First report of natural infection in hedgehogs with Leishmania major, a possible reservoir of zoonotic cutaneous leishmaniasis in Algeria

An overview of fleas (Siphonaptera) in wild and domestic mammals from Algeria with new data from the central north and south of the country

Fleas (Siphonaptera) are medically and veterinary important ectoparasites known to infest a wide range of host species. This study presents a systematic review complemented by new data on the diversity of flea species and host associations in Algeria. 198 mammals were examined, including previously understudied hosts such as sheep, red foxes, fennec foxes, and golden African wolves. Of these animals, 108 (54.55%) were infested with fleas. Overall, 1.906 fleas belonging to seven species (Archaeopsylla erinacei s.l., Ctenocephalides felis, C. canis, Nosopsyllus fasciatus, Pariodontis riggenbachi, Pulex irritans, Xenopsylla cheopis) were identified, originating from seven provinces across Algeria. Statistical analysis techniques were employed to process the data, including descriptive statistics, statistical tests, and principal component analysis (PCA). This study reveals the diverse flea fauna in Algeria and their association with various host species, including wild and domestic animals. This comprehensive survey aimed to combine literature reviews, fieldwork, and statistical analysis to understand fleas' diversity and host associations. The findings contribute to the growing knowledge of flea ecology and host-parasite interactions, with implications for public health and veterinary practices in Algeria and potentially other regions with similar ecological characteristics.

Occurrence of Leishmania infantum in Wild Mammals Admitted to Recovery Centers in Spain

Zoonotic leishmaniasis caused by Leishmania infantum is distributed worldwide and affects humans and domestic and wild mammals. In Europe, specifically in the Mediterranean basin, leishmaniasis is endemic due to the concurrence of the phlebotomine vectors and reservoir mammals, including carnivorous wildlife species and other less studied wild species. In this article, spleen, skin, and eye or oral swabs taken from 134 wild mammals admitted to five wildlife recovery centers in Spain were used. PCR employing fragments of the Repeat region, ITS1, and SSUrRNA were used for detection, and positive samples were processed for sequencing. L. infantum was detected in three out of the nine species analyzed, including European hedgehog, European badger, and red squirrel, with percentages ranging from 11.53 to 35.71%, depending on the species. Most of the species showed higher percentages of positivity in spleen samples than in skin samples. A small number of animals from the remaining six species tested negative, including Algerian hedgehog, stone marten, least weasel, garden dormouse, western polecat, and Egyptian mongoose. Hedgehogs and badgers are good candidates for consideration as epidemiological sentinels and pose a higher risk as potential reservoirs of leishmaniasis based on their percentage of infection and wide distribution.

Host competence of Algerian Gerbillus amoenus for Leishmania major

Cutaneous leishmaniasis (CL) is the most important neglected disease reported in North Africa, Algeria ranks second in the world with more than 5000 cases per year. In Algeria, two rodent species Psammomys obesus and Meriones shawi, are so far known as proven reservoirs of Leishmania major, however, they are absent in several endemic localities. In this study, we experimentally infected Gerbillus rodents trapped around human dwellings in Illizi, Algeria to assess their susceptibility to L. major. Seven gerbils, morphologically and molecularly identified as Gerbillus amoenus, were intradermally inoculated with 10⁴ parasites derived from culture, monitored for six months and their infectiousness for sand flies was tested by xenodiagnosis. The study revealed that G. amoenus was susceptible to L. major and was able to maintain and transmit the parasites to sand flies tested six months after infection, suggesting the role of this gerbil as a potential reservoir for L. major.

Microorganisms associated with hedgehog arthropods

Hedgehogs are small synanthropic mammals that live in rural areas as well as in urban and suburban areas. They can be reservoirs of several microorganisms, including certain pathogenic agents that cause human and animal public health issues. Hedgehogs are often parasitized by blood-sucking arthropods, mainly hard ticks and fleas, which in turn can also carry various vector-born microorganisms of zoonotic importance. Many biotic factors, such as urbanization and agricultural mechanization, have resulted in the destruction of the hedgehog's natural habitats, leading these animals to take refuge near human dwellings, seeking food and shelter in parks and gardens and exposing humans to zoonotic agents that can be transmitted either directly by them or indirectly by their ectoparasites. In this review, we focus on the microorganisms detected in arthropods sampled from hedgehogs worldwide. Several microorganisms have been reported in ticks collected from these animals, including various Borrelia spp., Anaplasma spp., Ehrlichia spp., and Rickettsia spp. species as well as Coxiella burnetii and Leptospira spp. As for fleas, C. burnetii, Rickettsia spp., Wolbachia spp., Mycobacterium spp. and various Bartonella species have been reported. The detection of these microorganisms in arthropods does not necessarily mean that they can be transmitted to humans and animals. While the vector capacity and competence of fleas and ticks for some of these microorganisms has been proven, in other cases the microorganisms may have simply been ingested with blood taken from an infected host. Further investigations are needed to clarify this issue. As hedgehogs are protected animals, handling them is highly regulated, making it difficult to conduct epidemiological studies on them. Their ectoparasites represent a very interesting source of information on microorganisms circulating in populations of these animals, especially vector-born ones.

First epidemiological survey of Leishmania infantum in the domestic ferret (Mustela putorius furo) in a canine leishmaniosis endemic area using serology and PCR

Background

Leishmaniosis, a vector-borne disease caused by Leishmania infantum, is one of the most important parasitic zoonoses in Europe. The transmission cycle of leishmaniosis is maintained by both domestic and wild animals. However, few data are available on the role of wild mammals in transmitting the parasite in the European Mediterranean basin. As feline leishmaniosis, diagnosis of the infection in ferrets can be a challenge, the use of different serological and molecular methods combined is a recommended approach. Our aim was to investigate the prevalence of infection of L. infantum in apparently healthy domestic ferrets (Mustela putorius furo) in an endemic region of Spain (Community of Valencia), using serological and molecular methods and to evaluate the results comparing the different techniques.

Methods

The prevalence of Leishmania infection was studied in domestic ferrets. Blood was collected from each animal for serology and molecular analysis. Two serological methods, enzyme-linked immunosorbent assay (ELISA) and western blot (WB), were used for the detection of L. infantum antibodies, and real-time polymerase chain reaction (qPCR) was used for the detection of L. infantum DNA.

Results

Blood samples from 102 apparently healthy ferrets were analyzed. In the serological study, 25.5% of the animals tested positive by western blot, and 9.0% by enzyme-linked immunosorbent assays. The seroprevalence of L. infantum infection, based on a positive result in any serological test, was 28.4% (95% confidence interval [CI] 20.6–S37.9%). No kinetoplast DNA (kDNA) was detected by qPCR in peripheral blood samples from the ferrets tested.

Conclusions

The immunological response revealed by these tests indicates that the ferrets are exposed to repeated inoculations with the endemic parasite L. infantum. Although the low population of domestic ferrets means their reservoir potential is limited in the absence of a primary host, it would be of interest to carry out further studies using xenodiagnosis to determine whether they are accidental or reservoir host species capable of spreading infection.

Graphical Abstract

Supplementary Information

The online version contains supplementary material available at 10.1186/s13071-022-05517-y.

Geographic distribution of Meriones shawi and Psammomys obesus, the main reservoirs and Phlebotomus papatasi vector of zoonotic cutaneous leishmaniasis in Middle East and North Africa

Rodents play a significant role in the balance of a terrestrial ecosystem; they are considered prey for many predators like owls and snakes. However, they present a high risk to agriculture (damaging crops) and health. These rodents are the main reservoirs of some vector-borne diseases like leishmaniasis. Meriones shawi (MS) and Psammomys obesus (PO) are the primary Zoonotic cutaneous leishmaniasis (ZCL) reservoirs in the Middle East and North Africa (MENA). A review on the MS and PO at the MENA scale was explored. A database of about 1500 papers was used. 38 sites were investigated as foci for MS and 36 sites for PO, and 83 sites of Phlebotomus papatasi (Pp) in the studied region. An updated map at the regional scale and the trend of the reservoir distribution was carried out using a performing proper density analysis. In this paper, climatic conditions and habitat characteristics of these two reservoirs were reviewed. The association of rodent density with some climatic variables is another aspect explored in a case study from Tunisia in the period 2009–2015 using Pearson correlation. Lastly, the protection and control measures of the reservoir were analyzed. The high concentration of the MS, PO, and Pp can be used as an indicator to identify the high-risk area of leishmaniasis infection.

High-resolution melting analysis identifies reservoir hosts of zoonotic Leishmania parasites in Tunisia

BACKGROUND

Leishmaniasis is endemic in Tunisia and presents with different clinical forms, caused by the species Leishmania infantum, Leishmania major, and Leishmania tropica. The life cycle of Leishmania is complex and involves several phlebotomine sand fly vectors and mammalian reservoir hosts. The aim of this work is the development and evaluation of a high-resolution melting PCR (PCR-HRM) tool to detect and identify Leishmania parasites in wild and domestic hosts, constituting confirmed (dogs and Meriones rodents) or potential (hedgehogs) reservoirs in Tunisia.

METHODS

Using in vitro-cultured Leishmania isolates, PCR-HRM reactions were developed targeting the 7SL RNA and HSP70 genes. Animals were captured or sampled in El Kef Governorate, North West Tunisia. DNA was extracted from the liver, spleen, kidney, and heart from hedgehogs (Atelerix algirus) (n = 3) and rodents (Meriones shawi) (n = 7) and from whole blood of dogs (n = 12) that did not present any symptoms of canine leishmaniasis. In total, 52 DNA samples were processed by PCR-HRM using both pairs of primers.

RESULTS

The results showed melting curves enabling discrimination of the three Leishmania species present in Tunisia, and were further confirmed by Sanger sequencing. Application of PCR-HRM assays on reservoir host samples showed that overall among the examined samples, 45 were positive, while seven were negative, with no Leishmania infection. Meriones shawi were found infected with L. major, while dogs were infected with L. infantum. However, co-infections with L. major/L. infantum species were detected in four Meriones specimens and in all tested hedgehogs. In addition, multiple infections with the three Leishmania species were found in one hedgehog specimen. Sequence analyses of PCR-HRM products corroborated the Leishmania species found in analyzed samples.

CONCLUSIONS

The results of PCR-HRM assays applied to field specimens further support the possibility of hedgehogs as reservoir hosts of Leishmania. In addition, we showed their usefulness in the diagnosis of canine leishmaniasis, specifically in asymptomatic dogs, which will ensure a better evaluation of infection extent, thus improving elaboration of control programs. This PCR-HRM method is a robust and reliable tool for molecular detection and identification of Leishmania and can be easily implemented in epidemiological surveys in endemic regions.

Epidemiological situation analysis of cutaneous leishmaniasis in Batna (northeast): An important focus in Algeria

Cutaneous leishmaniasis (CL) is a parasitic infection which poses a real public health problem in various countries, including Algeria. We aimed in this study to investigate the current epidemiological situation of CL in the wilaya of Batna (northeastern Algeria) during 2010-2020 and to discuss some control measures used to combat the disease in the most endemic foci. Data on CL cases and control measures were obtained from the "Direction de la Santé et de la Population (DSP) of Batna" and the "Etablissement Public de la Santé de Proximité (EPSP) of Barika". Data were analyzed and mapped using Microsoft Office Excel 2007, SPSS.21, and ArcGIS 10.3. A total of 9259 cases were notified, with a peak incidence of 1924 cases in 2010. The annual evolution of the disease showed decreasing and increasing trends during the study period. Cases were detected year-round, with a peak notification in November (1957 cases) and January (1663 cases). CL affects both genders and all age groups with predominance for males (58.6%) and infants less than 9 years old (54.4%). Most cases have occurred in western areas of the wilaya especially in the commune of Barika with 2979 cases (32.17%), followed by Abdelkader Azil (13.37%), Bitam (12.32%), Djezzar (8.67%), Ouled Ammar (7.07%), and Amdoukal (4.36%) communes. Spatiotemporal analysis showed that the highest frequencies of CL were exclusively reported in the western regions. There was no evidence of a possible relationship between Deltamethrin house spraying and leishmaniasis incidence. This study revealed that CL is highly endemic in the western areas of Batna, especially in Barika, with children less than 9 years old as the most age group at risk. The development of control measures and the selection of appropriate strategies are necessary to prevent, control, and eradicate the disease.

Microorganisms associated with the North African hedgehog Atelerix algirus and its parasitizing arthropods in Algeria

Hedgehogs are small mammals. They are potential reservoirs of various zoonotic agents. This study was conducted in Bouira, a north-central region of Algeria. A total of 21 Atelerix algirus corpses were picked up on roadsides and gardens. Hedgehog kidneys, spleens and ectoparasites were collected. Twelve hedgehogs were infested with ectoparasites, including Archaeopsylla erinacei, Rhipicephalus sanguineus s.l. and Haemaphysalis erinacei. Hedgehog organs and randomly selected arthropods were screened for microorganisms using molecular methods. Coxiella burnetii was detected in kidneys, spleens, A. erinacei, Hae. erinacei and Rh. sanguineus s.l. Leptospira interrogans was detected in kidneys. Rickettsia felis and Rickettsia massiliae were detected respectively in A. erinacei and in Rh. sanguineus s.l. DNA of an uncultivated Rickettsia spp. was found in Hae. erinacei. Wolbachia spp. DNA was detected in fleas. The DNA of potential new Bartonella and Ehrlichia species were found respectively in fleas and ticks. This study highlights the presence of DNA from a broad range of microorganisms in hedgehogs and their ectoparasites that may be responsible for zoonoses in Algeria.

Atelerix algirus, the North African Hedgehog: Suitable Wild Host for Infected Ticks and Fleas and Reservoir of Vector-Borne Pathogens in Tunisia

Small wild mammals are an important element in the emergence and transmission of vector-borne pathogens (VBPs). Among these species, hedgehogs have been found to be a reservoir of VBPs and host of arthropod vectors. Surveillance of VBPs in wildlife and their arthropods are crucial in a one health context. We conducted an exploratory study to screen Atelerix algirus hedgehogs and their infesting ticks and fleas for VBPs using a high throughput microfluidic real-time PCR system. Tested biopsies from hedgehogs were found to be naturally infected by Theileria youngi, Hepatozoon sp., Ehrlichia ewingii, Coxiella burnetii, and Candidatus Ehrlichia shimanensis. Similarly, Haemaphysalis erinacei and Rhipicephalus sanguineus tick species were infected by Ehrlichia ewingii, Rickettsia spp., Rickettsia massiliae, Borrelia sp., Coxiella burnetii, Rickettsia lusitaniae and Anaplasma sp. Archaeopsylla erinacei fleas were infected by Rickettsia asembonensis, Coxiella burnetii, and Rickettsia massiliae. Co-infections by two and three pathogens were detected in hedgehogs and infesting ticks and fleas. The microfluidic real-time PCR system enabled us not only to detect new and unexpected pathogens, but also to identify co-infections in hedgehogs, ticks, and fleas. We suggest that hedgehogs may play a reservoir role for VBPs in Tunisia and contribute to maintaining enzootic pathogen cycles via arthropod vectors.

A Systematic Review (1990-2021) of Wild Animals Infected with Zoonotic Leishmania

Leishmaniasis are neglected diseases caused by several species of Leishmania that affect humans and many domestic and wild animals with a worldwide distribution. The objectives of this review are to identify wild animals naturally infected with zoonotic Leishmania species as well as the organs infected, methods employed for detection and percentage of infection. A literature search starting from 1990 was performed following the PRISMA methodology and 161 reports were included. One hundred and eighty-nine species from ten orders (i.e., Carnivora, Chiroptera, Cingulata, Didelphimorphia, Diprotodontia, Lagomorpha, Eulipotyphla, Pilosa, Primates and Rodentia) were reported to be infected, and a few animals were classified only at the genus level. An exhaustive list of species; diagnostic techniques, including PCR targets; infected organs; number of animals explored and percentage of positives are presented. L. infantum infection was described in 98 wild species and L. (Viania) spp. in 52 wild animals, while L. mexicana, L. amazonensis, L. major and L. tropica were described in fewer than 32 animals each. During the last decade, intense research revealed new hosts within Chiroptera and Lagomorpha. Carnivores and rodents were the most relevant hosts for L. infantum and L. (Viannia) spp., with some species showing lesions, although in most of the studies clinical signs were not reported.

Molecular detection and characterization of Theileria sp. from hedgehogs (Paraechinus aethiopicus) in Saudi Arabia

In this study, we conducted molecular detection and characterization of piroplasms that infect the Ethiopian or desert hedgehogs (Paraechinus aethiopicus) in Saudi Arabia. Blood samples from 112 (68 males and 44 females) desert hedgehogs from Unaizah, Central Saudi Arabia were screened for Theileria/Babesia DNA using the polymerase chain reaction (PCR) employing specific primers amplifying the partial 18S small subunit rRNA gene. Theileria DNA was detected in 51 samples (45·5%), giving a prevalence of 45·5%. Theileria DNA was found in 33 (48·5%) males and 18 (40·9%) females, and there was no significant difference (P > 0·05) in the prevalence between males and females. Similarly, there was no significant difference (P > 0·05) in the prevalence between juveniles (40%) and adults (46·7%). There was a significant difference in the prevalence of Theileria in hedgehogs collected from May to September and the period from October to April (P = 0·003). Four haplotypes of Theileria sp. in hedgehogs were detected and designated as H1-H4. H1 was the predominant haplotype and found in 80·8% of the positive individuals. Partial sequences of the 18S rRNA of Theileria sp. from hedgehogs grouped with Theileria spp. that are benign. This study is the first report of the occurrence of Theileria spp. in Saudi Arabian desert hedgehogs.

Study of Zoonotic Enteric Pathogens of Atelerix algirus in Tenerife, Canary Islands, Spain

Atelerix algirus is an invasive species in the Canary Islands (Spain). There are few studies about the zoonotic pathogens this species could be hosting; therefore, this study was focused on analyzing causative agents of diarrhea in humans in feces from hedgehogs. A total of 45 fecal samples obtained in Tenerife (Canary Islands) were analyzed in this study using Biofire FilmArray gastrointestinal panel with an integrated Biofire FilmArray system. Forty-two (93.33%) of the samples presented at least one of the pathogens detected by the panel. The prevalence of four bacteria stands out as for enteropathogenic Escherichia coli (71.11%), Salmonella (66.67%), Clostridioides difficile (33.33%), and Campylobacter sp. (22.22%), all of which were widely distributed along Tenerife. Besides, other pathogens were found, Cryptosporidium sp. and enterotoxigenic E. coli lt/st in 6.66% of the animals, Shigella/enteroinvasive E. coli in 4.44%, and Norovirus GI/GII, Plesiomonas shigelloides, and Vibrio sp. in 2.22%. Of the hedgehogs, 26.66% were hosting just one pathogen, and the others showed coinfection: 24.44% hosted two, 31.11% hosted three, and 11.11% hosted four or more. The close contact with hedgehogs may imply the transmission of not only one causative agent of diarrhea but also multiple agents, since coinfection is highly prevalent. The lack of management measurements for this animal in the Canary Islands, the common habit of adopting hedgehogs from wildlife without veterinary control, and the fact that most of the hedgehogs studied belonged to highly populated areas imply a high risk of transmission of pathogens to humans.

Wild mammals as potential silent reservoirs of Leishmania infantum in a Mediterranean area

A molecular survey of wild mammals was performed to assess their potential as reservoirs of L. infantum. A total of 156 specimens of wild mammalian fauna were obtained for analysis from areas in Catalonia with a reported incidence of canine leishmaniasis. They consisted of 124 small mammals: 35 Mus spretus (Muridae); 64 Erinaceus europaeus (Erinaceidae), 25 Sciurus vulgaris (Sciuridae) and 32 carnivores: 11 Vulpes vulpes (Canidae), 1 Felis catus (Felidae), 15 Meles meles, 4 Martes foina and 1 Mustela vison (Mustelidae). The analysis was performed on samples of liver, spleen, skin (ear) and blood extracted from the heart. Leishmania DNA was determined by a qPCR and specific anti-Leishmania antibodies were detected by an in-house (ELISA). Among the 156 specimens studied, 29.48% were positive in at least one of the samples studied and considered infected. In M. spretus, Leishmania DNA was detected in the liver, spleen or skin of 37.1% of 35 specimens, and 2 of the 13 specimens tested serologically were positive (15.38%). In E. europaeus, 34.4% of the 64 specimens were infected. Leishmania DNA was detected in 19/51 spleens and 5/50 skins; 2 of the 37 specimens analysed in both spleen and skin gave positive results in both samples. Serology was positive in 12.8% (6/47) by ELISA; 3 specimens were positive by both ELISA and qPCR. In S. vulgaris, Leishmania DNA was detected in 5 of 25 specimens (20%). Of the 32 carnivore specimens analysed, Leishmania DNA was detected in both samples studied (spleen and liver) of 4 (12.5%) (2 M. foina, 1 M. vison and 1 F. catus), which were not studied serologically. The data obtained indicate that small mammals, above all wild rodents and carnivores, could act as naturally infected hosts of L. infantum in this endemic area. Among the rodents, M. spretus stands out with the highest prevalence of infection. In E. europaeus, the presence of L. infantum DNA in spleen and skin, and antibodies in heart blood, reported here for the first time, indicates this small mammal could be a possible reservoir. Additionally, S. vulgaris, not previously studied as an L. infantum reservoir, showed non-negligible prevalence values, indicating a potential role in leishmaniasis transmission.

major natural hybrids

The clinical manifestation and course of Leishmania infections depend on factors such as species, virulence and host-immunity. Although trypanosomatids are considered to have clonal propagation, genetic hybridization has produced successful natural hybrid lineages. Hybrids displaying strong selective advantages may have an impact on pathogenesis and the eco-epidemiology of leishmaniasis. Thus, characterization of phenotypic properties of Leishmania hybrids could bring significant insight into the biology, infectivity, pathogenicity and transmission dynamics of these atypical strains. The present study focuses on phenotypic features and survival capacity of Leishmania infantum/Leishmania major hybrid isolates as compared with representative putative parental species, L. infantum and L. major. In vitro assays (growth kinetics, susceptibility to different conditions) and in vivo infection (parasite detection and histopathological alterations) showed that hybrids present higher growth capacity and decreased susceptibility to reactive oxygen species. Furthermore, evaluation of infected spleen tissue suggests that hybrids induce a stronger immune reaction than their putative parents, leading to the development of white pulp hyperplasia in B-lymphocyte compartments. Overall, these hybrids have shown high plasticity in terms of their general behaviour within the different phenotypic parameters, suggesting that they might have acquired genetic features conferring different mechanisms to evade host cells.

First detection of Leishmania DNA in Psammomys obesus and Psammomys vexillaris: Their potential involvement in the epidemiology of leishmaniasis in Tunisia

Leishmaniasis, a public health problem in Tunisia, are diseases caused by different Leishmania species. Cutaneous leishmaniasis is present from the North to the South under different forms, due to Leishmania (L.) major, L. infantum or L. tropica. Whereas, Psammomys (P.) obesus is the confirmed reservoir host of L. major, those of L. tropica and dermotropic L. infantum wait to be identified. Importantly, P. vexillaris species have been recently highlighted; however, no studies have been carried out to explore its potential role in leishmaniasis epidemiology. Seventy two rodents were collected from Central and South-West of Tunisia between 2007 and 2010. Using several methods, 43 animals were identified as P. obesus and 29 as P. vexillaris. Leishmania kinetoplast DNA was detected in liver samples by real-time PCR in 18 P. obesus and in 8 P. vexillaris. Then, the direct sequencing of the amplified internal transcribed spacer 1, allowed the identification of L. infantum DNA in five P. obesus and in three P. vexillaris, as well as L. tropica DNA in three other P. vexillaris. Whereas, PCR fluorescent fragment length analysis of the 7 spliced leaders, allowed identifying L. major among infected P. obesus and P. vexillaris, and interestingly co-infection (L. major/L. infantum) among two P. obesus. We report here for the first time, the infection of P. obesus, from Central Tunisia, by L. infantum. Suggesting that P. obesus the known reservoir host of L. major, may also serve as reservoir host for L. infantum and thus play a role in the spread of sporadic cutaneous or visceral leishmaniasis in this region. Of equal importance, this work establish for the first time, the natural infection of P. vexillaris by different Leishmania species, suggesting its potential epidemiological role as reservoir host.

Phlebotomine sand fly-borne pathogens in the Mediterranean Basin: Human leishmaniasis and phlebovirus infections

Pathogens transmitted to humans by phlebotomine sand flies are neglected, as they cause infectious diseases that are not on the priority list of national and international public health systems. However, the infections caused by protozoa of the Leishmania genus and viruses belonging to the Phlebovirus genus (family Phenuiviridae)—the most significant group of viruses transmitted by sand flies—have a relevant role for human pathology. These infections are emerging in the Mediterranean region and will likely spread in forthcoming decades, posing a complex threat to human health. Four species and 2 hybrid strains of Leishmania are pathogenic for humans in the Mediterranean Basin, with an estimated annual incidence of 239,500–393,600 cases of cutaneous leishmaniasis and 1,200–2,000 cases of visceral leishmaniasis. Among the phleboviruses, Toscana virus can cause neuroinvasive infections, while other phleboviruses are responsible for a typical “3-day fever”; the actual incidence of Phlebovirus infections in the Mediterranean area is unknown, although at least 250 million people are exposed. Here, we reviewed the current literature on epidemiology of sand fly–borne infections in the Mediterranean Basin, with a focus on humans. Our analysis indicates the need for increased public health activities directed to determine the disease burden of these infections as well as to improve their surveillance. Among the emerging challenges concerning sand fly–borne pathogens, the relationships between sand fly–borne protozoa and viruses should be considered in future studies, including epidemiological links between Leishmania and phleboviruses as well as the conditional capacity for these pathogens to be involved in interactions that may evolve towards increased virulence.

Demographic and spatio-temporal distribution of cutaneous leishmaniasis in the Souf oasis (Eastern South of Algeria): Results of 13 years

Cutaneous leishmaniasis is one of many dangerous parasitic diseases. It remains a serious public health problem not only in Souf oasis, but also in Algeria and all developing countries. The results of our thirteen-year study shows a recording of 4813 confirmed cases of cutaneous leishmaniasis and the details shows that this disease affects all municipalities and all age groups, from infants to elderly, but the most affected ones are teenagers aging (10-19) years with 1512 cases (31.41%) and infants less than 9 years old with 1237 cases (25.70%). In addition, males are more prone to this disease than females (65% and 35% respectively). Among the 18 municipalities in the Souf, the most affected were El-Oued with 1171 cases (24.33%) followed by Guemar with 997 cases (20.71%). Furthermore, more than 40.03% of all cases (1927 cases), were record just in one year in 2010. A parallel, this study shows that the original factors of the studied area, such as climatological, agricultural and environmental factors, was the reason do not apparition this epidemic for a long time, but the changes in these conditions, resulting from various human activities create new environmental conditions, which help with the emergence and spread of leishmaniasis disease. The effective fight against this disease should be based on the elimination of the vectors and reservoirs populations, by the overall improvement of sanitary conditions and hygiene, extensive research in epidemiology of leishmaniasis could also reduce the incidence of cutaneous leishmaniasis.

Epidemiology of the outbreak, vectors and reservoirs of cutaneous leishmaniasis in Mali: A systematic review and meta-analysis

OBJECTIVE

To compile available data and to estimate the burden, characteristics and risks factors of cutaneous leishmaniasis (CL) in Mali.

METHODS

Articles in English and French were searched in Hinari, Google scholar and PubMed. Unpublished studies were identified by searching in Google.com. Terms used were cutaneous leishmaniasis Mali; Leishmaniasis Mali, Leishmania major Mali; or Phlebotomus Mali or Sergentomyia Mali. We select descriptive studies on CL and sandflies in Mali. Data were extracted and checked by the author, then analyzed by region, by study population and type of biological tests, meta-analysis approach with STATA software was used.

RESULTS

Nineteen published (n = 19) and three unpublished were included. CL epidemiology was characterized by occurrence of clinical cases in different areas of Mali, outbreaks restricted to known areas of transmission and isolated cases diagnosed in travelers. In endemic areas, population at risk are young age persons, farmers, ranchers, housewives, teachers and military personnel. The annual incidence ranged from 290 to 580 cases of CL. Leishmania major is the main species encountered throughout the country (North Savanna, Sahel and Sub-Saharan areas), and Phlebotomus duboscqi has been identified as the vector and Sergentomyia (Spelaeomyia) darlingi as possible vector. The overall estimated prevalence of positive LST (Leishmanin Skin Test) was 22.1%. The overall frequency of CL disease among suspected cases was 40.3%.

CONCLUSIONS

Although descriptive, hospital-based and cross-sectional studies are robust enough to determine the extent of CL in Mali; future well-designed eco-epidemiological studies at a nationwide scale are needed to fully characterize CL epidemiology and risk factors in Mali.

First detection of Leishmania major DNA in Sergentomyia (Sintonius) clydei (Sinton, 1928, Psychodidae: Phlebotominae), from an outbreak area of cutaneous leishmaniasis in Tunisia

In recent years there has been growing interest in Sergentomyia species. Their role in the spread of mammalian leishmaniasis appears repeatedly in the literature and the possibility of its implication in Leishmania transmission to humans remains controversial. Sergentomyia (Sintonius) clydei is one of several cryptic species sharing therefore common morphologic criteria with others species of the subgenera Sintonius. Little is known about this specie in Tunisia. We sampled and identified different specimens including four specimens of S. clydei collected from Sidi Bouzid and Kairouan areas (center of Tunisia) using morphological tools. Male Sergentomyia clydei and Sergentomyia christophersi are known to share several morphological characters and can be mistaken for. Consequently we took advantage of 5 male S. christophersi available in our collection (Tataouin, South of Tunisia). In our study morphological tools were completed by molecular study of cytochrome b gene to identify S. clydei. For the detection of Leishmania spp. that might infect our specimens, Leishmania DNA was analyzed by amplification of kinetoplast minicircle DNA using real-time PCR and nested-PCR. Obtained result was confirmed by restriction analysis of the amplified ribosomal internal transcribed spacer 1 (ITS1). We provide in our study, the first molecular identification of S. clydei, in Tunisia. Our Neighbor Joining tree based on mitochondrial cytochrome b gene shows two different clusters. The first includes the Tunisians S. clydei and other specimens from Africa, Middle East and the Arabic peninsula, and the second cluster containing the specimens from Seychelle. Unexpectedly, we also demonstrate the infection of one anthropophilic female S. clydei by Leishmania major DNA. This finding shows that more attention should be paid when identifying parasites by molecular tools within sandfly vector.

Natural infection of Algerian hedgehog, Atelerix algirus (Lereboullet 1842) with Leishmania parasites in Tunisia

In Tunisia, Leishmania parasites are responsible of visceral leishmaniasis, caused by Leishmania infantum species while three cutaneous disease forms are documented: chronic cutaneous leishmaniasis due to Leishmania killicki, sporadic cutaneous form (SCL) caused by L. infantum and the predominant zoonotic cutaneous leishmanaisis (ZCL) due to Leishmania major. ZCL reservoirs are rodents of the Psammomys and Meriones genera, while for SCL the dog is supposed to be a reservoir. Ctenodactylus gundii is involved in the transmission of L. killicki. However, other mammals could constitute potential reservoir hosts in Tunisia and other North African countries. In order to explore the role of hedgehogs as potential reservoirs of leishmaniasis, specimens (N=6) were captured during July-November period in 2011-2013 in an SCL endemic area in El Kef region, North-Western Tunisia. Using morphological characteristics, all specimens were described and measured. Biopsies from liver, heart, kidney and spleen of each animal were used to extract genomic DNA, which was further used in PCR assays to assess the presence of Leishmania parasites. Different PCRs targeting kinetoplast minicircles, ITS1, mini-exon genes and a repetitive Leishmania- specific sequence, were applied. To further identify Leishmania species involved, RFLP analysis of amplified fragments was performed with appropriate restriction enzymes. Using morphological characters, animals were identified as North African hedgehogs, also called Algerian hedgehogs, that belong to the Erinaceidae family, genus Atelerix Pomel 1848, and species algirus (Lereboullet, 1842). PCR results showed in total that all specimens were Leishmania infected, with different organs incriminated, mainly liver and spleen. Results were confirmed by direct sequencing of amplified fragments. Species identification showed that all specimens were infected with L. major, three of which were additionally co-infected with L. infantum. The present study demonstrates, for the first time in Tunisia, natural infection of hedgehog animals (Atelerix algirus) by the Leishmania parasites species L. major and L. infantum. L. major is also detected for the first time in wild animals captured in the North Western part of the country; likewise for the co-infection of these animals by the 2 Leishmania species. This mammal could play a potential reservoir role in epidemiology of SCL or ZCL and could contribute to emergence or extension of ZCL in the studied region.