Epidemiological and clinical profiles of cutaneous leishmaniasis diagnosed in Casablanca (Morocco) suggest a possible introduction of Leishmania tropica to urban areas

Abstract Leishmaniases are a group of infectious diseases that are caused by protozoan parasites in the genus Leishmania and are transmitted by the bites of infected phlebotomine sandflies. The heterogeneity of these diseases is influenced by both parasitic properties and host factors. Cutaneous leishmaniasis (CL) is a major public health problem in Morocco, where the geographical expansion of CL (particularly CL caused by L. tropica), the heterogeneous appearance of the lesions and the difficulty in diagnosing CL contribute to the late diagnosis and delayed treatment of patients. Therefore, the main objective of this study was to describe the epidemiological and clinical profiles of CL diagnosed in Casablanca (Morocco), which is a non-endemic area for CL. A cross-sectional study was carried out between 2010 and 2016, during which epidemiological and clinical data were collected from patients that met the inclusion criteria through an information sheet. Samples were then obtained from each patient for parasitological and molecular diagnosis, and only those patients who had positive PCR and genotyping results were included in the study. The data were statistically analyzed using SPSS 16.0. Overall, 106 cases of CL were genotyped, of which 61 (57.5%) were caused by L. tropica, 38 (35.9%) were caused by L. major and 7 (6.6%) were caused by L. infantum. While all age groups were affected, CL cases where L. tropica was the causative agent were most frequently diagnosed in children aged 0–9 years (p = .005), while those caused by L. major were more frequently diagnosed in elderly patients (p = .004). Multivariate analysis showed that two clinical variables were significantly associated with CL caused by L. tropica: lesion size (p = .002), and the occurrence of the lesion on the face (p = .005). Furthermore, the results of our survey highlighted the association of Leishmania infection when travelling into endemic areas. The high number of endemic foci where CL patients were infected with L. tropica illustrated the tendency of this form to spread and generate epidemics, placing young people at greater exposition. The epidemic situation for CL caused by L. tropica in Morocco and the increased movement of the population from rural to urban areas suggest a possible introduction of this species to urban areas.