Cutaneous Leishmaniasis Due to <em>Leishmania Tropica</em> in the Area of Ouezzane (North-Western, Morocco)

Research Article

Austin J Public Health Epidemiol. 2016; 3(2): 1034.

Cutaneous Leishmaniasis Due to Leishmania Tropica in the Area of Ouezzane (North-Western, Morocco)

Jellouli A1,2*, Belghyti D¹, Mirat A²and Guamri YE1,3

¹Department of Environment and Renewable Energy, Ibn Tofail University, Morocco

²Health Center in the Rural District of Teroual. Provincial Delegation of Health in Ouezzane, Morocco

³Department of Life Sciences and Earth, CRMEF of Marrakech, Morocco

*Corresponding author: Jellouli A, Department of Environment and Renewable Energy, Ibn Tofail University, Morocco

Received: January 25, 2016; Accepted: February 02, 2016; Published: February 04, 2016


The purpose of this work is to bring some clinical, diagnostic, therapeutic and evolutive and identify risk factors for cutaneous Leishmaniasis, observed Teroual (district of Ouezzane). We report an outbreak of 55 cases of indigenous cutaneous Leishmaniasis of Leishmania tropica occurred in 2005. The epidemiological situation has taken a more breadth and become epidemic in rural areas with 75% were women and 25% of men, 62% were between 0 and 15 years. The evolutionary stage of the lesions were classified into early lesions (26 cases including 12 with nodules and papules with 14) and advanced lesions (29 cases). The type of diagnostic certainty based on parasitological examination (73% positive) and clinical criteria.

The increase in the incidence of leishmaniasis in this region is due to several reasons including the influx of unimmunized population arriving in homes natural transmission, changes in the ecology of vectors, host reservoir, improved diagnosis and reporting of positive cases.

Keywords: Cutaneous leishmaniasis; Leishmania tropica; Ouezzane; Morocco


Cutaneous Leishmaniasis (CL) is parasitic diseases caused by protozoa of the genus Leishmania flagellates. They present two different evolutionary stages: promastigote in the sandfly gut and intracellular amastigotes in the vertebrate host. In Morocco, a LC rampant endemic and epidemic fashion and are a public health problem. No fewer than 1011 cases of LC to L. tropica and 2140 cases of LC in L. major were recorded during of the year 2003 [1].

In the distinct of Ouezzane, the number of reported human LC significantly increased from three cases in 1992 to 75 in 2003. In the rural area of Teroual, the most common species is L. tropica (Ministry of Health, Morocco, 2003), head of a cutaneous ulcer with a main and beginners or advanced lesions. The only reservoir of Leishmania tropica is currently known human (Ministry of Health, Morocco, 1997). This is a strictly human parasitosis or anthroponose. The vector is Phlebotomus sergenti present in the Mediterranean basin [2], which more readily bites man indoors and outdoors. This work reports some clinical, diagnostic, therapeutic and evolutionary LC anthroponotic observed Teroual (ditrict Ouezzane).

Materials and Methods

Place of study

The cases of LC were observed in the rural commune of Teroual, north-east of the district of Ouezzane. Teroual is a rural town of 295 km² (5°N latitude 34°16 40 W longitude) with a hilly and mountainous limestone-sandstone hills (Lainson, 1981) belonging to the Tangier- Tetouan region Hoceima. The population of 12621 inhabitants is composed of 52.8% men and is very young, especially in rural areas [3]. The climate is sub-humid temperate winter type with an average of 546.6 mm of precipitation and an annual average temperature of the warmest month of 30.3°C and the coldest month of 9.5°C.


The prospective study included patients with inclusion criteria such as a skin lesion and isolation of Leishmania. The epidemiological, clinical and biological were collected in a standardized way. The local lesions were cleaned with antiseptic based Betadine and treated by intralesional route glucantime by means of a syringe fitted with a fine needle (insulin syringe type) of 1 to 3 ml of product per session, 1 to 2 times per week depending on the lesion. The injection is practiced in healthy skin, 1 cm from the edge of the lesion, to infiltrate the periphery where mostly sit Leishmania [4].

Techniques used

For each patient, a sample of the dermal juice was made by scraping the edge of the ugly lesion with a sterile lancet. A puncture - aspiration of dermal juice enables a smear, and this for all the 55 cases reported. The detection of parasites was performed by staining with May- Grunwald-Giemsa (MGG). All cases are confirmed by parasitological examination with search amastigote forms of Leishmania. Leishmania are sought optical microscope (target 100) with oil immersion. They come in amastigote form or micromastigote that are strictly immobile intracellular elements. During the preparation of the smears, host macrophage cells can burst and leishmania are thereby scattered on the smear. These elements are round or ovoid diameter of from 2 to 6μ. The cytoplasm is blue with 2 red dots: one is big eccentric, purplish red corresponding to the kernel; the other is red vermilion bacilliform corresponding to blepharoplast [5].


55 cases of LC have been fixed for 2005: 73% parasitologically positive, and 27% only clinics. There were significantly more women (75%) than men. The child population under 15 years old represents 61% of cases, confirming an active indigenous transmission in this outbreak. Ages [10-15] and [15-45] are equal (Figure 1). Women and children consult more frequently than men.