Ait Kbaich Mouad, Mhaidi Idriss, Ezzahidi Abdelkacem, Dersi Nouredine, El Hamouchi Adil, Riyad Myriam, Akarid Khadija, Lemrani Meryem
Laboratory of Parasitology and Vector-Borne-Diseases, Institut Pasteur du Maroc, Casablanca, Morocco; Molecular Genetics and Immunophysiopathology Research Team, Health and Environment Laboratory, Hassan II University of Casablanca, Aïn Chock Faculty of Sciences, Morocco.
Ministry of Health's Delegation of Ouarzazate Province, Ouarzazate, Morocco.
Acta Trop. 2017 Sep;173:11-16. doi: 10.1016/j.actatropica.2017.05.016. Epub 2017 May 17.
Three Leishmania species are responsible of cutaneous leishmaniasis (CL) in Morocco. Zoonotic CL due to Leishmania major and Leishmania infantum, the first is known as established in the eastern arid regions, whereas the latter evolves sporadically, especially in the North. While Leishmania tropica, classically considered anthroponotic, is endemic in the semi-arid regions and is largely distributed throughout the country. The aim of this study was to identify the Leishmania species causing CL in two Provinces in arid pre-Saharan region known as zoonotic CL foci, and to contribute an update to the national data concerning the distribution of Leishmania species in both regions. The recruitment of patients was done in six localities in Ouarzazate and Zagoura provinces in 2015 and 2016. Out of 81 samples collected, 66 were positive (81%) by ITS1-PCR amplification of Leishmania DNA extracted from stained smears. The highest rate of Leishmania infection was registered in children aged 9 years or less (71,2%). The ITS1-PCR- RFLP analysis revealed the predominance of L. major infecting 52 patients (79%), followed by L. tropica in 12 patients (18%) and L. infantum in 2 patients who had no history of travel outside the studied area (3%). The sequencing of the ITS1 of both L. infantum, showed 100% similarities with L. infantum strains isolated from dogs and visceral leishmaniasis patients from the south and north of Morocco. The coexistence of the 3 Leishmania species in the same focus, and the difficult distinction of infections associated to the different Leishmania species based only on clinical lesions' aspects complicate the diagnosis and then the national control strategy, as well as the therapeutic management. The epidemiological pattern of CL in the studied areas appears to have changed during the last decades, from a predominant zoonotic CL caused by L. major to a polymorphic disease that can be due to any of the 3 Leishmania species. The expansion of L. infantum and L. tropica in southern parts of Morocco, calls for in depth epidemiological investigations for a better understanding of the CL situations in Southern parts of the country and for an assessment of the climate impact and environment changes on the leishmaniasis transmission system.
在摩洛哥，三种利什曼原虫可引发皮肤利什曼病（CL）。由硕大利什曼原虫和婴儿利什曼原虫引起的人兽共患型CL，前者在东部干旱地区有记录，而后者呈散发性，尤其在北部地区。热带利什曼原虫传统上被认为是 Anthroponotic，在半干旱地区为地方病，且在全国广泛分布。本研究旨在确定在撒哈拉沙漠前干旱地区的两个省份中导致CL的利什曼原虫种类，这些地区是人兽共患型CL疫源地，并更新这两个地区利什曼原虫种类分布的国家数据。2015年和2016年在瓦尔扎扎特省和扎古拉省的六个地点招募患者。在收集的81份样本中，通过对从染色涂片提取的利什曼原虫DNA进行ITS1-PCR扩增，66份呈阳性（81%）。利什曼原虫感染率最高的是9岁及以下儿童（71.2%）。ITS1-PCR-RFLP分析显示，硕大利什曼原虫占主导，感染52例患者（79%），其次是热带利什曼原虫感染12例患者（18%），婴儿利什曼原虫感染2例在研究区域外无旅行史的患者（3%）。对两例婴儿利什曼原虫的ITS1进行测序，结果显示与从摩洛哥南部和北部的狗及内脏利什曼病患者分离出的婴儿利什曼原虫菌株有100%的相似性。三种利什曼原虫在同一疫源地共存，且仅基于临床病变特征难以区分不同利什曼原虫引起的感染，这使得诊断以及国家防控策略和治疗管理变得复杂。在过去几十年中，研究区域CL的流行病学模式似乎已发生变化，从主要由硕大利什曼原虫引起的人兽共患型CL转变为可能由三种利什曼原虫中的任何一种引起的多态性疾病。婴儿利什曼原虫和热带利什曼原虫在摩洛哥南部的扩散，需要进行深入的流行病学调查，以更好地了解该国南部的CL情况，并评估气候影响和环境变化对利什曼病传播系统的作用。
