Seasonal distribution of CL in Libya.

<p><b>A.</b> Seasonal distribution of CL cases as reported by the Libyan National Centre for Infectious Diseases and Control (1995–2008). The highest peak was from November till February. <b>B.</b> Seasonal distribution of CL cases caused by <i>L.major</i> showing a peak from November till January and by <i>L.tropica</i> that peaked in February. These results are based on data collected form 1995 to 2008.</p

Species identification from positive slides and positive ITS1 PCR.

<p>Number of microscopically and PCR positive slides as well as the results of <i>Leishmania</i> species identification per year given for the total period from 1995 to 2008.</p

Molecular identification of causative CL species.

<p>Restriction fragment length polymorphism (RFLP) analysis of the amplified internal transcribed spacer 1 region (ITS1) digested with restriction enzyme <i>Hae</i>III and analysed by electrophoresis on 2.5% agarose gels. Three reference strains were used for comparison; Lane 1 = <i>L. major</i>: MHOM/PS/01/ISL659, Lane 2 = <i>L. tropica</i>: MHOM/PS/02/63JnF21 and Lane 3 = <i>L. infantum</i> MHOM/TN/1980/IPT1. 1 kb = molecular size marker. All other lanes show digested PCR product from clinical materials; lanes 4–7 = <i>L. tropica</i> cases from Al Jabal Al Gharbi, Misrata and Tarhuna districts; lanes 8–11 = <i>L.major</i> cases from Tripoli, Sirt, Misrata, Al Murqub.</p

Unrooted neighbor-joining tree inferred from genetic distances derived from the proportions of alleles shared among 55 Moroccan <i>L. infantum</i> strains based on 14 microsatellites markers.

<p>Two main clusters were detected and the “MON-1” cluster was further sub-divided into two sub-clusters. This was in full agreement with the STRUCTURE results (<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0077778#pone-0077778-g002" target="_blank">Figure 2</a>). Mixed 1A/1B genotypes were shown in intermediate positions in the tree.</p

Estimated population structure for 33 Moroccan <i>L. infantum</i> strains as inferred by STRUCTURE software on the basis of data for 14 microsatellite markers.

<p>Each of the strains is represented by a single vertical line divided into K colors, where K is the number of populations assumed. Each color represents one population, and the length of the colors segment shows the strain’s estimated proportion of membership in that population.(A) the two main populations derived from the whole dataset which divided strains into MON-1 and non-MON-1 populations. (B) Sub-population analysis of <b>Population 1</b> (MON-1 group) shows two sub-populations. K represents the true number of populations and sub-populations.</p

Map of Morocco with all areas endemic for VL (shadowed areas).

<p>Map of Morocco with all areas endemic for VL (shadowed areas).</p

Distribution of cutaneous leishmaniasis cases in Libya by district and year of infection.

<p><b>(A)</b> Comparison of the number of microscopically confirmed cases found in the respective districts for the time periods 2011–2012 (all cases registered in the Tripoli Central Hospital) and 1995–2008 (all cases stored in the archive of the Libyan National Centre for Infectious Diseases and Control (LNCIDC)) [<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0005873#pntd.0005873.ref012" target="_blank">12</a>]. <b>(B)</b> Progression in time of the number of the collected and verified cases including both time periods.</p

Distribution of cutaneous leishmaniasis cases per district, method of identification, causative <i>Leishmania</i> species and study period.

<p>Distribution of cutaneous leishmaniasis cases per district, method of identification, causative <i>Leishmania</i> species and study period.</p

Per-month distribution of Libyan cutaneous leishmaniasis (CL) cases (left charts) and seasonal distribution of CL cases caused by <i>L</i>.<i>major</i> and <i>L</i>.<i>tropica</i> (right charts).

<p><b>(A)</b> distribution of CL cases collected during 2011–2012, <b>(B)</b> distribution of CL cases collected during 1995–2008 as published elsewhere [<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0005873#pntd.0005873.ref012" target="_blank">12</a>], <b>(C)</b> overall distribution 1995–2012.</p

Clinical presentation of cutaneous leishmaniasis.

<p><b>(A)</b> Leishmaniasis recidivans (lupoid) activated after 2 years from clinical cure. <b>(B)</b> Sporotrichoid type of CL. <b>(C)</b> Cold cellulitis like CL. <b>(D)</b> Nodulo-crusted CL. <b>(E)</b> CL with nodular lymphangitis. <b>(F)</b> Large nodular type. <b>(G)</b> Ulcerated type CL.</p