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

First report of Leishmania (L) killicki Rioux, Lanotte & Pratlong, 1986 in Libya.

International audienc

Caractérisation comparative des trois formes de leishmaniose cutanée endémiques en Tunisie

International audienceBackground : The recent spread in the geographical distribution of the three forms of cutaneous leishmaniasis (CL) endemic in Tunisia has resulted in the coexistence of more than one species of Leishmania (L.) in some foci, rendering characterization on the basis of geographical criteria alone more difficult. The aim of the study was to establish clinical criteria associated with these noso-geographic forms, namely sporadic CL (SCL) due to L. infantum, zoonotic CL (ZCL) due to L. major and chronic CL (CCL) due to L. tropica.Patients and methods : One hundred and twelve patients with biologically confirmed CL were involved in the study. Leishmania species was systematically identified by iso-enzyme analysis and/or PCR-RFLP. Details of the number, the location, the morphological aspect and the month of outbreak of the lesions were noted for each patient.Results : SCL lesions appeared later than ZCL lesions (53.8% of cases appeared from December onwards vs. 23.6%, P < 0.001). ZCL lesions were often multiple (75%) and situated on the limbs (84.7%, P < 0.001), whereas SCL lesions were single (92.3%, P < 0.001) and located on the face (84.6%, P < 0.001). CCL lesions were also single (78.6%) and located on the face (71.4%). The classical ulcerous presentation with scabs was mainly observed in ZCL patients (69.4%) and the erythematous presentation was described more frequently in SCL patients (75%; P < 0.001).Conclusion : The number, site, morphological aspect and month of outbreak of lesions could be considered as useful criteria that help differentiate between the three noso-geographical forms of CL prevailing in Tunisia. Such characterization is useful for the individual management of patients and for optimizing the combat against the disease.Introduction : Les extensions récentes des aires de répartition des trois formes de leishmaniose cutanée (LC) endémiques en Tunisie font que désormais plus d’une espèce coexistent dans certains foyers, ce qui empêche la discrimination entre ces différentes formes à partir des seuls critères géographiques. L’objectif de ce travail est d’identifier certains critères cliniques qui seraient associés aux formes en question : la LC sporadique (LCS) due à Leishmania infantum, la LC zoonotique (LCZ) due à L. major et la LC chronique due à L. tropica.Patient et méthode : Cent douze cas de LC confirmés biologiquement ont fait partie de l’étude. L’espèce de leishmanie en cause a été systématiquement identifiée par électrophorèse des iso-enzymes et/ou PCR-RFLP. Étaient relevés systématiquement le nombre et la localisation des lésions, ainsi que leur aspect morphologique et le mois de leur apparition.Résultats : Les lésions de LCS semblent se déclarer plus tardivement que celles de LCZ (53,8 % à partir de décembre vs. 23,6 %, p < 0,001). Les lésions de LCZ sont souvent multiples (75 %) et localisées aux membres (84,7 %), alors que celles de LCS sont plutôt uniques (92,3 %, p < 0,001) et touchent le visage (84,6 %, p < 0,001). La LCC se présente également sous forme de lésions uniques (78,6 %) du visage (71,4 %). L’aspect ulcéro-croûteux dominait les présentations des lésions de LCZ (69,4 %) et l’aspect érythémateux infiltré celles de LCS (75 %, p < 0,001).Conclusion : En complément de la provenance géographique des cas, le nombre des lésions, leur localisation, leur aspect morphologique et le mois où elles surviennent facilitent la discrimination entre les trois formes de LC présentes en Tunisie, ce qui est utile pour la prise en charge des patients et l’adaptation des mesures de contrôle