Incidence Of Leishmaniasis Research Articles

Visceral leishmaniasis outbreaks in Bihar: community-level investigations in the context of elimination of kala-azar as a public health problem

BackgroundWith visceral leishmaniasis (VL) incidence at its lowest level since the 1960s, increasing attention has turned to early detection and investigation of outbreaks.MethodsOutbreak investigations were triggered by recognition of case clusters in the VL surveillance system established for the elimination program. Investigations included ascertainment of all VL cases by date of fever onset, household mapping and structured collection of risk factor data.ResultsVL outbreaks were investigated in 13 villages in 10 blocks of 7 districts. Data were collected for 20,670 individuals, of whom 272 were diagnosed with VL between 2012 and 2019. Risk was significantly higher among 10–19 year-olds and adults 35 or older compared to children younger than 10 years. Outbreak confirmation triggered vector control activities and heightened surveillance. VL cases strongly clustered in tolas (hamlets within villages) in which > 66% of residents self-identified as scheduled caste or scheduled tribe (SC/ST); 79.8% of VL cases occurred in SC/ST tolas whereas only 24.2% of the population resided in them. Other significant risk factors included being an unskilled non-agricultural laborer, migration for work in a brick kiln, living in a kuccha (mud brick) house, household crowding, habitually sleeping outside or on the ground, and open defecation.ConclusionsOur data highlight the importance of sensitive surveillance with triggers for case cluster detection and rapid, careful outbreak investigations to better respond to ongoing and new transmission. The strong association with SC/ST tolas suggests that efforts should focus on enhanced surveillance in these disadvantaged communities.Graphical

Identification of climatic and environmental factors associated with incidence of cutaneous leishmaniasis in Central Iran using satellite imagery

Objective: To determine the effect of climatic and environmental factors on the incidence of cutaneous leishmaniasis in Qom province in 2018. Methods: In this cross-sectional study, the data on cutaneous leishmaniasis incidence were collected from the Disease Control and Prevention Center in Qom province. Climatic and environmental data including Normalized Difference Vegetation Index (NDVI), Land Surface Temperature (LST), and soil moisture were extracted using satellite images. Data of altitude and sunny hours were provided based on shuttle radar topography mission digital elevation model and hemispherical viewshed algorithm, respectively. The associations of climatic and environmental variables with the incidence of the disease were analyzed by Pearson correlation method. The ArcGIS 10.3 software was used to determine the geographical distribution of these factors. Results: There were positive correlations between cutaneous leishmaniasis incidence and the two climatic factors: LST and sunny hours per day (P=0.041, P=0.016), and it had weak negative correlations with the digital elevation model (P=0.27), soil moisture (P=0.54), and NDVI (P=0.62). The time delay analysis showed that in one-, two-, and three month periods, the correlations increased with a 95% confidence interval. Accordingly, the correlation with the three-month time delay was positive and relatively strong between the cutaneous leishmaniasis incidence and LST and sunny hours (P=0.027, P=0.02); nevertheless, there were negative correlations between the cutaneous leishmaniasis incidence and the soil moisture (P=0.27) and NDVI (P=0.62). Conclusions: As Qom is located in one of the semi-arid climate zones, topography and solar energy are important factors affecting the incidence of cutaneous leishmaniasis in autumn. Therefore, appropriate disease control programs are recommended.

Leishmaniasis in the Colombian post-conflict era: a descriptive study from 2004 to 2019.

INTRODUCTION: Leishmaniasis is strongly associated with armed conflict. We describe the epidemiology of leishmaniasis before and after the peace agreement in Colombia. METHODS: Data for 2004-2019 period were collected from the National Public Health Surveillance System. The annual incidence per geographical department before and after the peace agreement was calculated and correlated with armed conflict severity. RESULTS: The annual incidence of leishmaniasis registered a downfall with an annual percentage change of 17.7% after the peace treaty. CONCLUSIONS: A decrease in hostilities has a positive impact on the leishmaniasis incidence, which may be the case for other public health issues.

Predictive Modeling of Sandfly Distribution Incriminated in the Transmission of <i>Leishmania (Viannia) Braziliensis</i> and the Incidence of Cutaneous Leishmaniasis in the State of Paraná, Brazil

Predictive Modeling of Sandfly Distribution Incriminated in the Transmission of <i>Leishmania (Viannia) Braziliensis</i> and the Incidence of Cutaneous Leishmaniasis in the State of Paraná, Brazil

Incidence of human visceral leishmaniasis: the importance of municipal socio-economic indicators in the state of Pernambuco, Brazil

Objective: To analyze the main municipal socioeconomic factors associated with the incidence of HVL in the state of Pernambuco, northeastern Brazil. Methods: It is a analytical cross-sectional study. Data on the incidence of HVL and socioeconomic factors were collected from 954 cases notified by the SINAN (National System of Notifiable Diseases) and SIM (Mortality Information System). The cases considered were reported by municipalities in the state of Pernambuco, Brazil, from 2005 to 2014. Statistical differences were analyzed by Pearson's correlation test, followed by multiple regression analysis. Significant differences were considered when p <0.05. Results: The FIRJAN Municipal Development Index was the variable that showed the most remarkable statistical robustness and strong negative association with the incidence of HVL. The municipal spending on health and residing in the metropolitan region also influenced its mean incidence rates. Conclusion: The indicators that had an influence on the performance of the incidence of LVH were the FIRJAN Municipal Development Index, health expenditure and residing in the metropolitan region.

Phase I and II Clinical Trial Comparing the LBSap, Leishmune®, and Leish-Tec® Vaccines against Canine Visceral Leishmaniasis

In this study, we performed a phase I and II clinical trial in dogs to evaluate the toxicity and immunogenicity of LBSap-vaccine prototype, in comparison to Leishmune® and Leish-Tec® vaccines. Twenty-eight dogs were classified in four groups: (i) control group received 1 mL of sterile 0.9% saline solution; (ii) LBSap group received 600 μg of Leishmania braziliensis promastigotes protein and 1 mg of saponin adjuvant; (iii) Leishmune®; and (iv) Leish-Tec®. The safety and toxicity of the vaccines were measured before and after three immunizations by clinical, biochemical, and hematological parameters. The clinical examinations revealed that some dogs of LBSap and Leishmune® groups presented changes at the site of vaccination inoculum, such as nodules, mild edema, and local pain, which were transient and disappeared seventy-two hours after vaccination, but these results indicate that adverse changes caused by the immunizations are tolerable. The immunogenicity results demonstrate an increase of B lymphocytes CD21+ regarding the Leishmune® group and monocytes CD14+ concerning LBSap and Leishmune® groups. In the in vitro analyses, an increase in lymphoproliferative activity in LBSap and Leishmune® groups was observed, with an increase of antigen-specific CD4+ and CD8+ T lymphocytes in the LBSap group. A second approach of in vitro assays aimed at evaluating the percentage of antigen-specific CD4+ and CD8+ T lymphocytes producers of IFN-γ and IL-4, where an increase in both IFN-γ producing subpopulations in the LBSap group was observed, also showed an increase in IFN-γ producers in CD8+ lymphocytes in the Leish-Tec® group. Our data regarding immunogenicity indicate that the vaccination process, especially with the LBSap vaccine, generated a protective immune response compatible with L. infantum parasite control. Based on the foregoing, the LBSap vaccine would be suitable for further studies of phase III clinical trial in endemic areas with high prevalence and incidence of canine visceral leishmaniasis (VL) cases.

Eco-epidemiologia da leishmaniose tegumentar americana em Itabuna – Bahia – Brasil, 2001 a 2014

Realizou-se estudo do tipo ecológico com o objetivo de investigar o perfil sociodemográfico e epidemiológico, a frequência de casos, os indicadores epidemiológicos e os aspectos eco-epidemiológicos da leishmaniose tegumentar americana em Itabuna. A metodologia usada foi o levantamento de dados secundários (DATASUS - 2001 a 2014). No período de 2001 a 2014 foram notificados 360 casos de leishmaniose tegumentar americana em Itabuna. Os dados foram analisados por meio de estatística descritiva e inferencial. A incidência média de leishmaniose tegumentar americana no município, de 2001-2014, foi de 12,1 casos/100.000 habitantes. Os resultados indicam que os indivíduos mais acometidos foram homens em idade economicamente ativa, com baixa escolaridade e residentes em área urbana. Os casos em sua maioria eram novos e a forma clínica mais prevalente foi a cutânea, sendo o critério de confirmação clínico-epidemiológico o mais frequente. O teste χ2 evidenciou a existência de diferença significativa entre a frequência populacional e a frequência de casos da doença. Os indicadores epidemiológicos mostraram a densidade espacial, a detecção da doença e a proporção de casos no município. No que se refere aos aspectos eco-epidemiológicos, foi possível estabelecer que a recente ocupação de áreas periurbanas no município, aliada a fatores ambientais, como clima, vegetação, acúmulo de matéria orgânica, parecem aumentar a vulnerabilidade da população a epidemias. Palavras-chave: Perfil epidemiológico. Populações vulneráveis. Determinantes epidemiológicos. Leishmaniose cutânea.

Ten-Year Trends of the Incidence of Cutaneous Leishmaniasis in the South of Fars Province, Iran, During 2007-2016

Background and aims: Leishmaniasis is one of the most overlooked diseases in tropical areas, which can lead to many deaths and illnesses. The present study was designed to determine the trend of cutaneous leishmaniasis in the south of Fars Province (south of Iran) during 2007-2016. Methods: The population of this cross-sectional study consisted of all people with cutaneous leishmaniasis referring to the Center for Infectious Diseases in Larestan, Gerash, Evaz, and Khonj in the south of Fars Province during 2007-2016. The incidence of cutaneous leishmaniasis was analyzed using the Cochrane-Armitage trend test, and the significance level was considered 5%. Results: In general, 4602 cases of cutaneous leishmaniasis were reported from 2007 to 2016. The highest and lowest incidence rates (659.1 versus 88. 3 per 100000 people) were observed in 2008 and 2012, respectively. In addition, the incidence of the disease significantly reduced (P Trend=0.003). Finally, the 0-4 age group had the highest incidence of the disease (69.64 per 100000 people), and the hands were the most common organ affected by cutaneous leishmaniasis (37%). Conclusion: According to the research findings, the incidence rate of cutaneous leishmaniasis is declining although leishmaniasis is still one of the endemic diseases in the region. Therefore, preventive and controlling interventional programs can be effective in reducing new cases of the disease, including the education of individuals, especially children, environmental cleanup, and extermination and control of stray dogs and rodents in the suburbs.

Time Series Analysis of Cutaneous Leishmaniasis in Sabzevar Northeastern Iran Using Segmented Regression Model

Background and aims: Cutaneous leishmaniasis (CL) is one of the most important parasitic diseases in the world. Sabzevar city is endemic area for CL in the north east of Iran. The aim of this study was to evaluate the time distribution of cutaneous leishmaniasis (CL) in Sabzevar County using the segmented regression model. Methods: This ecological study used the existing data related to the rural districts of Sabzevar County that were obtained from the Health Deputy of this county during 2011-2017. In addition, the segmented regression model was applied to evaluate the time trend of CLs. Finally, Joinpoint software was used for time series analysis. Results: A total of 1912 CL cases occurred in Sabzevar County from 2011 to 2017, with an incidence rate of 93.61 per 100000. The highest and lowest observed incidence rates were in 2011 (25 per 10000 persons) and 2015 (3.24 per 10000 persons), respectively. Based on the results, the annual incidence of CL in the intended region decreased and the annual percent change was equal to -22.40. Further, the time series analysis using segmented regression by rural districts showed a change point in the trend of the incidence of leishmaniasis in three rural districts (Pain Joveyn and Joghatai in 2014 and Qasabeh-ye Sharqi in 2013). In other words, the trend was different before and after the change point in the mentioned districts. Conclusion: In general, the results indicated that interventional, preventive, and therapeutic measures for breaking the chain of CL transmission in Sabzevar have been desirable in recent years. Eventually, it is suggested that further time-series studies be conducted at the level of the month or a longer interval in order to better evaluate the period effect and secular trend.

Leishmaniasis Diagnosis via Metagenomic Next-Generation Sequencing.

Leishmaniasis is a vector-borne disease caused by Leishmania. Although the incidence of leishmaniasis in China is currently low, it has not been completely eradicated. In 2019, visceral leishmaniasis was diagnosed in three patients using bone marrow microscopic examination and metagenomic next-generation sequencing (mNGS). The bone marrow mNGS results from the three patients indicated that 99.9, 99.6, and 30.3% of non-human reads matched the Leishmania genome, and plasma mNGS results from one of the patients revealed that 46.2% of non-human reads matched the Leishmania genome. In the second patient's plasma, no Leishmania sequences were detected by plasma mNGS, and the third patient's plasma was unavailable. The pathogen in all three patients was identified as Leishmania infantum. Leishmania amastigotes were observed by microscopic examination of bone marrow smears in all three patients, but were not found in peripheral blood smears. This indicates that the sensitivity of mNGS is higher than that of smear microscopy and that mNGS can be used to identify Leishmania at the species level. All three patients were elderly male farmers, two from Shanxi and one from Beijing. All three patients had splenomegaly and pancytopenia. Originally, these patients were misdiagnosed and treated for extended periods in other hospitals. Diagnoses of visceral leishmaniasis took place 6, 2, and 2 months after the onset of symptoms in the three patients. In conclusion, this study confirms that bone marrow mNGS can be used to quickly and accurately confirm a diagnosis in patients with suspected leishmaniasis.

An investigation of the effects of environmental and ecologic factors on cutaneous leishmaniasis in the old world: a systematic review study.

Leishmaniasis is a neglected and widespread parasitic disease that can lead to serious health problems. The current review study aimed to synthesize the relationship between ecologic and environmental factors (e.g., weather conditions, climatology, temperature and topology) and the incidence of cutaneous leishmaniasis (CL) in the Old World. A systematic review was conducted based on English, and Persian articles published from 2015 to 2020 in PubMed/Medline, Science Direct, Web of Science and Google Scholar. Keywords used to search articles were leishmaniasis, environmental factors, weather condition, soil, temperature, land cover, ecologic* and topogr*. All articles were selected and assessed for eligibility according to the titles or abstracts. The quality screening process of articles was carried out by two independent authors. The selected articles were checked according to the inclusion and exclusion criteria. A total of 827 relevant records in 2015-2020 were searched and after evaluating the articles, 23 articles met the eligibility criteria; finally, 14 full-text articles were included in the systematic review. Two different categories of ecologic/environmental factors (weather conditions, temperature, rainfall/precipitation and humidity) and land characteristics (land cover, slope, elevation and altitude, earthquake and cattle sheds) were the most important factors associated with CL incidence. Temperature and rainfall play an important role in the seasonal cycle of CL as many CL cases occurred in arid and semiarid areas in the Old World. Moreover, given the findings of this study regarding the effect of weather conditions on CL, it can be concluded that designing an early warning system is necessary to predict the incidence of CL based on different weather conditions.

Leishmaniases of the New World from a historical and global perspective, from the 1930s to the 1960s

The first autochthonous cases of cutaneous and mucocutaneous leishmaniasis in the Americas were described in 1909, but visceral leishmaniasis only erupted as a public health problem in the region in 1934. Today Brazil is the country with the most cases of American tegumentary leishmaniasis, and alongside India has the highest incidence of visceral leishmaniasis. Knowledge production and efforts to control these diseases have mobilized health professionals, government agencies and institutions, international agencies, and rural and urban populations. My research addresses the exchange and cooperation networks they established, and uncertainties and controversial aspects when notable changes were made in the approach to the New World leishmaniases.

Effectiveness of insecticide-impregnated collars for the control of canine visceral leishmaniasis

Visceral leishmaniasis is a neglected tropical disease widely distributed worldwide. In Brazil, the control measures adopted in the last decades have not been able to prevent the spread of the disease. This study aimed to evaluate the effectiveness of a population-based intervention using 4% deltamethrin-impregnated dog collars on the incidence of canine visceral leishmaniasis.A community intervention study was carried out in two areas of the city of Montes Claros, State of Minas Gerais, Brazil. In the control area, the preventive measures recommended by the Brazilian Program for Surveillance and Control of Visceral Leishmaniasis were implemented (culling of infected dogs and vector control with residual insecticides). In the intervention area, deltamethrin-impregnated collars were fit to domiciled dogs, in addition to the above mentioned preventive measures. At the beginning of the study, a census survey was carried out among domiciled dogs to detect the prevalence of L. infantum infection. Dogs found seronegative at recruitment were longitudinally followed-up to evaluate the incidence of infection. Monitoring of canine infection (control and intervention areas) and replacement of collars (intervention area) occurred through sequential surveys at 12, 18, and 24 months after the initial survey. At each survey, dogs were tested, and the owner answered a questionnaire about the general characteristics of the animal. Multilevel logistic regression models were used to test the effect of collars on the risk of canine infection, with households considered as aggregation units. Associations were expressed as odds ratios (OR) and respective 95% confidence intervals (95%CI).The prevalence of infection in the initial survey was 9.7% and 9.9% in the intervention and control areas, respectively (p = 0.732). Among a total of 20,477 dogs participating in the study, 9,770 were seronegative at recruitment. The cumulative incidence of infection was 4.1% in the intervention area and 7.9% in the control area (p < 0.001). In the multivariable analysis, the risk of infection was 52% lower in the intervention area as compared to the control area (OR = 0.48, 95%CI:0.39-0.59), after adjusting for the number of dogs in the house, period of recruitment, time of dog ownership, and age, sex, length of fur and breed.The use of 4% deltamethrin-impregnated dog collars was effective in reducing the incidence of canine leishmaniasis. Cost-effectiveness studies are recommended before the incorporation of collars in the arsenal of control measures of the Brazilian Program for Surveillance and Control of Visceral Leishmaniasis.

Relationship Between the Distribution and Biodiversity of Sand Flies (Diptera: Psychodidae) With the Incidence of Zoonotic Cutaneous Leishmaniasis in Endemic Foci of Golestan Province, Iran.

Zoonotic cutaneous leishmaniasis (ZCL) is prevalent in Golestan Province, Iran. The current study determined the relationship between the distribution and biodiversity of sand flies with cutaneous leishmaniasis at 14 villages in plain and hillsides areas. In each village from July to September 2017, 60 sticky traps and 2 CDC light traps were laid. Spearman and Mann-Whitney tests were used to determine the relationship between the incidence of ZCL and the abundance of different species of sand flies. Simpson, Shannon-Wiener, Evenness, and Margalef indices were calculated to estimate the diversity of species. A total of 5,295 phlebotomine sand flies were collected, comprising 10 species of the genus Phlebotomus (3,947 flies) and 7 species of genus Sergentomyia (1,248 flies). The abundance of sand flies and incidence of ZCL in plain areas were greater than that of hillsides areas (P = 0.013, P = 0.002). There was a significant correlation between the incidence of ZCL and the abundance of Phlebotomus papatasi (r = 0.72, P = 0.004) and P. caucasicus groups (P = 0.006; 0.022). In the Shannon-Wiener index, the rest of the biodiversity indices were reduced in higher-altitude areas. Increasing Shannon-Wiener index showed higher diversity of sand flies in higher-altitude areas. Data of the reported cases of leishmaniasis in plain areas can reveal the relationship between less diversity index (Shannon-Wiener), higher dominant diversity index (Simpson), and incidence of leishmaniasis in these areas.

Thematic Maps of the Impact of Urbanization and Socioeconomic Factors on the Distribution of the Incidence of Cutaneous Leishmaniasis Cases in Sefrou Province, Central North of Morocco (2007-2011).

Background Leishmaniases are vector-borne diseases with health risks. They cause a big health problem. These parasitic diseases are transmitted by the parasite of the genus Leishmania through sandflies. Objective The aim of this work is to study the distribution of the incidence of cutaneous leishmaniasis (CL) cases and the impact of urbanization and socioeconomic factors and their effects as leishmaniasis risk factors. Methods We conducted a retrospective study of CL cases collected at the level of Sefrou Province during the period from 2007 to 2011. The data was collected from registers of the Medical Delegation of Sefrou Province. The socioeconomic data, namely, the poverty rate, the popular density, and the type of environment (urban/rural) of Sefrou Province, were obtained from the High Commission for Planning. Statistical analysis was performed by SPSS software (version 20). The data were registered in a Microsoft Excel 2010 file. Statistical analysis was based on one-way analysis of variance (ANOVA), and then a correlation study was carried out (Pearson correlation). The results were considered significant when p was less than 0.05. The database was analyzed by QGIS 2.18, which is open source software. Results A total of 349 cases of CL were collected at Sefrou Province from 2007 to 2011. A percentage of 49% of the cases come from urban areas, while 51% of the cases come from rural areas. In the statistical analysis, the division of the incidence of CL cases was found to be significantly associated only with urbanization. For the other factors, the number of people or the poverty rate is not taken into account in the incidence dynamics. Conclusion This study may be useful for the implementation of future adequate measures and controls. Getting rid of leishmaniasis requires a comprehensive approach by acting on the sources of contamination through good continuous surveillance, appropriate management, effective vector control, and awareness-raising strategies.

A Canine-Directed Chimeric Multi-Epitope Vaccine Induced Protective Immune Responses in BALB/c Mice Infected with Leishmania infantum.

Leishmaniases are complex vector-borne diseases caused by intracellular parasites of the genus Leishmania. The visceral form of the disease affects both humans and canids in tropical, subtropical, and Mediterranean regions. One health approach has suggested that controlling zoonotic visceral leishmaniasis (ZVL) could have an impact on the reduction of the human incidence of visceral leishmaniasis (VL). Despite the fact that a preventive vaccination could help with leishmaniasis elimination, effective vaccines that are able to elicit protective immune responses are currently lacking. In the present study, we designed a chimeric multi-epitope protein composed of multiple CD8+ and CD4+ T cell epitopes which were obtained from six highly immunogenic proteins previously identified by an immunoproteomics approach, and the N-termini of the heparin-binding hemagglutinin (HBHA) of Mycobacterium tuberculosis served as an adjuvant. A preclinical evaluation of the candidate vaccine in BALB/c mice showed that when it was given along with the adjuvant Addavax it was able to induce strong immune responses. Cellular responses were dominated by the presence of central and effector multifunctional CD4+ and CD8+ T memory cells. Importantly, the vaccination reduced the parasite burden in both short-term and long-term vaccinated mice challenged with Leishmania infantum. Protection was characterized by the continuing presence of IFN-γ+TNFα+-producing CD8+ and CD4+ T cells and increased NO levels. The depletion of CD8+ T cells in short-term vaccinated mice conferred a significant loss of protection in both target organs of the parasite, indicating a significant involvement of this population in the protection against L. infantum challenge. Thus, the overall data could be considered to be a proof-of-concept that the design of efficacious T cell vaccines with the help of reverse vaccinology approaches is possible.

Risk Factors Associated with Leishmaniasis in the Most Affected Provinces by Leishmania infantum in Morocco.

Background Human leishmaniasis, both visceral and cutaneous, has been reported in Morocco for centuries and constitutes a serious public health problem. However, the evolution of this pathology depends on several factors such as ecological, socioeconomic, and climatic conditions. The risk study of the affected foci is of great value for the control and surveillance of this endemic disease, especially in the provinces where Leishmania infantum predominates. Methods This study concerned nine provinces located in the extreme and central north of Morocco (Taounate, Taza, Chefchaouen, Al Hoceima, Larache, Tétouane, Tanger-Assilah, M'diq-Fnideq, and Fahs-Anjra Provinces). In this work, leishmaniasis cases (VL and CL) were subjected to an epidemiological study which was performed using a linear regression model to identify the impact as well as the interaction between all predictor variables on the distribution of leishmaniasis in this region. Results During the period 1997–2018, a total of 6 128 cases of VL and CL were recorded in the study area. Our results showed that among demographic factors studied, urbanization showed significance for both cutaneous and visceral forms (P < 0.05). Regarding the environmental factors, the humidity and the altitude were significant for both CL and VL (P < 0.05), while the temperature and the normalized difference vegetation index (NDVI) showed a significance only for VL. Moreover, trends in season of occurrence revealed that wet season (October to April) had a higher incidence of leishmaniasis compared to the dry season (May to September) specifically for CL. As for socioeconomic factors, poverty was the only factor that influences the spread of VL. Finally, the distance from endemic foci showed significance for both VL and LC (P < 0.05). Conclusion Our study revealed that the risk factor associated with cutaneous and visceral leishmaniasis in northern Morocco could help in the establishment of a prediction program.

Cutaneous Leishmaniasis due to Three Leishmania Species Among Syrian Refugees in Sanliurfa, Southeastern Turkey.

Sanliurfa, a city in southeastern Turkey, is host to 477,166 Syrian refugees. The incidence of cutaneous leishmaniasis (CL) may be on the rise in areas affected by a refugee crisis, like Sanliurfa; thus, consequently, local uncommon species of Leishmania may be encountered in these regions. This might potentially make diagnosis and treatment more challenging over time. In this study, it was aimed to identify the causative agents of CL in clinical samples. A total of 154 patients (60 Syrian and 94 Turkish) who were diagnosed with CL via microscopical examination and PCR were enrolled this study. All of the samples were analyzed using internal transcribedspacer 1 genes, restriction fragment length polymorphism, DNA-sequencing, and phylogenetic analyses. In this study, Leishmania tropica was determined to be the predominant species in 140 of the patients (90.9%), followed by Leishmania major in 12 patients (7.8%), and Leishmania infantum in 2 patients (1.3%). Of the 94 Turkish patients, 94.7% were infected with L. tropica and 5.3% were infected with L. major, while none were infected with L. infantum. However, of the 60 Syrian patients, 85% were infected with L. tropica, 11.7% were infected with L. major, and 3.3% were infected with L. infantum. There was a significant association between the Leishmania species and the nations (Turkish-Syrian) (P < 0.001). The sequences were numbered from MH347941 to MH347953 and submitted to GenBank. This study confirmed that L. tropica, L. major, and L. infantum coexisted in Sanliurfa. This was the first time that the species L. infantum was reported among recent immigrants from Syria in Sanliurfa. Therefore, it is necessary to discriminate the Leishmania species for diagnosis, treatment, and controlled studies in hyper-endemic regions.

Leishmaniasis due to Leishmania infantum: Integration of human, animal and environmental data through a One Health approach.

The aim of this study was to explore Leishmania infantum epidemiology through a One Health approach that promotes a better estimation of leishmaniasis burden and a deeper understanding of the spatial distribution of the key actors of the parasite life cycle (vectors, reservoirs and humans). We conducted a 14-year mixed retrospective and prospective study of leishmaniasis cases in an endemic area in southern Spain (Granada province), to estimate the human incidence and its association with the vector presence, cryptic leishmaniasis rates and canine leishmaniasis prevalence. We found an annual linear increase in the incidence that cannot be fully explained by active case surveillance and the improvement of PCR diagnostic techniques. 49.4% of cases were not reported to the surveillance system. Approximately half of the human cases correspond to the visceral form that occurred more frequently in men; cutaneous, mucosal and cryptic forms were also detected. Leishmaniasis is no longer a disease of young children, accounting for a quarter of immunocompetent patients and most infected people remained asymptomatic. Human and canine leishmaniasis, cryptic or symptomatic, are present in the whole province, where there is a medium/high risk of the presence of Phlebotomus perniciosus, the main vector. We found association between the incidence of human leishmaniasis and the presence of the vector, but not with the prevalence of canine leishmaniasis and cryptic human leishmaniasis. A potential hot spot was also found, where high leishmaniasis incidence may be associated to the involvement of host species other than dogs.

Trend of Cutaneous Leishmaniasis in Jordan From 2010 to 2016: Retrospective Study.

BackgroundCutaneous leishmaniasis (CL) is endemic in the Middle East, with countries such as Syria reporting high incidence rates.ObjectiveThis study aimed to assess the trends in the incidence of cutaneous leishmaniasis (CL) in Jordan from 2010 to 2016.MethodsThis retrospective study included all cases of CL that had been reported to the Leishmaniasis Surveillance System in the Department of Communicable Diseases at the Jordan Ministry of Health during the period from 2010 to 2016. A total of 1243 cases were reported and met the case definition.ResultsA total of 1243 cases (60.65% [754/1243] males and 39.34% [489/1243] females) were diagnosed during the study period. Of this sample, 233 patients (19.13%) were aged <5 years old, 451 (37.03%) were aged between 5-14 years old, 190 (15.60%) were aged between 15-24 years old, and 344 (28.24%) were aged ≥25 years old. Of those, 646 (51.97%) were Jordanians and 559 (44.97%) were Syrians. The average annual incidence rate of 1.70 per 100,000 people between 2010 and 2013 increased to 3.00 per 100,000 people in the years 2014 to 2016. There was no difference in incidence rates between Jordanians and Syrian refugees between 2010 and 2012. After 2012, the incidence rate increased significantly among Syrian refugees from 1.20 per 100,000 people in 2012 to 11.80 per 100,000 people in 2016. On the contrary, the incidence rate did not change significantly among Jordanians.ConclusionsThe incidence rate of leishmaniasis in Jordan has increased in the last three years because of the influx of Syrian refugees into Jordan. A massive effort toward reservoir and vector control, along with actively pursuing diagnosis in endemic foci, will be helpful. Proper and studious reporting of cases is also a necessity for the eradication of this disease.