Amro Ahmad, Al-Dwibe Hamida, Gashout Aisha, Moskalenko Olga, Galafin Marlena, Hamarsheh Omar, Frohme Marcus, Jaeschke Anja, Schönian Gabriele, Kuhls Katrin
Faculty of Pharmacy, Al-Quds University, Abu-Dies, Jerusalem, Palestine.
Faculty of Medicine, Dermatology Department, University of Tripoli, Tripoli, Libya.
PLoS Negl Trop Dis. 2017 Sep 7;11(9):e0005873. doi: 10.1371/journal.pntd.0005873. eCollection 2017 Sep.
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.
Future projection of CL until 2060 showed a trend of increasing incidence of CL in the north-western 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.
皮肤利什曼病（CL）是利比亚的一个主要公共卫生问题。在本文中，我们描述了2011年1月至2012年12月武装冲突期间CL的生态流行病学参数。采用相关建模方法探索了CL病例的当前时空分布并预测其未来趋势。此外，还将目前的结果与我们之前在1995 - 2008年期间获得的数据进行了比较。
方法/主要发现：我们调查了312例到的黎波里中心医院皮肤科就诊的CL患者，他们来自分布在10个区的81个流行地区。患者表现为典型的局限性皮损，常见于面部、手臂和腿部。通过针对rDNA的ITS1区域的PCR - RFLP方法对寄生虫进行分子鉴定，81例患者鉴定成功，确定了两种致病物种：硕大利什曼原虫（L. major）和热带利什曼原虫（L. tropica），分别占59例（72.8%）和22例（27.2%）。约77.3%的热带利什曼原虫所致CL和57.7%的硕大利什曼原虫所致CL引起单个皮损。我们的数据集中有5例CL患者HIV血清学呈阳性。热带利什曼原虫主要发现于三个区，穆尔库卜（27.3%）、贾巴尔·加卜里（27.3%）和米苏拉塔（13.7%），而硕大利什曼原虫发现于两个区，贾巴尔·加卜里（61%）和贾法拉（20.3%）。CL病例的季节性发生情况表明，大多数病例（74.2%）于11月至3月入院，硕大利什曼原虫病例于11月至1月（69.4%），热带利什曼原虫病例主要在1月和2月（41%）。确定了这两种物种的两个危险因素；家中有先前感染的家庭成员，以及患者邻里中有啮齿动物和白蛉。基于当前病例数据和气候条件使用相关分布模型进行的时空预测表明，沿海地区由于传播媒介的条件更有利而风险水平更高。
对CL到2060年的未来预测显示，利比亚西北部CL发病率呈上升趋势，沿海地区有蔓延趋势，利比亚东北部地区可能出现新的流行区。在制定控制计划时应考虑这些结果，以防止新流行区的出现，同时也要考虑社会经济因素的变化，如移民、冲突、城市化、土地利用和获得医疗保健的情况。
