Human Cutaneous Leishmaniasis in North Africa and Its Threats to Public Health: A Statistical Study Focused on Djelfa (Algeria).

Cutaneous leishmaniasis, the most common form of leishmaniasis, causes long-term skin lesions on exposed areas of the skin. It is caused by a protozoan parasite belonging to the genus Leishmania and is transmitted via infected phlebotomine sand flies. In North Africa, particularly Algeria, the disease represents a major public health problem. This retrospective study, which focuses on the agropastoral region of Djelfa (central Algeria) during a period of 16 years, from 2006 to 2021, is part of the surveillance of cutaneous leishmaniasis to identify the key factors favouring its probable spread. The analyzed data reveal that this disease is more prevalent in male patients (53.60%) and is highly widespread in this vast area of 66,415 km2 with a total of 3864 CL cases, reaching a peak of 1407 cases in 2006. Statistically, the Pearson correlation validated by the p-value shows, in an original and sometimes unexpected way, that certain factors, such as temperature linked to climate change, are playing a significant role in the probable spread of the disease in Djelfa and its surrounding regions. The concentration of the population in some specific rural areas with limited or nonexistent access to public health services is another potential factor in disease transmission. The results were highlighted by a significant correlation coefficient (r=0.66) with a p-value less than 0.01. While there is currently no vaccine or prophylactic drug available, our research represents a preliminary approach that addresses various epidemiological aspects of the disease. This paves the way for a proactive preventive strategy involving the control of vector-borne diseases.

Cutaneous Leishmaniasis in Algeria; Highlight on the Focus of M'Sila.

Algeria ranks second after Afghanistan for the incidence of cutaneous leishmaniasis (CL) worldwide. Here, we report a 34-years retrospective analysis of CL in Algeria and focused on the most affected region, the M'Sila province. All 66 cutaneous isolates corresponded to Leishmania (L.) major. Our study of the sandfly and rodent fauna further highlighted the high density of Phlebotomus papatasi and additional phlebotomine species of medical importance, not previously identified in M'Sila. Wild rodents belonging to nine species were trapped in M'Sila, and Psammomys obesus and Meriones shawi were found infected by L. major. In addition, Leishmania infantum was isolated from two visceral leishmaniasis cases, one dog and its proven vectors (P. perniciosus, P. longicuspis, and P. perfiliewi) inventoried during the survey. The high incidence of CL in the M'Sila province is likely a consequence of the increase in minimum temperatures recorded that constitutes suitable conditions for establishing a high endemicity and leads to an explosive rise in leishmaniases cases in this region. A thorough investigation of the underlying risk factors is urgently needed to detect new cases earlier. All these would improve the preparedness to fight the disease.

Efficacy of ULV and thermal aerosols of deltamethrin for control of Aedes albopictus in nice, France.

BACKGROUND: Ultra-low volume (ULV) insecticidal aerosols dispensed from vehicle-mounted cold-foggers are widely considered the method of choice for control of Aedes aegypti and Ae. albopictus during outbreaks of dengue and chikungunya and, more recently, Zika. Nevertheless, their effectiveness has been poorly studied, particularly in Europe. Nearly all published studies of ULV efficacy are bio-assays based on the mortality of caged mosquitoes. In our study we preferred to monitor the direct impact of treatments on the wild mosquito populations. This study was undertaken to evaluate the efficiency of the two widely used space spraying methods to control Ae. albopictus and Ae. aegypti. METHODS: We determined the susceptibility of local Ae. albopictus to deltamethrin by two methods: topical application and the "WHO Tube Test". We used ovitraps baited with hay infusion and adult traps (B-G Sentinel) baited with a patented attractant to monitor the mosquitoes in four residential areas in Nice, southern France. The impact of deltamethrin applied from vehicle-mounted ULV fogging-machines was assessed by comparing trap results in treated vs untreated areas for 5 days before and 5 days after treatment. Four trials were conducted at the maximum permitted application rate (1 g.ha-1). We also made two small-scale tests of the impact of the same insecticide dispensed from a hand-held thermal fogger. RESULTS: Susceptibility to the insecticide was high but there was no discernable change in the oviposition rate or the catch of adult female mosquitoes, nor was there any change in the parous rate. In contrast, hand-held thermal foggers were highly effective, with more than 90% reduction of both laid eggs and females. CONCLUSIONS: We believe that direct monitoring of the wild mosquito populations gives a realistic assessment of the impact of treatments and suggest that the lack of efficacy is due to lack of interaction between the target mosquitoes and the ULV aerosol. We discuss the factors that influence the effectiveness of both methods of spraying in the context of epidemic situations.

Gender Bias in Insecticide Susceptibility of Aedes albopictus is Solely Attributable to Size.

Despite an extensive literature on mosquitoes, remarkably little attention has been paid to males. Current interest in control by release of transgenic males begs attention to this bias. It is well known that males are more susceptible to insecticides than females when determined by the standard World Health Organization (WHO) bioassay, and field observations have shown a higher impact of ultra-low-volume (ULV) space sprays. It is generally assumed that these differences are due to the smaller size of males and/or greater physiological susceptibility. We compared susceptibility by WHO bioassay and by topical application. There was a significant difference between the sexes in terms of dose effect and knockdown by the WHO test, but no significant difference by weight-adjusted topical application. We conclude that greater susceptibility of males is solely a function of their size and suggest that a ULV treatment before the release of transgenic males would greatly increase their competitive ratio versus wild mosquitoes and thus their impact as a control measure.

Ecological differentiation of members of the Culex pipiens complex, potential vectors of West Nile virus and Rift Valley fever virus in Algeria.

BACKGROUND: We investigated the ecological differentiation of two members of the Culex pipiens complex, Cx. p. pipiens form pipiens and Cx. p. pipiens form molestus in three sites, El-Kala, M'Sila and Tinerkouk in Algeria. These two forms are the most widespread mosquito vectors in temperate regions exhibiting important behavioural and physiological differences. Nevertheless, this group of potential vectors has been poorly studied, particularly in North Africa. METHODS: Ten larval populations of Cx. p. pipiens were sampled from various above- and underground habitats in three zones representing the three bioclimatic regions in Algeria. The reproduction characteristics were also investigated in the laboratory to define the rates of autogeny and stenogamy. Identification of Cx. p. pipiens members present in Algeria was achieved using a molecular analysis with the microsatellite CQ11 locus. RESULTS: We detected larvae of Cx. p. pipiens in all areas suggesting that the species is a ubiquitous mosquito well adapted to various environments. To our knowledge, this study provides the first molecular evidence of the presence of the Cx. p. pipiens form molestus and hybrids (molestus/pipiens) in Algeria with a high proportion of molestus form (48.3 %) in comparison with hybrids (36.8 %) and pipiens form (14.9 %). CONCLUSIONS: Some unexpected correlations between the proportion of forms pipiens, molestus and hybrids, and mosquito biological characteristics were observed suggesting some epigenetic effects controlling Cx. p. pipiens mating and reproduction. Consequences for pathogen transmission are discussed.

Remote sensing, land cover changes, and vector-borne diseases: use of high spatial resolution satellite imagery to map the risk of occurrence of cutaneous leishmaniasis in Ghardaïa, Algeria.

Ghardaïa, central Algeria, experienced a major outbreak of cutaneous leishmaniasis (CL) in 2005. Two Leishmania species occur in this region: Leishmania major (MON-25) and Leishmania killicki (MON-301). The two species are transmitted respectively by the sandflies Phlebotomus papatasi and Phlebotomus sergenti and probably involve rodent reservoirs with different ecologies, suggesting distinct epidemiological patterns and distribution areas. The aims of this study were to establish risk maps for each Leishmania species in Ghardaïa, taking into account the specificities of their vectors and reservoirs biotopes, using land cover and topographical characteristics derived from remote sensing imagery. Using expert and bibliographic knowledge, habitats of vectors and reservoirs were mapped. Hazard maps, defined as areas of presence of both vectors and reservoirs, were then combined with vulnerability maps, defined as areas with human presence, to map the risk of CL occurrence due to each species. The vector habitat maps and risk maps were validated using available entomological data and epidemiological data. The results showed that remote sensing analysis can be used to map and differentiate risk areas for the two species causing CL and identify palm groves and areas bordering the river crossing the city as areas at risk of CL due to L. major, whereas more limited rocky hills on the outskirts of the city are identified as areas at risk of CL due to L. killicki. In the current context of urban development in Ghardaïa, this study provides useful information for the local authorities on the respective risk areas for CL caused by both parasites, in order to take prevention and control measures to prevent future CL outbreaks.

Culex pipiens, an experimental efficient vector of West Nile and Rift Valley fever viruses in the Maghreb region.

West Nile fever (WNF) and Rift Valley fever (RVF) are emerging diseases causing epidemics outside their natural range of distribution. West Nile virus (WNV) circulates widely and harmlessly in the old world among birds as amplifying hosts, and horses and humans as accidental dead-end hosts. Rift Valley fever virus (RVFV) re-emerges periodically in Africa causing massive outbreaks. In the Maghreb, eco-climatic and entomologic conditions are favourable for WNV and RVFV emergence. Both viruses are transmitted by mosquitoes belonging to the Culex pipiens complex. We evaluated the ability of different populations of Cx. pipiens from North Africa to transmit WNV and the avirulent RVFV Clone 13 strain. Mosquitoes collected in Algeria, Morocco, and Tunisia during the summer 2010 were experimentally infected with WNV and RVFV Clone 13 strain at titers of 10(7.8) and 10(8.5) plaque forming units/mL, respectively. Disseminated infection and transmission rates were estimated 14-21 days following the exposure to the infectious blood-meal. We show that 14 days after exposure to WNV, all mosquito st developed a high disseminated infection and were able to excrete infectious saliva. However, only 69.2% of mosquito strains developed a disseminated infection with RVFV Clone 13 strain, and among them, 77.8% were able to deliver virus through saliva. Thus, Cx. pipiens from the Maghreb are efficient experimental vectors to transmit WNV and to a lesser extent, RVFV Clone 13 strain. The epidemiologic importance of our findings should be considered in the light of other parameters related to mosquito ecology and biology.

DNA barcodes confirm the presence of a single member of the Anopheles maculipennis group in Morocco and Algeria: An. sicaulti is conspecific with An. labranchiae.

Anopheles labranchiae Falleroni is the only member of the Maculipennis Group known to occur in northern Africa; however, confusion exists as to the taxonomic status of its junior synonym, An. sicaulti Roubaud (type locality: near Rabat, Morocco). Based on morphological and behavioural distinctions, it has been suggested that Moroccan populations have been isolated from other North African populations by the Atlas Mountains, and that Moroccan populations may represent An. sicaulti, originally described as a variety of An. maculipennis Meigen. DNA barcodes (658bp of the mitochondrial COI gene) obtained from 89 An. maculipennis s.l. collected in Morocco (n=79) and Algeria (n=10) in 2007 and 2008 were used to determine if Moroccan populations are genetically isolated from those east of the Atlas Mountains (Algeria), and whether there is molecular evidence to support the presence of more than one member of the Maculipennis Group in the region. No evidence for speciation was found between Moroccan and Algerian populations, or within populations in northern Morocco. Moreover shared COI haplotypes between Algeria and Morocco indicate ongoing gene flow between populations in these countries, suggesting that the Atlas Mountains are not a boundary to gene flow in An. labranchiae. The synonymy of An. sicaulti with An. labranchiae is confirmed. That An. labranchiae comprises the same species in these North African countries is important for malaria control.

Plasmodium falciparum malaria, southern Algeria, 2007.

An outbreak of Plasmodium falciparum malaria occurred in Tinzaouatine in southern Algeria in 2007. The likely vector, Anopheles gambiae mosquitoes, had not been detected in Algeria. Genes for resistance to chloroquine were detected in the parasite. The outbreak shows the potential for an increase in malaria vectors in Algeria.

Description of a dermatropic Leishmania close to L. killicki (Rioux, Lanotte & Pratlong 1986) in Algeria.

Cutaneous leishmaniasis (CL) is endemic in Algeria where two forms have been previously described, the sporadic form caused by Leishmania infantum in the north and the cutaneous form caused by L. major in central and southern parts of the country. During 2005, a CL outbreak occurred in the province of Ghardaïa, located in the north of Sahara, where 2040 cases were recorded, of which several were from urban areas. Six strains isolated from patients with active lesions were identified by isoenzyme electrophoresis and by molecular typing using systematic sequencing of a large subunit of the RNA polymerase. Four of the strains belonged to a new zymodeme, MON-301, close to L. killicki MON-8. The two other isolates were identified as L. major zymodeme MON-25. The new dermatropic Leishmania close to L. killicki is reported for the first time in Algeria and coexists sympatrically with L. major MON-25 in the region of Ghardaïa where they occur in their usual vectors of Phlebotomus papatasi (L. major) and P. sergenti (L. tropica). This new parasite demonstrates the need for further investigations to elucidate the life cycle and transmission of the emergent disease and to evaluate its phylogenetic position in the taxonomy of Leishmania.