Emerging and Re-Emerging Leishmaniases in the Mediterranean Area: What Can Be Learned from a Retrospective Review Analysis of the Situation in Morocco during 1990 to 2010?

Kahime Kholoud,Denis Sereno,Moulayabdelomain El Hidan,Mohamed Messouli,Lahouari Bounoua

doi:10.3390/microorganisms8101511

Abstract

In Morocco, cutaneous and visceral leishmaniases represent a public health concern. In this opinion paper, we propose to highlight chosen elements that have governed the drastic increase in the incidence of leishmaniases recorded in Morocco during the period between 1990 to 2010 in order to guide the prediction of the expansion of diseases and epidemic events. We highlight that the dispersion of the zoonotic cutaneous leishmaniasis (ZCL) form, caused by the Leishmania major parasite, appears to be closely related to that of its arthropod vector density, which is sensitive to changes in climate. The dissemination of anthroponotic cutaneous leishmaniasis (ACL) was related to an increase in human travel and local tourism during the studied decades. These are linked to economic expansion and infrastructure development. Interestingly, the main ACL foci are spatially aligned with the highways, and their occurrence was synchronized with the building of transportation infrastructure. During the above-mentioned decades, the zoonotic visceral leishmaniasis (ZVL) caused by Leishmania infantum has expanded from its historical northern territories, dispersing outwards in all directions. This spread follows the emergence of hamlets and villages connecting with major cities.

Highlights

Leishmaniases are a worldwide health problem and a scourge for those with limited means to combat them
Starting from 2000 cases, infections caused by L. tropica and L. infantum increased slowly at a rate of 1.15% and 0.48%, respectively, while cases caused by L major experienced an exponential increase (Supplementary Data S1)
Zoonotic cutaneous Leishmaniasis is caused by L. major

Summary

Introduction

Leishmaniases are a worldwide health problem and a scourge for those with limited means to combat them. These diseases rank only after malaria in terms of annual incidence, with a mortality between 20,000 to 40,000 persons annually worldwide [1], and are a public health concern in Morocco [2]. Cutaneous leishmaniasis due to L. tropica and VL due to L. infantum have both increased monotonically during the same period. Starting from 2000 cases, infections caused by L. tropica and L. infantum increased slowly at a rate of 1.15% and 0.48%, respectively, while cases caused by L major experienced an exponential increase (Supplementary Data S1). After a sharp decline in ZCL case numbers after 2010, a new epidemic situation has arisen (see Figure 2B). SSchchememataitcicrereppreresesnentattaitoionnoof fththee ddisistrtirbibuutitoionnoof fleleisishhmmaanniaiasissisininMMoororocccoco, ,aacccocordrdininggtotoththeecclilniniciacal lfoformrmss(A(A).).TToottaalllleeisishhmmaanniaiasseess (z(zoooonnootitcicccuutatanneeoouussleleisishhmmaanniaiassisis(Z(ZCCLL),),aannththrrooppoonnootitcicccuutatanneeoouussleleisishhmmaanniaiassisis(A(ACCLL) )aannddvvisiscceerraal l leleisishhmmaanniaiasissis(V(VLL))))ininMMoororoccccoofrfroomm22000000toto22001188. .CCasaesennuummbberersasnanddtototatlalcacasessesaarereggiviveennoonnththee ggrraapphh((BB))..DDiissttrriibbuuttiioonn ooff ZZVVLL ((LL..iinnffaannttuumm))ininrerelalatitoionnwwitihththtehedidspisepresraslaplopteontetinatliaolf orefsreersveorivrohiroshtoss(tCs). (CD)i.stDriibsutrtiibountoiofnAoCfLA(LC.Ltr(oLp.ictar)oipnicrae)laintiornelawtiitohnthweitdhevtheelodpemveenlotpomf tehnetroofadthienfrroaasdtruinctfurarset(rDuc).tuNrBe:(ZDC).L NcaBu: sZeCdLbcyaLu.siendfabnytuLm. iinsfannotturmepirsensoent treedprienstehnetegdraipnhths.e graphs

What Can We Learn from the Past Moroccan Situation?

Findings

Conclusions