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      Review of Leishmaniasis in the Middle East and North Africa

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          Abstract

          Background

          Cutaneous and visceral forms of leishmaniasis are the most important protozoan infection in the Middle East and North Africa (MENA).

          Objectives

          Review the current knowledge on leishmaniasis in the MENA.

          Methods

          The data presented in this review are gathered primarily from WHO reports and from an extensive literature search on PubMed.

          Results

          There are four cycles of transmission of leishmaniasis: zoonotic cutaneous leishmaniasis (ZCL), induce by Leishmania ( L.) major, transmitted by Phlebotomus ( P.) papatasi, with rodent species of Psammomys obesus, Meriones libycus, Nesokia indica, and Rhombomys opimus are considered as host reservoirs. Zoonotic visceral leishmaniasis (ZVL) is inducing by L. infantum, transmitted by several Phlebotomus spp. of the sub-genus Larroussius and mainly P. perniciosus in more than one-half of the MENA countries and the dog species of Canis familiaris are considered as the main reservoirs. Anthroponotic cutaneous leishmaniasis (ACL), induce by L. tropica and transmitted by P. sergenti, without any non-human reservoir in most cases. Anthroponotic visceral leishmaniasis (AVL) induces by L. donovani spreads through P. alexandri, circulates exclusively in humans.

          Conclusion

          There are many challenges facing the successful control of leishmaniasis. However, there is continuing research into the treatment of leishmaniasis and potentially vaccinations for the disease.

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          Most cited references59

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          Biology of phlebotomine sand flies as vectors of disease agents.

          Paul Ready (2013)
          Phlebotomines are the sole or principal vectors of Leishmania, Bartonella bacilliformis, and some arboviruses. The coevolution of sand flies with Leishmania species of mammals and lizards is considered in relation to the landscape epidemiology of leishmaniasis, a neglected tropical disease. Evolutionary hypotheses are unresolved, so a practical phlebotomine classification is proposed to aid biomedical information retrieval. The vectors of Leishmania are tabulated and new criteria for their incrimination are given. Research on fly-parasite-host interactions, fly saliva, and behavioral ecology is reviewed in relation to parasite manipulation of blood feeding, vaccine targets, and pheromones for lures. Much basic research is based on few transmission cycles, so generalizations should be made with caution. Integrated research and control programs have begun, but improved control of leishmaniasis and nuisance-biting requires greater emphasis on population genetics and transmission modeling. Most leishmaniasis transmission is zoonotic, affecting the poor and tourists in rural and natural areas, and therefore control should be compatible with environmental conservation.
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            The biology and control of phlebotomine sand flies.

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              Phlebotomine vectors of the leishmaniases: a review.

              R Killick (1989)
              An account is given of work published during the past 10 years incriminating species of phlebotomine sandflies as vectors of Leishmania species which infect man. An assessment is made of the degrees of certainty of the vectorial roles of eighty-one species and subspecies of sandflies (thirty-seven Old World and forty-four New World) in the transmission of twenty-nine leishmanial parasites of mammals. At least one species of sandfly is considered to be a proven vector of each of ten parasites. Of the eighty-one sandfly taxa, evidence is judged to be sufficient to incriminate nineteen as proven vectors (eleven Phlebotomus species and eight Lutzomyia species or subspecies) and evidence for a further fourteen (nine Phlebotomus species and five Lutzomyia species or subspecies) is considered to be strong. The suggested criteria for incrimination of a vector are anthropophily and common infection with the same leishmanial parasite as that found in man in the same place. More weight should be given to natural infections persisting after the digestion of a bloodmeal than those in the presence of blood. Supporting evidence is a concordance in the distribution of the fly and the disease in man, proof that the fly feeds regularly on the reservoir host, a flourishing development of the parasite in infected flies and the experimental transmission of the parasite by the bite of the fly.
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                Author and article information

                Journal
                Afr Health Sci
                Afr Health Sci
                African Health Sciences
                Makerere Medical School (Kampala, Uganda )
                1680-6905
                1729-0503
                March 2019
                : 19
                : 1
                : 1329-1337
                Affiliations
                Department of Hygiene and Environmental Protection, Ministry of Public Health, Tunis, Tunisia
                Author notes
                Corresponding author: Ahmed Tabbabi, Department of Hygiene and Environmental Protection, Ministry of Public Health, Tunis, Tunisia. tabbabiahmed@ 123456gmail.com
                Article
                jAFHS.v19.i1.pg1329
                10.4314/ahs.v19i1.4
                6531937
                31148958
                ec10d1a8-f0d7-40b8-a754-1d9ee78db612
                © 2019 Tabbabi.

                Licensee African Health Sciences. This is an Open Access article distributed under the terms of the Creative commons Attribution License ( https://creativecommons.org/licenses/BY/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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                cutaneous and visceral leishmaniasis,global distribution,middle east and north africa

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