Investigation of the spread of human visceral leishmaniasis in central Tunisia

Abstract

The epidemiology, clinical patterns, and spatial spread of Mediterranean visceral leishmaniasis were retrospectively studied in central Tunisia. The clinical profile of the disease was typical of the Mediterranean infantile form. Malnutrition and associated infectious diseases were observed in 62.5% and 55% of cases, respectively. The case-fatality rate was 6.2% and resistance to meglumine antimonate was observed in 1.6% of patients. The annual incidence of cases increased from approximately 10 cases per year before 1991 to approximately 50 cases per year between 1992 and 1994. The cumulative incidence was 133.7/100,000 among children aged < 15 years. This increase was preceded by 3 years of high mean annual rainfall in the region. The spatial distribution of the incidence of the infection through time showed an aggregation of cases in the northern part of the area where intensive agriculture projects took place during the last 10 years, leading to the establishment of a stable Leishmania infantum transmission cycle below the Atlas mountain chains, and an evident tendency to a progressive extension to the south.

Use of PCR, IFAT andin vitroculture in the detection ofLeishmania infantuminfection in dogs and evaluation of the prevalence of canine leishmaniasis in a low endemic area in Tunisia

“…However, in this study, we found that Kairouan, which is an arid region, supposed to be of very low endemicity 30 years ago (Dedet et al, 1973), had a prevalence as high as 20.9 %. This result may be due to: i) the increase of the disease in this region which has not been studied since 1973 in correlation with the important number of cases of Human visceral leishmaniais emerged recently (Ben Salah et al, 2000), and suggesting for a spread of the disease in the centre of Tunisia (Ayadi et al, 1991;Besbes et al, 1994;Ben Salah et al, 2000); ii) the prevalence was underestimated since all previous studies were conducted by serological methods, which, as we reported in this study, can not detect all infected dogs.…”

“…Human visceral leishmaniasis is known to be detected occasionally in the central Tunisia (Ayadi et al, 1991;Besbes et al, 1994). However, an important number of cases emerged recently in this region (Ben Salah et al, 2000). Tested dogs were examined for clinical signs of the disease, including dermatological lesions, ocular changes, lost of weight, apathy, lymph node and spleen enlargement.…”

Mechanisms of the Natural Reactivity of Lymphocytes from Noninfected Individuals to Membrane-AssociatedLeishmania infantumAntigens

“…3 Human infection by Leishmania infantum often runs a subclinical and self-healing course (1), but is also featured by the fatal syndrome of infantile visceral leishmaniasis (VL) (2).…”

Leishmaniasis in central and southern Tunisia: current geographical distribution of zymodemes

“…Indeed, many studies were carried on the prevalence of cutaneous and visceral leishmaniasis in Tunisia but the characterization of the parasite was hardly ever made (Ben Salah et al, 2000;Kharfi et al, 2004). Previously, 65 was the largest number of identified VL strains.…”