Urogenital Myiasis Caused by Psychoda albipennis in a Female Child in Libya

Urogenital myiasis is a parasitic infestation caused by larvae of Psychoda spp. and it is very rare in humans. A 10- year old female was presented with urogenital myiasis and 4th stage Larvae of Psychoda albipennis (Diptera: Psychodidae) were found in urine. The patient was complained of painful sensation, discomfort and burning while urination. Urinary tract antiseptics were prescribed for the patient and advised to drink plenty of water for hydration. Local health authorities should take proper measures to maintain hygienic conditions for the people under risk

Establishment of CD4 and CD8 Lymphocyte subsets in a healthy HIV and Toxoplasma seronegative pregnant women in Libya

Most of the diagnostic laboratories in Libya often depend on western textbooks for CD4+- and CD8+ T-lymphocyte reference values. In this paper, we established reference ranges for the Libyan Toxoplasma, HIV, HBV, and HCV seronegative healthy pregnant women in all trimesters of pregnancy, and compared them with a control group of non-pregnant women. Whole-blood samples were collected to provide normal ranges for CD4+ and CD8+ Lymphocyte subsets expressed as mean ± standard division. A total of 110 Libyan women who came from Tripoli and Zwara districts were investigated; 70 pregnant women (aged 27.8 ± 2.99, range 18-40 years old) and 40 non-pregnant women (aged 22.7±3.01, range 18-40 years old) were included as controls. All cases/controls were seronegative for toxoplasmosis, HIV, HBV and HCV. The CD4+ cell counts were 685±256 cell/μl at the first trimester (T1), 740±202 at T2, and 923±203 cell/μl at T3. While the CD8+ cell counts were 451±171 cell/μl at T1, 541±168 at T2, and 753±190 cell/μl at T3. The CD4:CD8 ratios were 1.5±0.64 at T1, 1.4±0.51 at T2, and 1.2±0.36 at T3. Moreover, the mean absolute CD4+ and CD8+ counts for the control group were 1001±232 cell/μl and 717±159 cell/μl respectively. Absolute counts of CD4+ and CD8+ cells in pregnant women were significantly lower as compared to controls (P0.05). The absolute CD4+ and CD8+ cell counts decreased with age for both groups. Geographical variation was reported for the cell counts between Tripoli and Zwara district at T3. We established reference ranges of CD4+ and CD8+ T-lymphocytes for the Libyan healthy pregnant women and discussed their use as prognostic markers. Further cohorts with greater sample size may be required to define the stage of the disease in relation to the normal CD4+ and CD8+ T lymphocyte count subsets in the Libyan population

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

Background: Several case reports describe diseases presenting with skin ulcerations, which resemble pyoderma gangrenosum especially in immune-compromised patients, often proven on further workup, to have an infective or malignant etiology. However, treatment of pyoderma gangrenosum by systemic steroids or other immunosuppressive agents may worsen the condition. Case presentation: We report here, a 45 year-old Libyan woman with rheumatoid arthritis on low dose steroids with pyoderma gangrenosum-like skin lesions and positive pathergy. Slit–smear was positive for Leishmania amastigotes and histopathological examination confirmed the diagnosis of cutaneous leishmaniasis. The lesions healed completely by parenteral sodium stibogluconate (Pentostam) 600 mg daily. Conclusion: We report for the first time, a rare and unusual presentation of pyoderma gangrenosum like-cutaneous leishmaniasis in a patient with rheumatoid arthritis. Atypical cutaneous leishmaniasis should not be ruled out in the differential diagnosis of unresponsive skin diseases, with slit/smear and a skin biopsy is required.Acknowledgements Not applicable. Funding The authors declare that no funding support was obtained for this study

First Molecular Epidemiological Study of Cutaneous Leishmaniasis in Libya

Cutaneous leishmaniasis (CL) is caused by protozoan parasites of the genus Leishmania. The disease is characterized by the formation of chronic skin lesions followed by permanent scars and deformation of the infected area. It is distributed in many tropical and subtropical countries with more than 2 million cases every year. During the past few years CL has emerged as a major public health problem in Libya. So far, diagnosis was based on clinical symptoms and microscopic observation of parasites. Disease outbreaks were not investigated and the causative leishmanial species of CL were not identified so far. Our study indicates the presence of two coexisting species: Leishmania major and Leishmania tropica. These results are crucial in order to provide accurate treatment, precise prognosis and appropriate public health control measures. The recent armed conflict in Libya that ended with the Gadhafi regime collapse on October 2011 has affected all aspects of the life in the country. In this study we discussed multiple risk factors that could be associated with this conflict and present major challenges that should be considered by local and national health authorities for evaluating the CL burden and highlighting priority actions for disease control

Molecular prevalence and estimated risk of cutaneous leishmaniasis in Libya

Background/Purpose: Cutanoeus leishmaniasis (CL) is an endemic disease in the Mediterranean area including Libya. The aim of the present study is to detect the prevalent Leishmania species obtained from smeared cutaneous lesions in addition to studying the diverse sociodemographic risk factors of the reported cases from different provinces of Libya. Methods: A total of 250 archived microscopic slides from clinically suspected cases of CL attending the leishmaniasis clinic in the Dermatology Department, Tripoli Central Hospital, Tripoli, Libya, were microscopically examined. Leishmania-DNA was amplified using combined polymerase chain reaction (PCR) targeting kinetoplast-DNA (kDNA) and ribosomal internal transcribed spacer 1 (ITS1)-DNA with restriction fragment length polymorphism analysis for direct Leishmania species identification. Results: Using kDNA and ITS1-PCR, 22.5% and 20% of cases were positive, respectively. Only 14.4% of cases were positive using microscopy. Nominating ITS1-PCR as the reference standard, kDNA-PCR assay was highly sensitive while microscopy was 100% specific but of limited sensitivity (72%) with a substantial agreement and an overall accuracy of 94.4%. Leishmania major and Leishmania tropica were the predominant species reported from the north-western provinces including Tripoli, Zintan, and Gharyan with their related subprovinces; Asabaa, Mizdan, Alkawasem, and Alorban. CL prevailed more among men and residents of rural areas. House wives and students were the most affected professions. Children were the least affected, while the middle-aged were the most affected age group. Conclusion: L. major and L. tropica are the predominant species in the north-western regions of Libya. ITS1-PCR-restriction fragment length polymorphism assay offered a sensitive, specific, and faster diagnostic method especially with negative parasitologic examination. Keywords: Archived microscopic slides, Cutaneous leishmaniasis, ITS1-PCR, kDNA-PC

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

Background: Several case reports describe diseases presenting with skin ulcerations, which resemble pyoderma gangrenosum especially in immune-compromised patients, often proven on further workup, to have an infective or malignant etiology. However, treatment of pyoderma gangrenosum by systemic steroids or other immunosuppressive agents may worsen the condition. Case presentation: We report here, a 45 year-old Libyan woman with rheumatoid arthritis on low dose steroids with pyoderma gangrenosum-like skin lesions and positive pathergy. Slit–smear was positive for Leishmania amastigotes and histopathological examination confirmed the diagnosis of cutaneous leishmaniasis. The lesions healed completely by parenteral sodium stibogluconate (Pentostam) 600 mg daily. Conclusion: We report for the first time, a rare and unusual presentation of pyoderma gangrenosum like-cutaneous leishmaniasis in a patient with rheumatoid arthritis. Atypical cutaneous leishmaniasis should not be ruled out in the differential diagnosis of unresponsive skin diseases, with slit/smear and a skin biopsy is required.Non

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

Background: Several case reports describe diseases presenting with skin ulcerations, which resemble pyoderma gangrenosum especially in immune-compromised patients, often proven on further workup, to have an infective or malignant etiology. However, treatment of pyoderma gangrenosum by systemic steroids or other immunosuppressive agents may worsen the condition. Case presentation: We report here, a 45 year-old Libyan woman with rheumatoid arthritis on low dose steroids with pyoderma gangrenosum-like skin lesions and positive pathergy. Slit–smear was positive for Leishmania amastigotes and histopathological examination confirmed the diagnosis of cutaneous leishmaniasis. The lesions healed completely by parenteral sodium stibogluconate (Pentostam) 600 mg daily. Conclusion: We report for the first time, a rare and unusual presentation of pyoderma gangrenosum like-cutaneous leishmaniasis in a patient with rheumatoid arthritis. Atypical cutaneous leishmaniasis should not be ruled out in the differential diagnosis of unresponsive skin diseases, with slit/smear and a skin biopsy is required.Non

Spatiotemporal and molecular epidemiology of cutaneous leishmaniasis in Libya

Cutaneous leishmaniasis (CL) is a skin infection caused by a single-celled parasite that is transmitted by the bite of a phlebotomine sandfly. CL is the most common form of leishmaniasis characterized by localized lesions in the skin and mucous membranes. The disease is prevalent in all countries around the Mediterranean Basin. In this paper, we describe spatiotemporal and eco-epidemiological parameters of CL in Libya. Moreover, we explored current spatiotemporal distributions of CL cases and explored the future projection of the disease. Our study indicates the presence of higher risk of CL in the coastal regions of Libya. Future projection 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 scenarios should be considered by health authorities in order to develop appropriate intervention strategies and plan effective control programs

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

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