Asian Pac J Trop Dis 2014; 4(Suppl 2): S530-S534 S530 Contents lists available at ScienceDirect Asian Pacific Journal of Tropical Disease journal homepage: www.elsevier.com/locate/apjtd Document heading doi: 10.1016/S2222-1808(14)60671-X 2014 by the Asian Pacific Journal of Tropical Disease. All rights reserved. 襃 Leishmaniasis in Morocco: diseases and vectors 1* 1,2 3 1 4 1* Kholoud Kahime , Samia Boussaa , Lahouari Bounoua , Ouanaimi Fouad , Mohammed Messouli , Ali Boumezzough 1Laboratory of Ecology and Environment, (URAC 32, CNRST; ERACNERS 06), Faculty of Sciences Semlalia, Cadi Ayyad University, Marrakesh, Morocco 2Institut Supérieur des Professions Infirmières et des Techniques de Santé, Marrakesh, Morocco 3Biospheric Sciences Laboratory, NASA’s Goddard Space Flight Center, Maryland, USA 4Laboratory of Hydrobiology, Ecotoxicology and Sanitation, Faculty of Sciences Semlalia, Cadi Ayyad University, Marrakesh, Morocco ARTICLE INFO ABSTRACT Article history: Leishmaniasis, a highly neglected disease, currently presents a significant health problem Received 23 Apr 2014 throughout Africa. This review presents a summarized analysis of its epidemiology in Moroccan Received in revised form 28 Jul 2014 context, a Mediterranean location in which leishmaniasis is prevalent and where both cutaneous Accepted 2 Aug 2014 and visceral leishmaniasis have been reported. Available online 15 Aug 2014 This study aims to determine the current leishmaniasis epidemiological situation in Morocco and the distribution of its different forms throughout the country. During the past 20 years, this disease Keywords: has emerged as a major public health threat in Morocco. So, we gave a particular attention to vectorial status of Moroccan sandflies (Diptera: Psychodidae, Phlebotominae) in view of its major L eishmaniasis role in diseases spreading. E pidemiology It seems clear that the risk of spread of the disease is rising in Morocco. Ecological characteristic V ector of proven and potential vectors, according to climate and environmental changes, should be S andfly regarded as good marker to anticipate leishmaniasis distribution in Morocco. Morocco 1. Introduction Phlebotomus papatasi P. papatasi I M ( ) n Phlebotomusorocco, the sergenti P. sergenti ( ) and L. major are L.th tropicae most I M n orocco, leishmaniases are endemic diseases posing a common vectorPhlebotomuss for the spre ariasiad of P. ariasi anPhlebotomusd , I 2011 M M [3] ( ) major threat to public health. n , oroccan inistry of perniciosusrespectively P.. perniciosus , Phlebotomus H 4 319 (CL) ( ) ealth reported cases of cutaneous leishmaniasis longicuspis P. longicuspis , and potentially 107 (VL)[1] ( ) and cases of visceral leishmaniasis . Leishmania L. infantum are reported to be the vectors of CL M [3] P is cLeishmaniaaused by th majorree cl inL.ic majorally impLeishmaniaortant tropica in editerranean countries . revious studies ( ) M sL.pe ctropicaies [ Leishmania infantum, L. infantum in orocco showed that the distribution of sandflies was ( ), and ( )], a due, in great part, to the bioclimate[4]. T I M flagellate protozoL.a infantumof the family rypanosomitidae, while, n orocco, both zoonotic and anthroponotic forms were VL is caused by . Recently, the mucocutaneous reported. The main reservoirs are dogs for zoonotic VL (ZVL), form was also reported in Morocco, but remains rare[2]. rodents for zoonotic CL (ZCL) and human for anthroponotic Leishmania infection is transmitted to human host as CL (ACL). (D a result of a bite by an infected female sanPhlebotomusdfly iptera: ) Psychodidae, Phlebotominae of the genus . 2. Epidemiology C K K A B L E * orresponding author: holéoud ahime and li oumezzoughé, aboratoire cologie Due to its geographical position, Morocco possesses and Environnement L2E, Facult des Sciences Semlalia, Universit Cadi Ayyad, BP 2390, Marrakech 40000, Morocco. different ecological and climatic conditions, which are Tel: +212 (0) 662 130 564 important factors in the repartition and epidemiology E-mail: [email protected], [email protected] Foundation Project: Supported by Laboratory of Ecology and Environment (CNRST, of endemic neglected diseases such as leishmaniasis. URAC 32; ERA-CNERS 06) and the National Centre for Studies and Research on the According to Moroccan Ministry of Health, CL caused S CNERS P (C N 06 ERACNERS) L. major ahara, roject ontract . / . by is the most dominant form (Figure 1), with Kholoud Kahime et al./Asian Pac J Trop Dis 2014; 4(Suppl 2): S530-S534 S531 24 000 [1] more than cases reported duL.ri nmajorg the last decade . dichotomy between visceral and cutaneous leishmaniasiL.s, E (F 2) A pidemiological data show that dominated in rinfantumespectively L. itropicagure . n overlap of foci, including 1990 2000 the s,L. h otropicawever startL.in ginfantum in , the apparition and and bL.eg ainfantumn then to emerge. (F C VL growth of L. major and L. tropica is noticeable igure urrently, due to is distributed mainly 1). Including and , the highest CL cases in Northern Morocco Rif and pre-Rif region (Figure 2A), 2000 2010 W VL were noted between and . hile cases remains geographically separated from other areas by mL.o utropicantains comparatively stable (Figure 1). which constitute a natural barrier[12]. The ACL has the widest geographic distribution with large foci in thL.e 6 C W M (F 2B) ZCL majorentral and estern orocco igure , while, the A 0 tlas is dispersed in the south and south-east of the 0 0 5 伊 ( ) 1 Mountain Figure 2C where the disease is located in the [10] s S e 4 steppe fringes of the ahara desert . s a c H owever, for the extreme south, there are no available f et al. o 3 r epidemiological data. Rioux have led an entomological e b W S m survey carried out in the littoral zone of the estern aharan u 2 N region of Morocco, namely in Tan-Tan, Tarfaya, Layoun, B D [13] T 1 oujdour and akhla . he authors noted the scarcit’y of vector species and absence of leishmaniasis cases. It s 0 necessary to update theses entomological data and assess 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 the current status of human leishmaniasis in the entire L.tropica L.infantum L.major S M Figure 1. L. major L. tropica L. extreme outhern orocco. Evolution of cutaneous ( + ) and visceral ( infantum ) leishmaniasis cases between 1990-2010 in Morocco. 3. ZCL According to the same source, all ages are affected by the different forms of disease, with a high incidence for youth. In the pre-Saharan area, ZCL has been identified since S VL [5] 1914[11] O T CL imilar to thL.e tropica case , young childL.re majorn are at high risk for , in the palm grove of ued ata where a major both CL by [6,7] and CL by [8]. In the same epidemic manifested during the late 1970s. Currently, foci of way, leishmaniasis affects both genders almost equally ZCL are basically linked to palm groves, rural and periurban [7,8] T with a slight increase in women . he large Leishmanianumbers of areas with degraded environmental and socio-economic women and children infected, indicates that conditions like poor housing and hygiene[8]. It is widespread transmission may have occurred in the peridomiciliar from the Atlantic coast, south of the Anti-Atlas mountains habitat[6]. to the north-east, crossing Saharan areas south of the Anti- T A H A M A here is evidence that changes in climate contribute to tlas and igh tlas mounL.ta imajorns, and east of the iddle tlas [14] C some extent to the incidence and expansion of the range of mountaP.in spapatasi. aused byMeriones shawi, this grandisform is transmitted the CL[9,10], but the absence of leishmaniasis epidemiological by the , with as the main information collection system pre-1993 did not allow reservoir host[10]. All strains isolated from the host, human to accurately describe the epidemiological situation in and vector are iL.de nmajortical and are identified biochemically Morocco[11] or to establish correlations between dynamics of as being due to MON-25[15]. The same results were the disease and global changes. found on skin smears in 2007, in the provinces of Ouarzazate S 1993 E [16] ince , various studies of leishmaniasis foci together andP. papatasirrachidia . with the national incidence statistics confirmed the change was reported in Morocco as early as 1916[17]. in geographical distribution of leishmaniasis in Morocco, This species is very common and has a significant ecological marked by the disappearance of the traditional North-South plasticity. It can be found in various biotopes, including Tetouan N Tetouan N T ador Taownate ador Larache aounale Berkane Taza Berkane C Taza Ouazane F hefchaouen Fes es Guerclf J Sale Guercif Settat erada Boulemane Boulem ane B M A ElkelaaBeni Mellai Midelt eni ellal zilal Chichoua M Tinghir Azilal Errachidia Figuig arr akech Alh aouz Essaouira T Aihaouz inghir Tinghir Essaouira Zagora Taroudannt Quarzazate Inzgane Zagora Tiznit Chtouka ait baha Tata Guelmim Number of VL cases Number of ZCL cases Number of ACL cases 1-6 16-146 1-42 146 295 6-17 42-199 - 199-447 295-587 C A B Figure 2. L. infantum L. tropica L. major Geographical distribution of VL due to (A), ACL cases due to (B) and ZCL cases due to (C) in Morocco (cases recorded in 2011). Kholoud Kahime et al./Asian Pac J Trop Dis 2014; 4(Suppl 2): S530-S534 S532 [17,18] E T [34] W N hou-ses, animal sheds and caves , and is most frequent at ssaouira and aza . hen its populations from orthern 400 800 [19] S M P. papatasi m above sea level . and oP.u tsergentihern orocco were investigated by isoenzymatic is well adapted to arid climate and its density tools, did not present genetic characteristics of a increases with the aridity[10].