1995, le Maroc a connu une réactivation des foyers de leishmanioses cutanées (LC) à L. major et une nouvelle répartition géographique des foyers à L. tropica. Le but de cette étude est de comparer les aspects épidémio-cliniques associés aux LC potentiellement dûes à L. major et à L. tropica.

Méthodes

Une étude rétrospective a colligé 268 cas de LC au service de dermatologie du CHU Ibn Rochd de Casablanca entre Janvier 1995 et Septembre 2010. Les données étaient analysées par Epi info version 3.5.1. Le test X2 était appliqué (Différence significative = p< 0,05).

Résultats

Deux cent soixante-huit cas de LC ont été colligés, dont 160 femmes et 108 hommes. Ils ont été répartis en 123 patients originaires des foyers à L.major et 145 patients originaires des foyers à L. tropica. L'aspect ulcéronodulaire, ulcérovégétant ou végétant était retrouvé dans 58 cas (47,2%) des cas de LC à L. major versus 24 cas (16,7%) dans la L.C à L. tropica. L'aspect papulonodulaire était retrouvé dans 84 cas (58%) de LC à L. tropica contre 41 cas (33,3%) de LC à L. major.

Conclusion

Dans la LC à L. major, l'atteinte des membres et les aspects cliniques végétant ou ulcéro-végétant restent toujours prédominants. Dans la L.C à L. tropica, l'atteinte papulonodulaire unique du visage reste prédominante mais des formes ulcéronodulaires, végétantes ou ulcérovégétantes existent également dans les foyers récents à L. tropica, prêtant à confusion cliniquement avec des LC à L. major.

Multilocus Microsatellite Typing reveals intra-focal genetic diversity among strains of Leishmania tropica in Chichaoua Province, Morocco

In Morocco, cutaneous leishmaniasis (CL) caused by Leishmania (L.) tropica is a major public health threat. Strains of this species have been shown to display considerable serological, biochemical, molecular biological and genetic heterogeneity; and Multilocus Enzyme Electrophoresis (MLEE), has shown that in many countries including Morocco heterogenic variants of L. tropica can co-exist in single geographical foci. Here, the microsatellite profiles discerned by MLMT of nine Moroccan strains of L. tropica isolated in 2000 from human cases of CL from Chichaoua Province were compared to those of nine Moroccan strains of L. tropica isolated between 1988 and 1990 from human cases of CL from Marrakech Province, and also to those of 147 strains of L. tropica isolated at different times from different worldwide geographical locations within the range of distribution of the species. Several programs, each employing a different algorithm, were used for population genetic analysis. The strains from each of the two Moroccan foci separated into two phylogenetic clusters independent of their geographical origin. Genetic diversity and heterogeneity existed in both foci, which are geographically close to each other. This intra-focal distribution of genetic variants of L. tropica is not considered owing to in situ mutation. Rather, it is proposed to be explained by the importation of pre-existing variants of L. tropica into Morocco.

Genotype profile of Leishmania major strains isolated from tunisian rodent reservoir hosts revealed by multilocus microsatellite typing

Zoonotic cutaneous leishmaniasis (ZCL) caused by Leishmania (L.) major parasites represents a major health problem with a large spectrum of clinical manifestations. Psammomys (P.) obesus and Meriones (M.) shawi represent the most important host reservoirs of these parasites in Tunisia. We already reported that infection prevalence is different between these two rodent species. We aimed in this work to evaluate the importance of genetic diversity in L. major parasites isolated from different proven and suspected reservoirs for ZCL. Using the multilocus microsatellites typing (MLMT), we analyzed the genetic diversity among strains isolated from (i) P. obesus (n = 31), (ii) M. shawi (n = 8) and (iii) Mustela nivalis (n = 1), captured in Sidi Bouzid, an endemic region for ZCL located in the Center of Tunisia. Studied strains present a new homogeneous genotype profile so far as all tested markers and showed no polymorphism regardless of the parasite host-reservoir origin. This lack of genetic diversity among these L. major isolates is the first genetic information on strains isolated from Leishmania reservoirs hosts in Tunisia. This result indicates that rodent hosts are unlikely to exert a selective pressure on parasites and stresses on the similarity of geographic and ecological features in this study area. Overall, these results increase our knowledge among rodent reservoir hosts and L. major parasites interaction.

Phlebotomus (Paraphlebotomus) riouxi: a synonym of Phlebotomus chabaudi without any proven vectorial role in Tunisia and Algeria

Phlebotomus (Paraphlebotomus) riouxi Depaquit, Léger & Killick-Kendrick (Diptera: Psychodidae) was described as a typological species based on a few morphological characters distinguishing it from Phlebotomus (Paraphlebotomus) chabaudi Croset, Abonnenc & Rioux. The naming of P. riouxi coincided with its incrimination as a rural vector of Leishmania tropica Wright (junior synonym: Leishmania killicki Rioux, Lanotte & Pratlong) in Tataouine governorate, an arid region of southern Tunisia. The current report finds insufficient evidence to incriminate either phlebotomine sandfly as a vector of L. tropica in North Africa. Phlebotomus riouxi was found not to have the characteristics of a phylogenetic or biological species, and therefore it is synonymized with P. chabaudi. Both taxa were recorded together for the first time in Tunisia, in Tataouine, where three of 12 males showed intermediate morphology and both sexes of each taxon were not characterized by specific lineages of the nuclear gene elongation factor-1α or the mitochondrial gene cytochrome b, for which a long 3' terminal fragment is recommended for phlebotomine phylogenetics. This case study indicates that the eco-epidemiology of leishmaniasis should focus more on identifying key components of vectorial transmission that are susceptible to interventions for disease control, rather than on defining sibling species of vectors.

Molecular detection and identification of Leishmania infection in naturally infected sand flies in a focus of cutaneous leishmaniasis in northern Morocco

Background

Cutaneous leishmaniasis is an infectious disease caused by various species of the flagellate protozoan Leishmania. During the past 20 years, cutaneous leishmaniasis has emerged as a major public health threat in Morocco. The main objective of this study was to study the occurrence of Leishmania infection in vectors and to identify sand fly blood meal sources in an endemic locality of cutaneous leishmaniasis within Sefrou province, where the vectors of leishmaniasis were still unknown.

Methods

2650 sand flies were collected using CDC miniature light traps and identified morphologically. The identified sand flies were tested for Leishmania infection by nested PCR. The source of blood meal of 10 freshly engorged females: 6 Phlebotomus longicuspis and 4 Phlebotomus sergenti, was determined using the Cyt b sequence.

Results

The collected sand flies consisted of 10 species, seven of which belonged to the genus Phlebotomus and three to the genus Sergentomyia. The most abundant species was P. longicuspis, accounting for 72% of the total sand flies collected. In females of three P. longicuspis and four P. sergenti, Leishmania infantum and Leishmania tropica DNA was detected, respectively.

The source of blood meal of engorged females showed that all sand flies tested fed on humans.

Conclusions

We report for the first time the natural infection of P. longicuspis with L. infantum in Morocco. The high frequency of this species in this region, in addition to its anthropophilic character make P. longicuspis the putative vector of L. infantum in this cutaneous leishmaniasis focus where L. tropica is confirmed as the causative agent of the disease and P. sergenti as its vector. The presence of L. infantum, and its presumed vector in this area, makes this a site of high risk of visceral leishmaniasis, mostly because of the proximity of a focus of human and canine visceral leishmaniasis.

Limits of a rapid identification of common Mediterranean sandflies using polymerase chain reaction-restriction fragment length polymorphism

A total of 131 phlebotomine Algerian sandflies have been processed in the present study. They belong to the species Phlebotomus bergeroti, Phlebotomus alexandri, Phlebotomus sergenti, Phlebotomus chabaudi, Phlebotomus riouxi, Phlebotomus perniciosus, Phlebotomus longicuspis, Phlebotomus perfiliewi, Phlebotomus ariasi, Phlebotomus chadlii, Sergentomyia fallax, Sergentomyia minuta, Sergentomyia antennata, Sergentomyia schwetzi, Sergentomyia clydei, Sergentomyia christophersi and Grassomyia dreyfussi. They have been characterised by sequencing of a part of the cytochrome b (cyt b), t RNA serine and NADH1 on the one hand and of the cytochrome C oxidase I of the mitochondrial DNA (mtDNA) on the other hand. Our study highlights two sympatric populations within P. sergenti in the area of its type-locality and new haplotypes of P. perniciosus and P. longicuspis without recording the specimens called lcx previously found in North Africa. We tried to use a polymerase chain reaction-restriction fragment length polymorphism method based on a combined double digestion of each marker. These method is not interesting to identify sandflies all over the Mediterranean Basin.

Effect of night time-intervals, height of traps and lunar phases on sand fly collection in a highly endemic area for canine leishmaniasis

The activity of phlebotomine sand flies was monitored in a sub-urban area of Sicily in order to acquire data on seasonality and to elucidate the effect of the night time-intervals, height of traps from ground and lunar phases on the abundance of the capture. The study was conducted in the farm of the University of Messina (Italy). Light traps were placed as in the following: biweekly, from dusk to dawn, and from May to November; for three consecutive nights from 18:00 to 6:00, with the net bag being changed every 2h; for 30 days, at different heights from 18:00 to 6:00. A total of five species (i.e., Phlebotomus perniciosus, Phlebotomus neglectus, Phlebotomus sergenti, Phlebotomus perfiliewi, and Sergentomyia minuta), three of which are proven vectors of Leishmania infantum, were captured. The most abundant species was P. perniciosus (73.3%) followed by S. minuta (23.3%). The highest number of phlebotomine sand flies was collected in August and September with a peak of collection recorded in the evening (i.e., from 20:01 to 22.00). The number of phlebotomine sand flies collected at 50cm above the ground was significantly higher (P=0.041) than that captured at 150cm. Results of this study shed light on the ecology of main phlebotomine species in the Mediterranean area, and on the influence of some factors, such as time and height of traps, on the light trap capture efficiency.

Leishmaniases in Maghreb: an endemic neglected disease

Maghreb is known to be one of the most endemic areas of leishmaniases where both visceral and cutaneous forms are reported. Cutaneous leishmaniasis (CL) is older and has a higher prevalence than visceral one (VL). It is caused by four taxa (Leishmania (L.) major, L. infantum, L. tropica and L. killicki) which are responsible for a large clinical spectrum of lesions. Most transmission cycles of these taxa are known and many phlebotomine sandflies vectors and reservoir hosts are identified. The zoonotic transmission is well established for L. major. However, for L. infantum and L. killicki it needs more investigations to be proven. Regarding L. tropica, studies suggest it to be of both zoonotic and anthroponotic types. The isoenzymatic characterization of these four taxa showed a large enzymatic polymorphism varying from two zymodemes for L. major to 10 zymodemes for L. tropica. Cutaneous leishmaniasis is widely distributed and covers all bioclimatic stages with the coexistence of more than one taxon in the same foci. Visceral leishmaniasis is the second form of leishmaniases in Maghreb. Only L. infantum is known to cause this disease. The transmission cycle of this parasite is zoonotic but still not well known. The isoenzymatic identification of L. infantum causing VL showed the presence of six zymodemes. Geographically, VL is distributed in all bioclimatic stages of Maghreb countries. Despite all the previous studies realized on leishmaniases in Maghreb, they are still considered as neglected diseases because of the rarity or the absence of efficient control strategies.