Spatiotemporal and molecular epidemiology of cutaneous leishmaniasis in Libya
Date
2017-09-07
Authors
Amro, Ahmad
Al-Dwibe, Hamida
Gashout, Aisha
Moskalenko, Olga
Galafin, Marlena
Hamarsheh, Omar
Frohme, Marcus
Jaeschke, Anja
Kuhls, Katrin
Schoenian, Gabriele
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Abstract
Background
Cutaneous leishmaniasis (CL) is a major public health problem in Libya. In this paper, we
describe the eco-epidemiological parameters of CL during the armed conflict period from
January 2011 till December 2012. Current spatiotemporal distributions of CL cases were
explored and projected to the future using a correlative modelling approach. In addition the
present results were compared with our previous data obtained for the time period 1995±
2008.
Methodology/Principal findings
We investigated 312 CL patients who presented to the Dermatology Department at the Tripoli
Central Hospital and came from 81 endemic areas distributed in 10 districts. The patients
presented with typical localized lesions which appeared commonly on the face, arms and
legs. Molecular identification of parasites by a PCR-RFLP approach targeting the ITS1
region of the rDNA was successful for 81 patients with two causative species identified:
L. major and L. tropica comprised 59 (72.8%) and 22 (27.2%) cases, respectively. Around
77.3% of L. tropica CL and 57.7% of L. major CL caused single lesions. Five CL patients
among our data set were seropositive for HIV. L. tropica was found mainly in three districts,
Murqub (27.3%), Jabal al Gharbi (27.3%) and Misrata (13.7%) while L. major was found in
two districts, in Jabal al Gharbi (61%) and Jafara (20.3%). Seasonal occurrence of CL cases
showed that most cases (74.2%) admitted to the hospital between November and March,
L. major cases from November till January (69.4%), and L. tropica cases mainly in January
and February (41%). Two risk factors were identified for the two species; the presence of
previously infected household members, and the presence of rodents and sandflies in
patient's neighborhoods. Spatiotemporal projections using correlative distribution models
based on current case data and climatic conditions showed that coastal regions have a
higher level of risk due to more favourable conditions for the transmitting vectors.
Conclusion
Future projection of CL until 2060 showed a trend of increasing incidence of CL in the northwestern
part of Libya, a spread along the coastal region and a possible emergence of new
endemics in the north-eastern districts of Libya. These results should be considered for control
programs to prevent the emergence of new endemic areas taking also into consideration
changes in socio-economical factors such as migration, conflicts, urbanization, land use
and access to health care.
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Citation
Amro A, Al-Dwibe H, Gashout A, Moskalenko O, Galafin M, Hamarsheh O, et al. (2017) Spatiotemporal and molecular epidemiology of cutaneous leishmaniasis in Libya. PLoS Negl Trop Dis 11(9): e0005873.