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 PubM ed. Unpublished studies were identified by searching in Google.com.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 Results: Nineteen published(n=19) and three unpublished were included.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.

Molecular markers for artemisinin and partner drug resistance in natural Plasmodium falciparum populations following increased insecticide treated net coverage along the slope of mount Cameroon:cross-sectional study

Background:Drug resistance is one of the greatest challenges of malaria control programmes,with the monitoring of parasite resistance to artemisinins or to Artemisinin Combination Therapy(ACT)partner drugs critical to elimination efforts.Markers of resistance to a wide panel of antimalarials were assessed in natural parasite populations from southwestern Cameroon.Methods:Individuals with asymptomatic parasitaemia or uncomplicated malaria were enrolled through crosssectional surveys from May 2013 to March 2014 along the slope of mount Cameroon.Plasmodium falciparum malaria parasitaemic blood,screened by light microscopy,was depleted of leucocytes using CF11 cellulose columns and the parasite genotype ascertained by sequencing on the Illumina HiSeq platform.Results:A total of 259 participants were enrolled in this study from three different altitudes.While some alleles associated with drug resistance in pfdhfr,pfmdr1 and pfcrt were highly prevalent,less than 3%of all samples carried mutations in the pfkelch13 gene,none of which were amongst those associated with slow artemisinin parasite clearance rates in Southeast Asia.The most prevalent haplotypes were triple mutants PfdhfrI51R59N108I164(99%),pfcrt-C72V73I74E75T76(47.3%),and single mutants PfdhpsS_(436)G_(437)K_(540)A_(581)A_(613)(69%)and Pfmdr1 N_(86)F)(184)D_(1246)(53.2%).Conclusions:The predominance of the Pf pfcrt CVIET and Pf dhfr IRN triple mutant parasites and absence of pfkelch13 resistance alleles suggest that the amodiaquine and pyrimethamine components of AS-AQ and SP may no longer be effective in their role while chloroquine resistance still persists in southwestern Cameroon.