Investigation of the spread of human visceral leishmaniasis in central Tunisia.

Abstract The epidemiology, clinical patterns, and spatial spread of Mediterranean visceral leishmaniasis were retrospectively studied in central Tunisia. The clinical profile of the disease was typical of the Mediterranean infantile form. Malnutrition and associated infectious diseases were observed in 62·5% and 55% of cases, respectively. The case-fatality rate was 6·2% and resistance to meglumine antimonate was observed in 1·6% of patients. The annual incidence of cases increased from ~ 10 cases per year before 1991 to ~50 cases per year between 1992 and 1994. The cumulative incidence was 133·7/100000 among children aged Leishmania infantum transmission cycle below the Atlas mountain chains, and an evident tendency to a progressive extension to the south.