Spatiotemporal and molecular epidemiology of cutaneous leishmaniasis in Libya

Abstract

BackgroundCutaneous leishmaniasis (CL) is a major public health problem in Libya. In this paper, we describe the eco-epidemiological parameters of CL during the armed conflict period from January 2011 till December 2012. Current spatiotemporal distributions of CL cases were explored and projected to the future using a correlative modelling approach. In addition the present results were compared with our previous data obtained for the time period 1995–2008.Methodology/Principal findingsWe investigated 312 CL patients who presented to the Dermatology Department at the Tripoli Central Hospital and came from 81 endemic areas distributed in 10 districts. The patients presented with typical localized lesions which appeared commonly on the face, arms and legs. Molecular identification of parasites by a PCR-RFLP approach targeting the ITS1 region of the rDNA was successful for 81 patients with two causative species identified: L. major and L. tropica comprised 59 (72.8%) and 22 (27.2%) cases, respectively. Around 77.3% of L. tropica CL and 57.7% of L. major CL caused single lesions. Five CL patients among our data set were seropositive for HIV. L. tropica was found mainly in three districts, Murqub (27.3%), Jabal al Gharbi (27.3%) and Misrata (13.7%) while L. major was found in two districts, in Jabal al Gharbi (61%) and Jafara (20.3%). Seasonal occurrence of CL cases showed that most cases (74.2%) admitted to the hospital between November and March, L. major cases from November till January (69.4%), and L. tropica cases mainly in January and February (41%). Two risk factors were identified for the two species; the presence of previously infected household members, and the presence of rodents and sandflies in patient’s neighborhoods. Spatiotemporal projections using correlative distribution models based on current case data and climatic conditions showed that coastal regions have a higher level of risk due to more favourable conditions for the transmitting vectors.ConclusionFuture projection of CL until 2060 showed a trend of increasing incidence of CL in the north-western part of Libya, a spread along the coastal region and a possible emergence of new endemics in the north-eastern districts of Libya. These results should be considered for control programs to prevent the emergence of new endemic areas taking also into consideration changes in socio-economical factors such as migration, conflicts, urbanization, land use and access to health care.

Epidemiological Features of Cutaneous Leishmaniasis in Zliten (North West of Libya)

“…remained the same compared into the previous years from 2011 up to the end of 2016 with peak incidence at December, this is similar to what was found in wide areas of north west of Libya, where L. major was found to be the cause of CL [11,12].…”

“…CL is found to be more prevalent in northwestern region of Libya, and L. major is found to be the main species, followed by L. tropica [11].…”

“…When systemic therapy with Pentavalent Antimonials was contraindicated because of age (more than 50 yrs) or because of cardiovascular disease, oral fluconazole 150 mg/ day was given for about 4-6 weeks, but allergy and drug interactions should be considered. While the alternative to Pentavalent Antimonials (in Tripoli Central Hospital) were oral rifampicin (600 mg/day) and isoniazide (300 mg/day) [11,15].…”

Cutaneous leishmaniasis mimicking sarcoidosis in Libyan patient: A case report

“…Moreover, it has enabled a precise identification of the causative species, better deferential diagnosis from comorbidities, and consequently better treatment and recovery of patients. [23][24][25] The sensitivity of molecular diagnostic methods for CL including kDNA and ITS1 PCR was higher compared to other diagnostic approaches. These differences in sensitivity become more significant in patients with chronic forms of nodular skin lesions.…”

A pyoderma gangrenous-like cutaneous leishmaniasis in a Libyan woman with rheumatoid arthritis: a case report

“…The clinical diagnosis of CL was suspected since this patient came from an endemic area, having multiple lesions on exposed parts of body, not responding to treatment with antibiotics, had positive personal and family history of CL which are confirmed as risk factors for CL [ 11 , 12 ] as well as confirmation of the case by a slit–skin smear and histopathological examination. The reason for this rare unusual clinical type of Pyoderma gangrenosum like CL is unknown and raises speculation and assumptions about the host parasite relationship and the capacity of Leishmania parasites to modulate the host immune response [ 13 – 16 ].…”