International Journal of Civil Engineering and Technology (IJCIET)
Volume 10, Issue 04, April 2019, pp. 302–308, Article ID: IJCIET_10_04_031
Available online at http://www.iaeme.com/ijmet/issues.asp?JType=IJCIET&VType=10&IType=4
ISSN Print: 0976-6308 and ISSN Online: 0976-6316
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CUTANEOUS LEISHMANIASIS IN AIN DFALI
PROVINCE, WEST MOROCCO (2006-2015)
El Alaoui Zakaria, Amayour Abdelaziz, El Aasri Aziz, EL Kharim Khadija,
EL Belghyti Driss
Biotechnology and Environment Laboratory (LABEL), Parasitology and Environment Team,
Department of Biology, Faculty of Sciences, University, Ibn Tofail, Kenitra, Morocco
ABSTRACT
In the west of Morocco, between 2006 and 2014. The mean age of patients was
19.8 years with extremes from 6 months to 61 years. The sex ratio was 0.76 M / F. The
mean duration of lesions was 1.6 months with extremes of 2 weeks to 10 months. Fall
preponderance was noted (41.6%). The most frequent clinical appearance was that of
a single ulcero-pulmonary nodule (61%) (71.9%) and was seated on the face (57.5%).
Cutaneous leishmaniasis continues to pose a real public health problem in our
country. The emergence of severe and resistant forms throughout the world should
encourage the multiplication and strengthening of prophylactic measures.
Key words: Cutaneous Leishmaniasis, Morocco
Cite this Article: El Alaoui Zakaria, Amayour Abdelaziz, El Aasri Aziz, EL Kharim
Khadija, EL Belghyti Driss, Cutaneous Leishmaniasis in Ain Dfali province, West
Morocco (2006-2015), International Journal of Civil Engineering and Technology
10(4), 2019, pp. 302–308.
http://www.iaeme.com/IJCIET/issues.asp?JType=IJCIET&VType=10&IType=4
1. INTRODUCTION
Described the first time in Morocco in 1914 by Foley and Vialate (Rhajaoui et al., 2004),
cutaneous leishmaniasis (CL) is a public health problem in our country. It is sharply
recrudescence, due to a flagellated protozoan belonging to the genus Leishmania. The aim of
our work is to describe the epidemiological, clinical and evolutionary characteristics of CL in
the Ain Dfali health center.
2. METHODS
Through a study conducted between Department of Parasitic Diseases and Ain Dfali Health
Center, Provincial Delegation of Health Sidi Kacem, during the period from January 2006 to
December 2015, including patients diagnosed with cutaneous leishmaniasis with
parasitological and histological confirmation. For each patient were specified: the age, the
sex, the geographical origin, the duration of evolution, the clinical aspect, the therapeutic
scheme used as well as the evolution under treatment. The statistical analysis was performed
using the Exel software (2010 version).
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Cutaneous Leishmaniasis in Ain Dfali province, West Morocco (2006-2015)
3. FIELD OF STUDY
The commune Ain Dfali Figure 1 is limited to the West by commune Sidi Azouz Sidi Kacem
province, to the North commune of Rurale Bni Oual province Sidi Kacem, to the common
East Ouennan province Ouazzan, and to the South by municipality Rural Mrabih province
Sidi Kacem . It covers approximately 234 km2. Its population is 24181 (projection 2009).
This area has a high climatic diversity in mountainous areas, the climate is moderate with a
hot and dry summer with temperatures ranging from 7 ° C to 47 ° C and average winter
rainfall of 500 to 700 mm.
Map 1. Field of study
4. RESULT
Map 2 Spatial distribution of cases at the province of west morocco.
During the studied period, 132 patients were collected. The age of our patients ranged
from 6 months to 63 years with an average of 19.5 years. Female predominance was noted
(56%) (Figure 2)
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140
120
ffectif
100
80
60
40
20
0
00-09
10 - 19
20-29
30-39
40-49
50-59
≥ 60 ans
TOTAL
Masculin
20
27
4
3
1
1
1
57
Féminin
23
24
3
11
6
6
2
75
Total
43
51
7
14
7
7
3
132
Figure 2. Age and Sex Distribution of Cutaneous Leishmaniasis Cases in Ain Dfali (2006-2015).
Fall preponderance was noted (41.6%) (Figure 3)
60
50
40
30
20
10
0
Effecctif
Figure 3. Distribution by month of diagnosis of cutaneous leishmaniasis cases in Ain Dfali (2006-2015)
The average consultation time was 1.6 months (2 weeks -10 months) (Figure 4).
100
Effectif
80
0-1 mois
60
1-2mois
40
2-3mois
4+
20
0
Délai de consultation
Figure 4. Distribution according to the consultation time of cutaneous leishmaniasis cases in Ain Dfali (2006-2015)
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Cutaneous Leishmaniasis in Ain Dfali province, West Morocco (2006-2015)
Lesions were unique in 71.9% with an average of 1.39 lesions per patient (Figure 5).
Unique
Deux
Trois
Quatre et plus
Figure 5. Distribution by number of lesions of cutaneous leishmaniasis cases in Ain Dfali (20062015)
The lesions sitting on the face in 71.9% of the cases, on the upper limbs in 14.39%, on the
lower limbs in 13.63% of the cases (Figure 6).
35
30
25
20
15
10
5
0
nez
nombre
32
bras pied paup main joue front oreill lévre
iére
e
2
18
6
17
19
24
9
5
Figure 6. Distribution by site of lesions of cutaneous leishmaniasis cases in Ain Dfali (2006-2015)
The clinical features found were 48% ulcero-crust (Photo A), 34% papulo-nodular form
(Photo B), 11% erythematous-squamous form (Photo C) and 7% unspecified (Figure 7).
Non spécifié
7%
érythémato-squameuse
11%
papulo-nodulaire
34%
ulcéro-croûteuse
48%
0%
10%
20%
30%
40%
50%
60%
pourcentage
Figure 7. Distribution by lesion aspects of cutaneous leishmaniasis cases in Ain Dfali (2006-2015)
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5. DISCUSSION
Cutaneous leishmaniasis has a circum-terrestrial geographical area. According to the WHO,
the population at risk of leishmaniasis is estimated at 350 million people (WHO, 2010). The
global incidence of LC, in all clinical forms, is between 1 and 1.5 million / year. More than
90% of LF cases come from Afghanistan, Iran, Saudi Arabia and Syria for the old world,
Brazil and Peru for the new world (Momeni, 1994).
Morocco is an endemic country of the LC. Infection occurs in three noso-geographic
forms: the zoonotic LC to Leishmania major in the south, the anthroponotic LC to Leishmania
tropica in the center with emergence of new outbreaks in the north and the sporadic LC to
Leishmania infantum in the north whose first Moroccan case has revealed in 1996 (Rhajaoui
2004, Guessous 1994, Chihab 1999).
Between 2007 and 2011, 27457 cases of CL were identified (Ministry of Health Morocco,
2012). The analysis of the epidemiological data revealed a control of the LC profile at L.
major in the majority of the old foci with a reactivation observed during the year 2010.
Moreover, the LC to L. tropica has experienced outbreaks epidemic (El Assri, 2016).
LC affects all ages and the child can be exposed to the disease in the first months of life (6
-10). We note a predominant impairment of school-aged children, especially those over ten
years of age (38.6% of cases). The distribution of LC by sex is variously appreciated in the
literature (EL Aasri, 2015). There does not seem to be any significant difference in our series.
Clinically, our results are superimposable to those of the literature. The predominance of
the ulcero-crustal form in our series, noted also in the other studies carried out in North
Africa, is explained by the frequency of LC to L. Major (Guessous, 1999). The latter form is
characterized by multiple lesions, localization at the level of the regions discovered especially
at the level of face and limbs as well as the short duration of evolution (Aoun, 2012).
The long consultation time found in our work is explained by the slowly insidious,
indolent and benign nature of the lesions. In our context, the diagnosis is often made in
autumn or winter away from the contamination that occurred in summer (after a stay in
endemic area).
Numerous clinical presentations are possible during LC, the impetigo, warty, vegetative,
lupoidal, pseudotumoral, psoriasiform, lichenified, ulcerous, echtymatous, lymphangitic,
abortive, sporotrichoid and nodular forms. This clinical polymorphism does not only depend
on the genetic characteristics of the parasite, but also on the immunological status of the host.
Indeed, the balance of functional phenotypes of CD4 T lymphocytes plays an important role
in the determinism of this affection; schematically the Th1-type response corresponds to a
benign localized lesion, the Th2 response involves extensive severe injury.
Leishmania-HIV co-infection is currently considered an emerging disease, especially in
southern Europe (Dedet, 2000). WHO estimates that 1.5 to 9% of AIDS patients have visceral
leishmaniasis (Momni, 1994). The cutaneous form is more and more described during HIV
infection (Durant, 1998).
The diagnosis of LC is evoked clinically, confirmation is based on the detection of the
parasite. The direct examination on the smear or the colored puncture with the MGG seems to
be the best examination for the diagnosis because economic, easy, fast and without danger.
However, it lacks sensitivity. Special Environment (NNN) culture improves the sensitivity of
parasitological examination by 16% (Belhadej 2005, Grevlink 2003)]. Pathological
examination also contributes to the diagnosis. The enzymatic identification of species is a
reference technique, reserved for specialized laboratories, as well as for PCR, the results of
which seem very promising (98% sensitivity versus 80% with conventional diagnostic means)
(Chergui, 2003; Matsumoto, 1999). This makes discuss the interest of this new method in our
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Cutaneous Leishmaniasis in Ain Dfali province, West Morocco (2006-2015)
context in front of an evocative clinical presentation without isolation of the parasite with the
usual techniques. In our experience other arguments have been taken into account: the notion
of stay in an endemic zone, the slow evolution and the non-response to other therapies
(antibiotics, antimycotics).
The therapy of leishmaniasis has only changed for many years. Glucantime is the standard
treatment for cutaneous leishmaniases (Buffet, 1994). However, this treatment exposes many
side effects, and resistance is increasingly reported in several countries. For single or
infrequent LC, intralesional infiltration has proved its effectiveness (100% success in our
series) The results obtained in our patients are similar to those of the literature, with an
efficacy of Glucantime without general adverse effects nor pigmented scars. Many products
have been tried in the literature (amphotericin B, fluconazole, disulone, rifampicin), as well as
the laser, bleomycin intra-lesional. Currently, hopes are placed in allopurinol, aminosidine
sulfate (paromomycin) or triazoles, or even in some hydroxynaphthoquinones, such as
atovaquone. Immunostimulation with interferon has been the subject of convincing clinical
trials that have unfortunately no future (Buffet, 1994, Morizot, 2007).
6. CONCLUSION
Cutaneous leishmaniasis continues to pose a real public health problem in our country. The
emergence of severe and resistant forms throughout the world should encourage the
multiplication and reinforcement of prophylactic measures through the fight against the
reservoirs and vectors of the parasite. Therapeutic optimization, standardized protocol
monitoring and consensual repository remain necessary.
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