MENA leishmaniasis.

<p>Although at least 20 <i>Leishmania spp.</i> infect humans worldwide, the primary epidemiologically relevant species in the MENA region are <i>L. major</i>, <i>L. tropica</i>, <i>L. infantum</i>, and <i>L. donovani</i>, transmitted by approximately 25 different <i>Phlebotomus spp</i>. Etiological agents of visceral leishmaniasis (VL) in MENA include <i>L. donovani</i>, <i>L. infantum</i>, and occasionally <i>L. tropica</i>. Cutaneous leishmaniasis (CL) caused by <i>L. major</i>, <i>L. tropica</i>, and <i>L. infantum</i> differ slightly in lesion presentation depending on the species. As with vector species, a variety of animal hosts have been implicated as reservoirs in the transmission of zoonotic leishmaniasis, including rodents, hyraxes, and canids. For CL caused by <i>L. major</i>, the primary cycle is zoonotic between <i>P. papatasi</i> (shown) and <i>Psammoys</i> (shown) and <i>Meriones</i> rodents. Although hyraxes have been implicated as a reservoir host for <i>L. tropica</i>, transmission is thought to be primarily anthroponotic as is the VL agent, <i>L. donovani</i>. Mediterranean VL caused by <i>L. infantum</i> is typically zoonotic where candids are the primary reservoir and man is an accidental host; however, anthroponitic cycles also have been characterized. Regardless of species or clinical manifestation, all <i>Leishmania</i> species infecting humans are transmitted by the bite of an infected sand fly. During a blood meal, metacyclic promastigotes are released by the sand fly and enter the skin of the vertebrate host. <i>Leishmania</i> parasites infect cells of the myeloid lineage, including neutrophils, followed by macrophages and dendritic cells (shown). These parasites reside within a phagolysosome where they differentiate into a dividing, aflagellated amasitogotes. Sand flies take up parasites when feeding on an infected host. Infected host cells are lysed and amastigotes differentiate into flagellated procyclic promastigotes that attach to the midgut of the sand fly vector. Subsequent development and migration towards the anterior end of the sand fly completes the cycle. Photo Credits: <i>P. papatasi</i> courtesy of Tim Gathany, Center for Disease Control Photo Services; <i>Psammomys obesus</i> from <a href="http://commons.wikimedia.org/wiki/File:Psammomys_obesus_01.jpg" target="_blank">http://commons.wikimedia.org/wiki/File:Psammomys_obesus_01.jpg</a>; rock hyrax from <a href="http://www.marietta.edu/~biol/biomes/biome_main.htm" target="_blank">http://www.marietta.edu/~biol/biomes/biome_main.htm</a>.</p

Countries Represented.

<p>Countries Represented.</p

Leishmaniasis: Road to Translation.

<p>Leishmaniasis: Road to Translation.</p

Policy recommendations for the translation of laboratory discoveries into field applications for the control of leishmanisis.

<p>Policy recommendations for the translation of laboratory discoveries into field applications for the control of leishmanisis.</p

Descriptive statistics revealing genetic characteristics and variation of the ten microsatellite loci detected in the population of 55 <i>L. major</i> strains isolated from Tunisian rodents and worldwide.

<p>N, number of genotypes; NA, number of allele per locus; Ho, observed heterozygosity; He, expected heterozygosity; Fis, inbreeding coefficient.</p><p>Descriptive statistics revealing genetic characteristics and variation of the ten microsatellite loci detected in the population of 55 <i>L. major</i> strains isolated from Tunisian rodents and worldwide.</p

Theoretical sizes and repetition numbers among the ten-microsatellite loci in Tunisian studied isolates.

<p>*: New allele not previously described.</p><p>Theoretical sizes and repetition numbers among the ten-microsatellite loci in Tunisian studied isolates.</p

Neighbour-joining tree inferred from the Dps distances calculated for 55 <i>L. major</i> strains isolated from different rodents (40 Tunisian and 15 from other geographic origins) according to the 10 microsatellites analyzed.

<p>Strains isolated among <i>P. obesus</i> (P), <i>M. shawi</i> (M), <i>Tatera sp.</i> (T) and <i>R. opimus</i> (R) were classified into 10 genotypes Lmj01, Lmj02, Lmj14, Lmj15, Lmj17, Lmj21, Lmj37, Lmj39, Lmj65 (as described in<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0107043#pone.0107043-AlJawabreh1" target="_blank">[21]</a>) and RdTN from Africa (AF), Middle East (ME) and Central Asia (CA). RdTN indicates the genotype obtained from Tunisian reservoirs. Results are shown as radial tree where the percentages (under 80%) with which a branch is supported in 1000 bootstrap replications are indicated.</p

Geographical distribution of strains isolated from the Central Tunisia study area.

<p>Panel A shows the square delimited study area in the Governorate of Sidi Bouzid (in gray). Panel B represents the land satellite image of the study area showing the distribution of animal reservoir hosts from which the <i>L. major</i> strains were isolated. Isolates from <i>P. obesus</i> origin were noted P and colored in green, from <i>M. shawi</i> origin were noted Mer and colored in yellow, and from <i>M. nivalis</i> was noted M and colored in red. Spatial data related to the reservoir hosts of these strains were collected using the Global Positioning System (GPS). Satellite imagery: ArcGIS software.</p

Box plot with monthly ZCL incidence.

<p>Data was aggregated from January 1991 to December 2007. The box represents the 25th and 75th percentiles. The median is represented by a solid horizontal line. The whiskers of the graph show the 1st percentile to the 99th percentile. Values lower than the first and greater than the 99th percentile are represented by a point.</p

Autocorrelation Function (ACF) of monthly ZCL incidence.

<p>Autocorrelation Function (ACF) of monthly ZCL incidence.</p