Endemic characteristics of infantile visceral leishmaniasis in the People's Republic of China

Epidemiological Characteristics and Spatiotemporal Patterns of Visceral Leishmaniasis in Xinjiang, China, during 2004-2021

The spread of visceral leishmaniasis (VL), a serious global zoonotic parasitic disease, is mostly under control; however, several cases have been reported in recent decades in Xinjiang, China. This study aimed to analyze the epidemiological status and spatiotemporal clustering characteristics of VL in Xinjiang, China, between 2004 and 2021 to provide a basis for the development and implementation of surveillance and response measures. Data on VL incidence during 2004-2021 were collected from the National Diseases Reporting Information System of China. Global spatial autocorrelation analysis, identification of local indicators of spatial association, and spatial-temporal clustering analysis were conducted to identify the distribution and high-risk areas. A total of 2034 VL cases were reported, with a mean annual incidence of 0.50 per 100,000. There was a general decreasing trend in the incidence of VL during our study period. The majority of the cases were reported from October to February of the following year, and fewer cases were reported from April to July. Spatial autocorrelation analysis revealed that the incidence of VL was spatially clustered within a few counties. Significant differences were observed during the study period (Moran's I = 0.74, Z = 4.900, p < 0.05). The male-to-female ratio was 1.37:1, and most patients were in the age group 0-3 years. Cases were primarily distributed in seven regions and two autonomous prefectures, and Kashgar reported the highest number of cases (1688, 82.98%). Spatial analysis revealed that the aggregation of VL was predominantly observed in southwest Xinjiang. This was in alignment with the high-risk areas identified by spatiotemporal clustering analysis. The H-H clustering region was primarily observed in Gashi, Atushi, Shufu, Injisha, Kashgar, Yepuhu, and Bachu. These findings indicate that integrated control measures must be taken in different endemic areas to strengthen the VL control program in Xinjiang, China.

Case Report: Visceral Leishmaniasis Falsely Diagnosed as Viral Hepatitis C Without Febrile Symptoms

Background

Visceral leishmaniasis (VL), also known as kala-azar, is caused by an intracellular parasite transmitted to humans by the bite of a sand fly, and with the source of the infection mainly being dogs. The main features of the disease are irregular fever, weight loss, hepatosplenomegaly and anaemia. Diagnosis relies mainly on bone marrow aspiration tests to find Leishman-Donovan(LD) bodies. And we report the case without febrile symptoms and hepatitis C virus antibody was probably false positive.

Case Presentation

The case was a 74-year-old male residing in Yangquan City, Shanxi Province, a VL endemic area. He presented with generalised malaise, hepatosplenomegaly and scarring pigmentation on the skin as a result of scratching. Laboratory tests showed pancytopenia, positive hepatitis C virus antibody (HCV-Ab), positive direct anti-human globulin test (DAT), positive anti-cardiolipin antibody IgG, IgM (+), and increased immunoglobulin IgG. Symptomatic treatments such as hepatoprotection and blood transfusion were given, but the patient's symptoms still persisted and his spleen and liver further enlarged. Further repeat tests were performed and found to be negative for hepatitis C virus antibodies and antigens. The patient was eventually found to be infected with Leishmania protozoa by rk39 rapid diagnostic test and metagenomic next-generation sequencing(mNGS). And the patient quickly relieved after one course of treatment with sodium stibogluconate.

Conclusion

Patients with VL may cause abnormalities in the immune system, leading to false positives for various antibodies without clear febrile symptoms, resulting in misdiagnosis or delayed diagnosis. It is important to consider VL in cases where there is a significant hepatosplenomegaly with a relevant epidemiological history. If the diagnosis cannot be confirmed through bone marrow aspiration and the patient is not suitable for splenic aspiration, the rk39 test can be used for initial exclusion and further verified through mNGS.

Reemergence of Visceral Leishmaniasis in Henan Province, China

Visceral leishmaniasis (VL) was widely prevalent in Henan Province in the 1950s. Through active efforts by the government, there were no local cases reported from 1984 to 2015. In 2016, local VL cases reoccurred, and there was an increasing trend of VL cases in Henan Province. To provide a scientific control of VL, an investigation was conducted in Henan Province from 2016 to 2021. The data from VL cases were obtained from the Disease Surveillance Reporting System of the Chinese Center for Disease Control and Prevention. The rK39 immunochromatographic test (ICT) and PCR assay were performed among high-risk residents and all dogs in the patients' village. ITS1 was amplified, sequenced, and subjected to phylogenetic analyses. A total of 47 VL cases were reported in Henan Province during 2016-2021. Of the cases, 35 were local, and they were distributed in Zhengzhou, Luoyang, and Anyang. The annual average incidence was 0.008/100,000, showing an upward trend year by year (χ² = 3.987, p = 0.046). Their ages ranged from 7 months to 71 years, with 44.68% (21/47) in the age group of 0-3 years and 46.81% (22/47) in the age group ≥15 years. The cases occurred throughout the year. The high-risk populations were infants and young children (age ≤3), accounting for 51.06% (24/47), followed by farmers at 36.17% (17/47). The ratio of males to females was 2.13:1. The positive rates of rK39 ICT and PCR were 0.35% (4/1130) and 0.21% (1/468) in the residents. The positive rates of rK39 ICT and PCR were 18.79% (440/2342) and 14.92% (139/929) in the dogs. The ITS1 amplification products in the patients and positive dogs were sequenced. The homology between the target sequence and Leishmania infantum was more than 98%. The phylogenetic analysis indicated that the patients and the positive dogs were infected by the same type of Leishmania, which was consistent with the strains in the hilly endemic areas in China. This paper showed that patients and domestic dogs were infected by the same type of L. infantum and that the positive rate in dogs was relatively high in Henan Province. Because the measures of patient treatment and culling of infected dogs were not effective in reducing VL incidence in Henan Province, it is urgent to develop new approaches for the control of VL, such as wearing insecticide-impregnated collars on dogs, treating the positive dogs, spraying insecticide for sandflies control, and improving residents' self-protection awareness to prevent the further spread of VL in Henan Province.

Epidemiological features and spatial-temporal distribution of visceral leishmaniasis in mainland China: a population-based surveillance study from 2004 to 2019

BACKGROUND

Although visceral leishmaniasis (VL) was largely brought under control in most regions of China during the previous century, VL cases have rebounded in western and central China in recent decades. The aim of this study was to investigate the epidemiological features and spatial-temporal distribution of VL in mainland China from 2004 to 2019.

METHODS

Incidence and mortality data for VL during the period 2004-2019 were collected from the Public Health Sciences Data Center of China and annual national epidemic reports of VL, whose data source was the National Diseases Reporting Information System. Joinpoint regression analysis was performed to explore the trends of VL. Spatial autocorrelation and spatial-temporal clustering analysis were conducted to identify the distribution and risk areas of VL transmission.

RESULTS

A total of 4877 VL cases were reported in mainland China during 2004-2019, with mean annual incidence of 0.0228/100,000. VL incidence showed a decreasing trend in general during our study period (annual percentage change [APC] = -4.2564, 95% confidence interval [CI]: -8.0856 to -0.2677). Among mainly endemic provinces, VL was initially heavily epidemic in Gansu, Sichuan, and especially Xinjiang, but subsequently decreased considerably. In contrast, Shaanxi and Shanxi witnessed significantly increasing trends, especially in 2017-2019. The first-level spatial-temporal aggregation area covered two endemic provinces in northwestern China, including Gansu and Xinjiang, with the gathering time from 2004 to 2011 (relative risk [RR] = 13.91, log-likelihood ratio [LLR] = 3308.87, P < 0.001). The secondary aggregation area was detected in Shanxi province of central China, with the gathering time of 2019 (RR = 1.61, LLR = 4.88, P = 0.041). The epidemic peak of October to November disappeared in 2018-2019, leaving only one peak in March to May.

CONCLUSIONS

Our findings suggest that VL is still an important endemic infectious disease in China. Epidemic trends in different provinces changed significantly and spatial-temporal aggregation areas shifted from northwestern to central China during our study period. Mitigation strategies, including large-scale screening, insecticide spraying, and health education encouraging behavioral change, in combination with other integrated approaches, are needed to decrease transmission risk in areas at risk, especially in Shanxi, Shaanxi, and Gansu provinces.

Spatiotemporal patterns and spatial risk factors for visceral leishmaniasis from 2007 to 2017 in Western and Central China: A modelling analysis

Visceral leishmaniasis (VL) is a neglected disease caused by trypanosomatid protozoa in the genus Leishmania, which is transmitted by phlebotomine sandflies. Although this vector-borne disease has been eliminated in several regions of China during the last century, the reported human VL cases have rebounded in Western and Central China in recent decades. However, understanding of the spatial epidemiology of the disease remains vague, as the spatial risk factors driving the spatial heterogeneity of VL. In this study, we analyzed the spatiotemporal patterns of annual human VL cases in Western and Central China from 2007 to 2017. Based on the related spatial maps, the boosted regression tree (BRT) model was adopted to explore the relationships between VL and spatial correlates as well as predicting both the existing and potential infection risk zones of VL in Western and Central China. The mined links reveal that elevation, minimum temperature, relative humidity, and annual accumulated precipitation make great contributions to the spatial heterogeneity of VL. The maps show that Xinjiang Uygur Autonomous Region, Gansu, western Inner Mongolia Autonomous Region, and Sichuan are predicted to fall in the highest infection risk zones of VL. Approximately 61.60 million resident populations lived in the high-risk regions of VL in Western and Central China. Our results provide a better understanding of how spatial risk factors driving VL spread as well as identifying the potential endemic risk region of VL, thereby enhancing the biosurveillance capacity of public health authorities.

Visceral leishmaniasis in northwest China from 2004 to 2018: a spatio-temporal analysis

BACKGROUND

Although visceral leishmaniasis (VL), a disease caused by parasites, is controlled in most provinces in China, it is still a serious public health problem and remains fundamentally uncontrolled in some northwest provinces and autonomous regions. The objective of this study is to explore the spatial and temporal characteristics of VL in Sichuan Province, Gansu Province and Xinjiang Uygur Autonomous Region in China from 2004 to 2018 and to identify the risk areas for VL transmission.

METHODS

Spatiotemporal models were applied to explore the spatio-temporal distribution characteristics of VL and the association between VL and meteorological factors in western China from 2004 to 2018. Geographic information of patients from the National Diseases Reporting Information System operated by the Chinese Center for Disease Control and Prevention was defined according to the address code from the surveillance data.

RESULTS

During our study period, nearly 90% of cases occurred in some counties in three western regions (Sichuan Province, Gansu Province and Xinjiang Uygur Autonomous Region), and a significant spatial clustering pattern was observed. With our spatiotemporal model, the transmission risk, autoregressive risk and epidemic risk of these counties during our study period were also well predicted. The number of VL cases in three regions of western China concentrated on a few of counties. VL in Kashi Prefecture, Xinjiang Uygur Autonomous Region is still serious prevalent, and integrated control measures must be taken in different endemic areas.

CONCLUSIONS

The number of VL cases in three regions of western China concentrated on a few of counties. VL in Kashi Prefecture, Xinjiang Uygur Autonomous Region is still serious prevalent, and integrated control measures must be taken in different endemic areas. Our findings will strengthen the VL control programme in China.

Leishmaniasis Diagnosis via Metagenomic Next-Generation Sequencing

Leishmaniasis is a vector-borne disease caused by Leishmania. Although the incidence of leishmaniasis in China is currently low, it has not been completely eradicated. In 2019, visceral leishmaniasis was diagnosed in three patients using bone marrow microscopic examination and metagenomic next-generation sequencing (mNGS). The bone marrow mNGS results from the three patients indicated that 99.9, 99.6, and 30.3% of non-human reads matched the Leishmania genome, and plasma mNGS results from one of the patients revealed that 46.2% of non-human reads matched the Leishmania genome. In the second patient's plasma, no Leishmania sequences were detected by plasma mNGS, and the third patient's plasma was unavailable. The pathogen in all three patients was identified as Leishmania infantum. Leishmania amastigotes were observed by microscopic examination of bone marrow smears in all three patients, but were not found in peripheral blood smears. This indicates that the sensitivity of mNGS is higher than that of smear microscopy and that mNGS can be used to identify Leishmania at the species level. All three patients were elderly male farmers, two from Shanxi and one from Beijing. All three patients had splenomegaly and pancytopenia. Originally, these patients were misdiagnosed and treated for extended periods in other hospitals. Diagnoses of visceral leishmaniasis took place 6, 2, and 2 months after the onset of symptoms in the three patients. In conclusion, this study confirms that bone marrow mNGS can be used to quickly and accurately confirm a diagnosis in patients with suspected leishmaniasis.

A case of visceral leishmaniasis found by left oblique hernia: A case report

Visceral leishmaniasis (VL) is an infectious disease caused by Leishmania protozoa. Since sporadic cases of this disease are noted in non-endemic areas and are associated with a limited outbreak, the disease is easily overlooked. In addition, other illnesses exhibit similar symptoms. It is difficult for clinicians to establish an accurate diagnosis and develop effective treatments for this disease. The present study reported a case of a 25-year-old young man admitted to the hospital due to oblique hernia. The case was diagnosed as VL. The patient presented with persistent night sweats and fatigue as described in his admission history. However, the body temperature was normal. Routine examination revealed that the patient exhibited chronic hepatitis B infection, pancytopenia, hepatosplenomegaly, increased erythrocyte sedimentation rate, significant plasma cell infiltration in bone marrow aspirate and hypergammaglobulinemia. The retrospective analysis of the present case can improve the diagnostic accuracy and treatment rate of VL in non-epidemic areas.

Pathogenic Leishmania spp. detected in lizards from Northwest China using molecular methods

BACKGROUND

Leishmaniosis, a disease caused by pathogenic Leishmania parasites, remains an unresolved health problem in the New World and the Old World. It is well known that lizards can be infected by a subgenus of Leishmania parasites, i.e. Sauroleishmania, which is non-pathogenic to humans. However, evidence suggests that lizards may also harbor pathogenic Leishmania species including the undetermined Leishmania sp., discovered in our previous work. Leishmania DNA in lizard blood can be detected by using molecular methods, such as the polymerase chain reaction (PCR).

RESULTS

Three hundred and sixteen lizards, representing 13 species of four genera, were captured for blood samples collection in Northwest China. Two reliable molecular markers (cytochrome b and heat shock protein 70 genes) were used for detection in the lizard blood samples, to confirm a widespread presence of pathogenic Leishmania parasites and the distribution pattern of Leishmania spp. in lizards from Northwest China. The PCR data indicated positive detection rate for Leishmania in all the tested lizards with an overall prevalence of 57.91% (183/316). Apart from lizard parasites like Leishmania tarentolae and Leishmania sp., several pathogenic Leishmania including L. turanica, L. tropica and L. donovani complex were identified by using phylogenetic analysis. Co-existence of different haplotypes was observed in most Leishmania DNA-positive lizards with an overall rate of 77.6% (142/183). Even mixed infections with different Leishmania species appeared to occur in the lizards with an overall rate of 37.7% (69/183).

CONCLUSIONS

Lizards can harbor pathogenic Leishmania spp. Co-existence of different haplotypes or even species of Leishmania indicates mixed infections in natural lizard host. Lizards may contribute to the spread of Leishmania parasites. The pathogenic Leishmania species detected in lizards from Northwest China may be of great eco-epidemiological importance.

Risk factors and predicted distribution of visceral leishmaniasis in the Xinjiang Uygur Autonomous Region, China, 2005-2015

BACKGROUND

Visceral leishmaniasis (VL) is a neglected disease that is spread to humans by the bites of infected female phlebotomine sand flies. Although this vector-borne disease has been eliminated in most parts of China, it still poses a significant public health burden in the Xinjiang Uygur Autonomous Region. Understanding of the spatial epidemiology of the disease remains vague in the local community. In the present study, we investigated the spatiotemporal distribution of VL in the region in order to assess the potential threat of the disease.

METHODS

Based on comprehensive infection records, the spatiotemporal patterns of new cases of VL in the region between 2005 and 2015 were analysed. By combining maps of environmental and socioeconomic correlates, the boosted regression tree (BRT) model was adopted to identify the environmental niche of VL.

RESULTS

The fitted BRT models were used to map potential infection risk zones of VL in the Xinjiang Uygur Autonomous Region, revealing that the predicted high infection risk zones were mainly concentrated in central and northern Kashgar Prefecture, south of Atushi City bordering Kashgar Prefecture and regions of the northern Bayingolin Mongol Autonomous Prefecture. The final result revealed that approximately 16.64 million people inhabited the predicted potential infection risk areas in the region.

CONCLUSIONS

Our results provide a better understanding of the potential endemic foci of VL in the Xinjiang Uygur Autonomous Region with a 1 km spatial resolution, thereby enhancing our capacity to target the potential risk areas, to develop disease control strategies and to allocate medical supplies.

Genetic manipulation of Leishmania donovani threonyl tRNA synthetase facilitates its exploration as a potential therapeutic target

Background

Aminoacyl tRNA synthetases are central enzymes required for protein synthesis. These enzymes are the known drug targets in bacteria and fungi. Here, we for the first time report the functional characterization of threonyl tRNA synthetase (LdThrRS) of Leishmania donovani, a protozoan parasite, the primary causative agent of visceral leishmaniasis.

Methodology

Recombinant LdThrRS (rLdThrRS) was expressed in E. coli and purified. The kinetic parameters for rLdThrRS were determined. The subcellular localization of LdThrRS was done by immunofluorescence analysis. Heterozygous mutants of LdThrRS were generated in Leishmania promastigotes. These genetically manipulated parasites were checked for their proliferation, virulence, aminoacylation activity and sensitivity to the known ThrRS inhibitor, borrelidin. An in silico generated structural model of L. donovani ThrRS was compared to that of human.

Conclusions

Recombinant LdThrRS displayed aminoacylation activity, and the protein is possibly localized to both the cytosol and mitochondria. The comparison of the 3D-model of LdThrRS to human ThrRS displayed considerable similarity. Heterozygous parasites showed restrictive growth phenotype and had attenuated infectivity. These heterozygous parasites were more susceptible to inhibition by borrelidin. Several attempts to obtain ThrRS homozygous null mutants were not successful, indicating its essentiality for the Leishmania parasite. Borrelidin showed a strong affinity for LdThrRS (K_D: 0.04 μM) and was effective in inhibiting the aminoacylation activity of the rLdThrRS (IC₅₀: 0.06 μM). Borrelidin inhibited the promastigotes (IC₅₀: 21 μM) stage of parasites. Our data shows that LdThrRS is essential for L. donovani survival and is likely to bind with small drug-like molecules with strong affinity, thus making it a potential target for drug discovery efforts.

Aminoacyl tRNA synthetases (aaRSs) are ubiquitous enzymes required for protein translation. They play a vital role in helping an organism's survival. Therefore, they have been suggested as favourable targets for the development of antileishmanial drugs. Leishmania, a protozoan parasite that causes leishmaniasis is known to encode 26 aaRSs. In the present study, we have worked on the functional characterization of L. donovani threonyl tRNA synthetase (LdThrRS) protein. We report that the L. donovani encodes a functional copy of ThrRS. The protein is localized in the cytosol and possibly also in mitochondria. The LdThrRS seems to be an essential gene for the parasite since null mutants did not survive. The deletion of one allele of the gene caused reduced growth and attenuated virulence in the heterozygous parasites. These parasites showed increased sensitivity to the known ThrRS inhibitor, borrelidin. Furthermore, borrelidin was found to inhibit the aminoacylation activity of LdThrRS thus, indicating that parasitic ThrRS can be exploited as a drug target for antileishmanial chemotherapy.

Visceral Leishmaniasis in China: an Endemic Disease under Control

Visceral leishmaniasis (VL) caused by Leishmania spp. is an important vector-borne and largely zoonotic disease. In China, three epidemiological types of VL have been described: anthroponotic VL (AVL), mountain-type zoonotic VL (MT-ZVL), and desert-type ZVL (DT-ZVL). These are transmitted by four different sand fly species: Phlebotomus chinensis, P. longiductus, P. wui, and P. alexandri. In 1951, a detailed survey of VL showed that it was rampant in the vast rural areas west, northwest, and north of the Yangtze River. Control programs were designed and implemented stringently by the government at all administrative levels, resulting in elimination of the disease from most areas of endemicity, except the western and northwestern regions. The control programs consisted of (i) diagnosis and chemotherapy of patients, (ii) identification, isolation, and disposal of infected dogs, and (iii) residual insecticide indoor spraying for vector control. The success of the control programs is attributable to massive and effective mobilization of the general public and health workers to the cause. Nationally, the annual incidence is now very low, i.e., only 0.03/100,000 according to the available 2011 official record. The overwhelming majority of cases are reported from sites of endemicity in the western and northwestern regions. Here, we describe in some depth and breadth the current status of epidemiology, diagnosis, treatment, and prevention of the disease, with particular reference to the control programs. Pertinent information has been assembled from scattered literature of the past decades in different languages that are not readily accessible to the scientific community. The information provided constitutes an integral part of our knowledge on leishmaniasis in the global context and will be of special value to those interested in control programs.

Mitochondrial genomes of two phlebotomine sand flies, Phlebotomus chinensis and Phlebotomus papatasi (Diptera: Nematocera), the first representatives from the family Psychodidae

BACKGROUND

Leishmaniasis is a worldwide but neglected disease of humans and animal transmitted by sand flies, vectors that also transmit other important diseases. Mitochondrial genomes contain abundant information for population genetic and phylogenetic studies, important in disease management. However, the available mitochondrial sequences of these crucial vectors are limited, emphasizing the need for developing more mitochondrial genetic markers.

METHODS

The complete mitochondrial genome of Phlebotomus chinensis was amplified in eight fragments and sequenced using primer walking. The mitochondrial genome of Phlebotomus papatasi was reconstructed from whole-genome sequencing data available on Genbank. The phylogenetic relationship of 24 selected representatives of Diptera was deduced from codon positions 1 and 2 for 13 protein coding genes, using Bayesian inference (BI) and maximum likelihood (ML) methods.

RESULTS

We provide the first Phlebotomus (P. chinensis and P. papatasi) mitochondrial genomes. Both genomes contain 13 protein-coding genes, 22 transfer RNA genes, two ribosomal RNA genes, and an A + T-rich region. The gene order of Phlebotomus mitochondrial genomes is identical with the ancestral gene order of insect. Phylogenetic analyses demonstrated that Psychodidae and Tanyderidae are sister taxa. Potential markers for population genetic study of Phlebotomus species were also revealed.

CONCLUSION

The generated mitochondrial genomes of P. chinensis and P. papatasi represent a useful resource for comparative genomic studies and provide valuable future markers for the population genetic study of these important Leishmania vectors. Our results also preliminary demonstrate the phylogenetic placement of Psychodidae based on their mitochondrial genomes.

Knowledge of the population about visceral leishmaniasis transmission in endemic areas near the banks of the Mossoró River in northeastern Brazil

Visceral leishmaniasis (VL) is an anthropozoonosis with high prevalence and incidence in the Northeastern region of Brazil. This study aimed to determine whether people living near the Mossoró River in the city of Mossoró, Rio Grande do Norte, have knowledge of VL and to characterize the environmental properties of this region. Questionnaires were administered to 478 residents in three neighborhoods near the Mossoró River, addressing the population's knowledge about VL and environmental characteristics. Most survey participants were female, with ages between 18 and 40 years, 53.8% had completed primary education, and 61.5% owned pet dogs (p<0.05). The majority (95.9%) showed little knowledge about the characteristics inherent to sandflies, and 85.3% were unaware of the environments preferred by this vector (p<0.05). Sewage from the homes of respondents was mainly dumped into the river (44.6%), and 76.6% of the respondents complained about the accumulation of garbage in the streets (p<0.05). The association between education and knowledge about the transmission of VL and preferred vector locations was statistically significant (p<0.05). The lack of knowledge in the population about VL and the residential environment indicates a risk of maintaining sand fly habitats and hence disease transmission.

Clinical Features and Laboratory Findings of Visceral Leishmaniasis in Children Referred To Children Medical Center Hospital, Tehran, Iran during 2004-2011

BACKGROUND

Visceral leishmaniasis (VL) is one of the most important parasitic diseases endemic in northwestern and southern areas of Iran. The aim of the present study was to review the records of children hospitalized with VL in order to characterize the clinical features of children as well as laboratory finding in Children Medical Center Hospital, Tehran, Iran.

METHODS

The medical records of all children with a final diagnosis of VL were reviewed from 2004 to 2011. Demographic, clinical information, laboratory finding and treatment were considered.

RESULTS

A total number of 34 children with confirmed VL through 2004-2011 were included in the study. The most prevalent sign and symptoms were fever (97.1%), pallor and weakness (97.1%), appetite loss (61.8%), splenomegaly (97.1%) and hepatomegaly (88.2%). The most frequent laboratory abnormalities were hematological including anemia (97.1%), thrombocytopenia (91.2%) and leukopenia (67.6%). Direct agglutination test (DAT) was performed in 23 cases and all of them showed anti-Leishmania antibodies with titers of ≥ 1: 3200. In addition, 90% of patients had positive rK39 results. Identification of Leishmania in the aspirates of the bone marrow was found in 83.3% of patients.

CONCLUSION

Regional surveillance system in order to monitoring of leishmaniasis trends as well as detection of new emerging foci is recommended.