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Ribeiro JM, Rodrigues-Alves ML, Oliveira E, Guimarães PPG, Maria Murta Santi A, Teixeira-Carvalho A, Murta SMF, Peruhype-Magalhães V, Souza-Fagundes EM. Pamidronate, a promising repositioning drug to treat leishmaniasis, displays antileishmanial and immunomodulatory potential. Int Immunopharmacol 2022; 110:108952. [PMID: 35716482 DOI: 10.1016/j.intimp.2022.108952] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/26/2022] [Accepted: 06/09/2022] [Indexed: 11/18/2022]
Abstract
Visceral leishmaniasis (VL) is an infectious disease caused by Leishmania infantum (L. infantum). Currently, there are no vaccines and/or prophylactic therapies against VL, and the recentpharmacological approaches come from the drug repositioning strategy. Here, we evaluated the anticancer drug pamidronate (PAM) to identify a new therapeutic option for the treatment of human VL. We assessed its in vitro antileishmanial activity against the promastigote and amastigote forms of L. infantum by evaluating cell cytotoxicity. The antileishmanial and immunomodulatory activities were assessed using human peripheral blood leukocytes ex vivo. PAM induced the formation of vacuoles in the cytoplasm of the promastigotes and alterations in the morphology of the kinetoplast and mitochondria in vitro, which indicates anti-promastigote activity. PAM also reduced the number of infected macrophages and intracellular amastigotes in a concentration-dependent manner, with cell viability above 70%. In ex vivo, PAM reduced the internalized forms of L. infantum in the classical monocyte subpopulation. Furthermore, it enhanced IL-12 and decreased IL-10 and TGF-β by monocytes and neutrophils. Increased IFN-γ and TNF levels for CD8- and CD8+ T lymphocytes and B lymphocytes, respectively, were observed after the treatment with PAM, as well as a reduction in IL-10 by the lymphocyte subpopulations evaluated. Taken together, our results suggest that PAM may be eligible as a potential therapeutic alternative for drug repurposing to treat human visceral leishmaniasis.
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Affiliation(s)
- Juliana M Ribeiro
- Departamento de Fisiologia e Biofísica, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, 31270-901, Belo Horizonte, Minas Gerais, Brazil; Grupo de Genômica Funcional de Parasitos, Instituto René Rachou, Fundação Oswaldo Cruz, 30190-002, Belo Horizonte, Minas Gerais, Brazil
| | - Marina L Rodrigues-Alves
- Grupo Integrado de Pesquisa em Biomarcadores, Instituto René Rachou, Fundação Oswaldo Cruz, 30190-002, Belo Horizonte, Minas Gerais, Brazil
| | - Edward Oliveira
- Grupo de Genômica Funcional de Parasitos, Instituto René Rachou, Fundação Oswaldo Cruz, 30190-002, Belo Horizonte, Minas Gerais, Brazil
| | - Pedro P G Guimarães
- Departamento de Fisiologia e Biofísica, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, 31270-901, Belo Horizonte, Minas Gerais, Brazil
| | - Ana Maria Murta Santi
- Grupo de Genômica Funcional de Parasitos, Instituto René Rachou, Fundação Oswaldo Cruz, 30190-002, Belo Horizonte, Minas Gerais, Brazil
| | - Andrea Teixeira-Carvalho
- Grupo Integrado de Pesquisa em Biomarcadores, Instituto René Rachou, Fundação Oswaldo Cruz, 30190-002, Belo Horizonte, Minas Gerais, Brazil
| | - Silvane M F Murta
- Grupo de Genômica Funcional de Parasitos, Instituto René Rachou, Fundação Oswaldo Cruz, 30190-002, Belo Horizonte, Minas Gerais, Brazil
| | - Vanessa Peruhype-Magalhães
- Grupo Integrado de Pesquisa em Biomarcadores, Instituto René Rachou, Fundação Oswaldo Cruz, 30190-002, Belo Horizonte, Minas Gerais, Brazil.
| | - Elaine M Souza-Fagundes
- Departamento de Fisiologia e Biofísica, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, 31270-901, Belo Horizonte, Minas Gerais, Brazil.
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Rostamian M, Bashiri H, Yousefinejad V, Bozorgomid A, Sohrabi N, Raeghi S, Khodayari MT, Ghadiri K, Rezaeian S. Prevalence of human visceral leishmaniasis in Iran: A systematic review and meta-analysis. Comp Immunol Microbiol Infect Dis 2020; 75:101604. [PMID: 33388595 DOI: 10.1016/j.cimid.2020.101604] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 12/03/2020] [Accepted: 12/10/2020] [Indexed: 01/08/2023]
Abstract
Leishmania infantum is the main cause of human visceral leishmaniasis (HVL; also known as kala-azar) in the Middle East and may be fatal if left untreated. This disease was first reported in 1949 in Iran. Despite marked improvements in hygiene and sanitation conditions, the disease is still endemic in some parts of Iran. It is difficult to determine the current prevalence of HVL in Iran due to the scarcity of comprehensive studies in this regard. In response to this gap, a systematic review and meta-analysis was conducted to gain better understanding of HVL epidemiology in the general population of Iran. English and Persian databases were searched for studies reporting the prevalence and risk factors associated with HVL in the Iranian people from January 1995 to December 2019. The reported data were selected according to inclusion and exclusion criteria. The pooled prevalence of HVL infection and its 95 % confidence intervals were calculated. Quality assessment, heterogeneity testing and publication bias assessment were also done. Literature search revealed 3634 studies, of which 35 studies met our eligibility criteria, with a total of 50,716 individuals. The meta-analysis was performed on 31 out of 35 included studies. The estimated pooled prevalence of HVL infection according to seropositivity was 2% (95 % CI: 1-2%) in the general population of Iran in which western and northern provinces had the lowest and the highest prevalence, 0.5 % (95 %CI, 0.2-0.7%) and 3% (95 %CI, 1-5 %), respectively. The seroprevalence of HVL among females (2%; 95 %CI, 1-2 %) was more than males (1%; 95 %CI, 1-2 %). The ≤10 and >10 years age groups had similar seroprevalence rates (1%, 95 %CI, 1-2 % versus 1%, 95 %CI, 0-1 %, respectively). There was no significant difference in terms of geographic area, age and sex. Of 31 studies included in the meta-analysis, the most common diagnostic test was the direct agglutination test (96.77 %). To the best of our knowledge, this is the first systematic review of the prevalence of HVL in Iran. The results showed a low seroprevalence of HVL infection. However, the lack of published reports of HVL in an area does not exclusively mean the absence of the disease or carrier. We therefore recommend further studies in this regard.
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Affiliation(s)
- Mosayeb Rostamian
- Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Homayoon Bashiri
- Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Vahid Yousefinejad
- Liver and Digestive Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Arezoo Bozorgomid
- Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Nasrollah Sohrabi
- Department of Medical Laboratory Sciences, School of Paramedical, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Saber Raeghi
- Department of Laboratory Sciences, Maragheh University of Medical Sciences, Maragheh, Iran
| | | | - Keyghobad Ghadiri
- Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shahab Rezaeian
- Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Saini S, Dube A, Sahasrabuddhe AA, Thakur CP, Joshi S, Rawat K, Rai AK. Comparison Between Immuno-Clinicopathological Features of Experimental and Human Visceral Leishmaniasis by Leishmania donovani. Acta Parasitol 2020; 65:57-67. [PMID: 31578670 DOI: 10.2478/s11686-019-00127-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 09/17/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Current understanding of visceral leishmaniasis (VL) depends upon the experimental model. Different species of mouse and hamster have been used as model for VL. It is already evident that the mouse model of VL is not a true reflection of the pathology of human visceral leishmaniasis (HuVL). On the other hand, hamster is reported to be a better model of VL to study the progressive as well as chronic pathology of the disease. OBJECTIVE To compare immuno-clinicopathological features of experimental VL (ExVL) and HuVL by Leishmania donovani. METHODS Hamsters were infected (15 and 60 days) and their immunological, clinical and biochemical parameters were compared with the cases of HuVL. RESULTS Splenomegaly and hepatomegaly were observed in infected hamster post-infection, which are hallmarks of symptomatic HuVL cases. Clinical, biochemical and pathological manifestations of infected hamsters were consistent with that of HuVL cases, except parameters such as body weight, uric acid, alkaline phosphatase and random glucose. The absence of clear dichotomy between pro- and anti-inflammatory cytokines was also observed after infection at different sites of infection. CONCLUSION Our results suggest that the golden hamster (Mesocricetus auratus), infected via the intracardiac route, constitutes a very good model for the study of experimental Leishmania donovani infections. However, certain differences in clinical presentations of infected hamsters (via intracardiac route) with HuVL suggest further optimization of this animal model like route of infection such as intradermal, which is more close to natural infection.
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Prestes-Carneiro LE, Daniel LAF, Almeida LC, D'Andrea LZ, Vieira AG, Anjolete IR, André L, Flores EF. Spatiotemporal analysis and environmental risk factors of visceral leishmaniasis in an urban setting in São Paulo State, Brazil. Parasit Vectors 2019; 12:251. [PMID: 31113445 PMCID: PMC6528369 DOI: 10.1186/s13071-019-3496-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 05/09/2019] [Indexed: 12/04/2022] Open
Abstract
Background In Latin America, Brazil harbors the most cases of human visceral leishmaniasis (HVL). Since the early 1980s, the disease has spread to the urban centers of the north, and now the south and west of Brazil; it reached São Paulo state in the southeast in 1996, and Presidente Prudente in the western region in 2010. Our aim was to describe the spatiotemporal analysis and environmental risk factors associated with the dispersion of VL in Presidente Prudente, an urban setting with recent transmission. Methods An entomological survey was carried out from 2009 to 2015. A canine visceral leishmaniasis (CVL) serosurvey was performed from 2010 to 2015 using enzyme-linked immunosorbent assays (ELISA), a dual-path platform CVL rapid test, and indirect fluorescent antibodies (IFAT). Data from HVL cases were obtained from the Municipal Surveillance Epidemiology Center from 2013 to 2017. Data on water drainage and forest fragments were obtained from public platforms and irregular solid-waste deposits were determined by monthly inspections of the urban area. Kernel density maps of the distribution of CVL were constructed. Results From 2009 to 2015, Lutzomyia longipalpis sand flies were found in all seven areas of Presidente Prudente. From 2010 to 2015, 40,309 dogs were serologically screened and 638 showed positive results, i.e. a prevalence rate of 1.6%. From 2013 to 2017, six human cases were diagnosed with a mortality rate of 33.3%. In 2015, 56 points of irregular solid-waste deposits were identified, predominantly in the neighborhoods. Three different hotspots of CVL showed an increased distribution of vectors, seropositive dogs, irregular solid-waste deposits, forest fragments and water drainage. Conclusions The use of tools that analyze the spatial distribution of vectors, canine and human VL as environmental risk factors were essential to identifying the areas most vulnerable to the spread or maintenance of VL. The results may help public health authorities in planning prevention and control measures to avoid expansion and future outbreaks.
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Affiliation(s)
- Luiz E Prestes-Carneiro
- Infectious Diseases and Immunology Department, Universidade do Oeste Paulista, Presidente Prudente, São Paulo, Brazil.
| | - Loris A F Daniel
- Infectious Diseases and Immunology Department, Universidade do Oeste Paulista, Presidente Prudente, São Paulo, Brazil
| | - Lívia C Almeida
- Infectious Diseases and Immunology Department, Universidade do Oeste Paulista, Presidente Prudente, São Paulo, Brazil
| | - Lourdes Zampieri D'Andrea
- Center for Biomedical Sciences and Regional Laboratory, Instituto Adolfo Lutz, Presidente Prudente, São Paulo, Brazil.,Statistics Department, School of Sciences and Technology, São Paulo State University, Presidente Prudente Campus, Presidente Prudente, São Paulo, Brazil
| | - André G Vieira
- Municipal Secretariat of Environment, Presidente Prudente, São Paulo, Brazil
| | - Ivete R Anjolete
- Supervision in Control of Endemics, Presidente Prudente, São Paulo, Brazil
| | - Lenira André
- Statistics Department, School of Sciences and Technology, São Paulo State University, Presidente Prudente Campus, Presidente Prudente, São Paulo, Brazil
| | - Edilson F Flores
- Statistics Department, School of Sciences and Technology, São Paulo State University, Presidente Prudente Campus, Presidente Prudente, São Paulo, Brazil
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Asfaram S, Hosseini Teshnizi S, Fakhar M, Banimostafavi ES, Soosaraei M. Is urine a reliable clinical sample for the diagnosis of human visceral leishmaniasis? A systematic review and meta-analysis. Parasitol Int 2018; 67:575-583. [PMID: 29775824 DOI: 10.1016/j.parint.2018.05.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 04/03/2018] [Accepted: 05/14/2018] [Indexed: 11/24/2022]
Abstract
Visualization of amastigotes in lymph nodes, bone marrow, and other tissues samples remains the gold standard method for the diagnosis of visceral leishmaniasis (VL) in humans. This gold standard diagnostic method uses a technically challenging microscopy procedure that is often not accessible in many places in the world where VL is endemic. Here, we report the current systematic review and meta-analysis to evaluate whether urine is a reliable clinical sample for diagnosis of human VL. Data were extracted from ten available databases during the period from 2002 to 2017. Overall, 29 articles fulfilled the inclusion criteria and were used for data extraction in this systematic review. Most studies (72.4%) using urine specimens were reported from five countries: India 6 (20.7%), Iran 5 (17.2%), Bangladesh 4 (13.8%), Japan 3 (10.3%) and Spain 3 (10.3%), respectively. The most common diagnostic tests performed on urine were Katex (62.1%), ELISA (24.1%), and the rK39 (17.2%) assays. In meta-analysis the sensitivity and specificity of the three most commonly used diagnostic assays were rK39 (97%; CI: 91-99; 98%;76-100), ELISA (91%; 82-95; 99%; CI: 94-100), and Katex (83%; 73-90; 98%; 98-100), suggesting that the rK39 assay provided the highest sensitivity and the ELISA assay provided the highest specificity for diagnosis of VL from urine samples. Our findings suggest that urine is a valuable clinical sample for the diagnosis of human VL, particularly in areas where the gold standard test for VL is not available.
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Affiliation(s)
- Shabnam Asfaram
- Student Research Committee, Department of Parasitology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Saeed Hosseini Teshnizi
- Infectious and Tropical Diseases Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Mahdi Fakhar
- Molecular and Cell Biology Research Center, Department of Parasitology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Elham Sadat Banimostafavi
- Department of Radiology, Imam Khomeini Hospital, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Masoud Soosaraei
- Student Research Committee, Department of Parasitology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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Menon SS, Rossi R, Nshimyumukiza L, Zinszer K. Decentralized control of human visceral leishmaniasis in endemic urban areas of Brazil: a literature review. Trop Med Health 2016; 44:9. [PMID: 27433128 PMCID: PMC4940922 DOI: 10.1186/s41182-016-0011-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 03/17/2016] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Human migration and concomitant HIV infections are likely to bring about major changes in the epidemiology of some parasitic infections in Brazil. Human visceral leishmaniasis (HVL) control is particularly fraught with intricacies. It is against a backdrop of decentralized health care that the complex HVL control initiatives are brought to bear. This comprehensive review aims to explore the obstacles facing decentralized HVL control in urban endemic areas in Brazil. METHOD A literature search was carried out in December 2015 by means of three databases: MEDLINE, Google Scholar, and Web of Science. RESULTS Although there have been many strides that have been made in elucidating the eco-epidemiology of Leishmania infantum, which forms the underpinnings of the national control program, transmission risk factors for HVL are still insufficiently elucidated in urban settings. Decentralized HVL epidemiological surveillance and control for animal reservoirs and vectors may compromise sustainability. In addition, it may hamper timely human HVL case management. With the burgeoning of the HIV-HVL co-infection, the potential human transmission may be underestimated. CONCLUSION HVL is a disease with focal transmission at a critical juncture, which warrants that the bottlenecks facing the control program within contexts of decentralized healthcare systems be taken into account. In addition, HIV-driven HVL epidemics may substantially increase the transmission potential of the human reservoir. Calculating the basic reproductive number to fine-tune interventions will have to take into consideration the specific socio-economic development context.
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Affiliation(s)
- Sonia S. Menon
- />International Centre for Reproductive Health (ICRH), Ghent University, De Pintelaan 185 P3, 9000 Ghent, Belgium
- />Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
| | | | - Leon Nshimyumukiza
- />Department of Social and Preventive Medicine, Laval University, Boston, USA
| | - Kate Zinszer
- />Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
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Barhoumi W, Qualls WA, Archer RS, Fuller DO, Chelbi I, Cherni S, Derbali M, Arheart KL, Zhioua E, Beier JC. Irrigation in the arid regions of Tunisia impacts the abundance and apparent density of sand fly vectors of Leishmania infantum. Acta Trop 2015; 141:73-8. [PMID: 25447265 DOI: 10.1016/j.actatropica.2014.10.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 09/23/2014] [Accepted: 10/08/2014] [Indexed: 10/24/2022]
Abstract
The distribution expansion of important human visceral leishmaniasis (HVL) and sporadic cutaneous leishmaniasis (SCL) vector species, Phlebotomus perfiliewi and P. perniciosus, throughout central Tunisia is a major public health concern. This study was designed to investigate if the expansion of irrigation influences the abundance of sand fly species potentially involved in the transmission of HVL and SCL located in arid bioclimatic regions. Geographic and remote sensing approaches were used to predict the density of visceral leishmaniasis vectors in Tunisia. Entomological investigations were performed in the governorate of Sidi Bouzid, located in the arid bioclimatic region of Tunisia. In 2012, sand flies were collected by CDC light traps located at nine irrigated and nine non-irrigated sites to determine species abundance. Eight species in two genera were collected. Among sand flies of the subgenus Larroussius, P. perfiliewi was the only species collected significantly more in irrigated areas. Trap data were then used to develop Poisson regression models to map the apparent density of important sand fly species as a function of different environmental covariates including climate and vegetation density. The density of P. perfiliewi is predicted to be moderately high in the arid regions. These results highlight that the abundance of P. perfiliewi is associated with the development of irrigated areas and suggests that the expansion of this species will continue to more arid areas of the country as irrigation sites continue to be developed in the region. The continued increase in irrigated areas in the Middle East and North Africa region deserves attention, as it is associated with the spread of L. infantum vector P. perfiliewi. Integrated vector management strategies targeting irrigation structures to reduce sand fly vector populations should be evaluated in light of these findings.
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Zoghlami Z, Chouihi E, Barhoumi W, Dachraoui K, Massoudi N, Helel KB, Habboul Z, Hadhri MH, Limam S, Mhadhbi M, Gharbi M, Zhioua E. Interaction between canine and human visceral leishmaniases in a holoendemic focus of Central Tunisia. Acta Trop 2014; 139:32-8. [PMID: 25004438 DOI: 10.1016/j.actatropica.2014.06.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 06/21/2014] [Accepted: 06/27/2014] [Indexed: 11/29/2022]
Abstract
Canine visceral leishmaniasis (CVL) is endemic in the Mediterranean basin. In Tunisia, CVL is spatially associated with human visceral leishmaniasis (HVL) affecting mostly children younger than 5 years old. In this study, seroprevalence of Leishmania infantum infection in dogs was assessed in highly endemic districts of the governorate of Kairouan where more than 50% of HVL cases in Tunisia were reported. An entomological investigation was also carried out in two endemic districts (Bouhajla and Haffouz) to assess sand fly fauna and infection status of sand flies with Leishmania. A total of 191 serum samples were collected from healthy dogs and tested for anti-L. infantum antibodies by indirect immunofluorescence antibody test (IFAT). Overall seroprevalence for L. infantum was 26.7% being highest among dogs in the district of Bouhajla (52.7%) and the lowest in the district of Chbika (5.2%). In dogs, seroprevalence did not differ significantly based on gender or age, with dogs younger than 1 year showing a higher seroprevalence compared to older dogs. These findings suggest strong force of infection in naïve animals in holoendemic regions leading to emerging high incidence of HVL. Concomitant to the high CVL prevalence observed in the Bouhajla district, a significantly high cumulative HVL incidence also was observed in this district. Phlebotomus perniciosus and Phlebotomus longicuspis were the most abundant sand fly species in Bouhajla and Haffouz districts. The rate of Leishmania-DNA infection in sand flies was 9.4%. This finding points to spatial correlation between the occurrence of disease in humans, a high rate of infection in dogs and a high abundance of P. pernicious and P. longicuspis. Thus, CVL is the main risk factor for transmission to humans and subsequently, it is an important parameter for controlling transmission to humans.
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Affiliation(s)
- Z Zoghlami
- Laboratory of Vector Ecology, Pasteur Institute of Tunis, 13 Place Pasteur BP 74, 1002 Tunis, Tunisia
| | - E Chouihi
- Laboratory of Vector Ecology, Pasteur Institute of Tunis, 13 Place Pasteur BP 74, 1002 Tunis, Tunisia
| | - W Barhoumi
- Laboratory of Vector Ecology, Pasteur Institute of Tunis, 13 Place Pasteur BP 74, 1002 Tunis, Tunisia
| | - K Dachraoui
- Laboratory of Vector Ecology, Pasteur Institute of Tunis, 13 Place Pasteur BP 74, 1002 Tunis, Tunisia
| | - N Massoudi
- Laboratory of Vector Ecology, Pasteur Institute of Tunis, 13 Place Pasteur BP 74, 1002 Tunis, Tunisia
| | - K Ben Helel
- Pediatric Department, University Hospital of Kairouan, Tunisia
| | - Z Habboul
- Pediatric Department, University Hospital of Kairouan, Tunisia
| | - M H Hadhri
- Regional Department of Health, Governorate of Kairouan, Tunisia
| | - S Limam
- Veterinary School of Sidi Thabet, Sidi Thabet, Tunisia
| | - M Mhadhbi
- Veterinary School of Sidi Thabet, Sidi Thabet, Tunisia
| | - M Gharbi
- Veterinary School of Sidi Thabet, Sidi Thabet, Tunisia
| | - E Zhioua
- Laboratory of Vector Ecology, Pasteur Institute of Tunis, 13 Place Pasteur BP 74, 1002 Tunis, Tunisia.
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