Harmonized clinical trial methodologies for localized cutaneous leishmaniasis and potential for extensive network with capacities for clinical evaluation

International audienceINTRODUCTION: Progress with the treatment of cutaneous leishmaniasis (CL) has been hampered by inconsistent methodologies used to assess treatment effects. A sizable number of trials conducted over the years has generated only weak evidence backing current treatment recommendations, as shown by systematic reviews on old-world and new-world CL (OWCL and NWCL).MATERIALS AND METHODS: Using a previously published guidance paper on CL treatment trial methodology as the reference, consensus was sought on key parameters including core eligibility and outcome measures, among OWCL (7 countries, 10 trial sites) and NWCL (7 countries, 11 trial sites) during two separate meetings.RESULTS: Findings and level of consensus within and between OWCL and NWCL sites are presented and discussed. In addition, CL trial site characteristics and capacities are summarized.CONCLUSIONS: The consensus reached allows standardization of future clinical research across OWCL and NWCL sites. We encourage CL researchers to adopt and adapt as required the proposed parameters and outcomes in their future trials and provide feedback on their experience. The expertise afforded between the two sets of clinical sites provides the basis for a powerful consortium with potential for extensive, standardized assessment of interventions for CL and faster approval of candidate treatments

Estimated Incidence and Prevalence of Serious Fungal Infections in Morocco

Few data are published from Morocco on fungal disease, although numerous case reports attest to a wide range of conditions in the country. Here, we estimate for the first time the incidence and prevalence of serious fungal diseases in the country. Detailed literature searches in English and French were conducted for all serious fungal infections. Demographic and individual underlying condition prevalence or annual incidence were obtained from UNAIDS (HIV), WHO (TB) and other international sources. Deterministic modelling was then applied to estimate fungal disease burden. Morocco’s population in 2021 was 36,561,800. Multiple publications describe various fungal diseases, but epidemiological studies are rare. The most frequent serious fungal infections were tinea capitis (7258/100,000) and recurrent vulvovaginal candidiasis (2794/100,000 females). Chronic pulmonary aspergillosis is also common at a prevalence of 19,290 (53/100,000) because of the relatively high rate of tuberculosis. The prevalence of asthma in adults exceeds one million, of whom fungal asthma (including allergic bronchopulmonary aspergillosis (ABPA)) probably affects 42,150 (115/100,000). Data are scant on candidaemia (estimated at 5/100,000), invasive aspergillosis (estimated at 4.1/100,000), HIV-related complications such as cryptococcal meningitis and Pneumocystis pneumonia and mucormycosis. Fungal keratitis is estimated at 14/100,000). Mycetoma and chromoblastomycosis are probably rare. Fungal disease is probably common in Morocco and diagnostic capacity is good in the teaching hospitals. These estimates need confirmation with methodologically robust epidemiological studies

Estimated Incidence and Prevalence of Serious Fungal Infections in Morocco

International audienceFew data are published from Morocco on fungal disease, although numerous case reports attest to a wide range of conditions in the country. Here, we estimate for the first time the incidence and prevalence of serious fungal diseases in the country. Detailed literature searches in English and French were conducted for all serious fungal infections. Demographic and individual underlying condition prevalence or annual incidence were obtained from UNAIDS (HIV), WHO (TB) and other international sources. Deterministic modelling was then applied to estimate fungal disease burden. Morocco’s population in 2021 was 36,561,800. Multiple publications describe various fungal diseases, but epidemiological studies are rare. The most frequent serious fungal infections were tinea capitis (7258/100,000) and recurrent vulvovaginal candidiasis (2794/100,000 females). Chronic pulmonary aspergillosis is also common at a prevalence of 19,290 (53/100,000) because of the relatively high rate of tuberculosis. The prevalence of asthma in adults exceeds one million, of whom fungal asthma (including allergic bronchopulmonary aspergillosis (ABPA)) probably affects 42,150 (115/100,000). Data are scant on candidaemia (estimated at 5/100,000), invasive aspergillosis (estimated at 4.1/100,000), HIV-related complications such as cryptococcal meningitis and Pneumocystis pneumonia and mucormycosis. Fungal keratitis is estimated at 14/100,000). Mycetoma and chromoblastomycosis are probably rare. Fungal disease is probably common in Morocco and diagnostic capacity is good in the teaching hospitals. These estimates need confirmation with methodologically robust epidemiological studies

ISSN 2347-954X (Print) A Comparative Study of Intestinal Parasitic Carriage in Pregnant-Non Pregnant Women

Abstract: Intestinal parasitoses are a public health problem in developing countries. Our study aims to determine the frequency and contributing factors of intestinal parasitic infections in pregnant women are often exposed to the environment but also by their own behavior. This is a prospective descriptive study of prevalence conducted over a period of fifteen months from October 2009 to December 2010 in collaboration between the Department for Parasitology and Medical Mycology and Gynecology department obstetrics of the Military Hospital of Instruction Mohammed V (HMIM V) in Rabat. After establishing a information sheet (epidemiological data, medical history) and collected stool, stool examination was held in two stages: a macroscopic examination and microscopic examination. During the study period, we included 70 pregnant women of which 46 are parasitized, with an infection rate of 65.7% compared to 48.7% among 70 non-pregnant women examined, corresponding to a 17% difference between the two populations and that is statistically significant. No helminthes was found. Porting of protozoa with pathogenicity is encountered in 4.3% of pregnant women parasitized. 23 pregnant women are poly-parasitized, with 32.8% of the total sample. This study shows that the prevalence of intestinal parasitism is quite high in pregnant women. Several parasitic species are found. This finding can be explained by the poor living conditions and poor hygiene favoring endemicity and sustaining transmission. The impact on health is significant especially when compounded by malnutrition. The best way to fight against this scourge is prevention and awareness

Evaluation of six commercial kits for the serological diagnosis of Mediterranean visceral leishmaniasis

International audienceMETHODOLOGY/PRINCIPAL FINDINGS: Serum samples from 319 patients living in France, Tunisia or Morocco were tested using two ICT (IT LEISH and TruQuick LEISH IgG/IgM Meridian) and four ELISA reagents (NovaLisa Leishmania infantum IgG, Bordier Leishmania infantum, Ridascreen Leishmania IgG, and Vircell Leishmania). The population with proven VL (n = 181) included 65 immunocompromised patients. Significantly higher percentages of false-negative results were obtained with all assays in immunocompromised patients, compared with the immunocompetent population. In the whole population, sensitivity and specificity ranged from 80.7% to 93.9% and from 95.7% to 100%, respectively. The maximum accuracy was observed with the Bordier and Vircell ELISA kits (96.2%), and the lowest accuracy with Ridascreen reagent (88.7%). New thresholds of positivity are proposed for the Bordier, Vircell and NovaLisa ELISA kits to achieve 95% sensitivity with the highest possible specificity. Western blot (WB), used as a confirmation method, showed 100% sensitivity and identified 10.1% of asymptomatic carriers among the control population from the South of France.CONCLUSIONS/SIGNIFICANCE: This is the first study that compared commercially available kits for VL serodiagnosis in the endemic region of the Mediterranean basin. It provides specific information about the tests' performance to help clinicians and biologists to select the right assay for VL screening

Human cystic echinococcosis in Morocco: Ultrasound screening in the Mid Atlas through an Italian-Moroccan partnership

<div><p>Background</p><p>Cystic echinococcosis (CE) is a neglected parasitic zoonosis with considerable socioeconomic impact on affected pastoral communities. CE is endemic throughout the Mediterranean, including Morocco, where the Mid Atlas is the most prevalent area for both human and animal infection. The highest hospital annual incidence of human CE is recorded in the provinces of Ifrane and El Hajeb. However, hospital-based statistics likely underestimate the real prevalence of infection, as a proportion of cases never reach medical attention or official records.</p><p>Methodology/Principal findings</p><p>In 2012, a project on clinical management of CE in Morocco was launched with the aims of estimating the prevalence of human abdominal CE in selected rural communes of the above mentioned provinces using ultrasound (US) screening and training local physicians to implement US-based focused assessment and rational clinical management of CE according to the WHO-IWGE Expert Consensus. A total of 5367 people received abdominal US during four campaigns in April-May 2014. During the campaigns, 24 local general practitioners received >24 hours of hands-on training and 143 health education sessions were organized for local communities. We found an overall CE prevalence of 1.9%, with significantly higher values in the rural communes of Ifrane than El Hajeb (2.6% vs 1.3%; p<0.001). CE cysts were predominantly in inactive stage, especially in older age groups. However, active cysts were present also in adults, indicating acquisition of infection at all ages. Province of residence was the only risk factor consistently associated with CE infection.</p><p>Conclusions/Significance</p><p>Our results show a high prevalence and on-going, likely environmental transmission of CE in the investigated provinces of Morocco, supporting the implementation of control activities in the area by national health authorities and encouraging the acceptance and divulgation of diagnosis and treatment algorithms based on imaging for CE at both national and local level.</p></div

Distribution of CE lesions.

<p><b>A.</b> Number of subjects with untreated and previously treated CE cysts (bars; left Y axis) and overall prevalence of CE in the screened population (dotted line; right Y axis) according to gender and age group (X axis). M = males; F = females. Age groups are expressed in years. Three children (aged 3, 8 and 9 years) and 19 adults (aged 81–94 years) were outside the target age range target; none of these subjects were infected with CE. <b>B.</b> Number of hepatic CE cysts in different stages. <b>C.</b> Percentage of CE cyst stages in patients never previously treated for CE within age groups. <b>D.</b> Percentage of CE cyst stages in patients never previously treated for CE within gender groups.</p

Demographic characteristics distribution of the screened and general population of the investigated provinces.

<p>Three children (aged 3, 8 and 9 years) and 19 adults (aged 81–94 years) were outside the target age range.</p

Examined people and CE cases observed during the screening campaigns.

<p>*One patient reported previous surgery for pulmonary CE.</p

Map of Morocco and the survey area.

<p>The survey area is indicated in black. This includes the rural communes of Timahdit and Ain Louh in the province of Ifrane, and the rural communes of Bouderbala and Sebt Jehjouh in the province of El Hajeb, Meknes-Tafilalet region (designated as such until December 2014). Modified from Di Hanhil [Public Domani] Wikimedia Commons.</p