Case Report: First Report of Mucocutaneous Leishmaniasis in Algeria: Observations from a Case Report.

We present the first case of mucocutaneous leishmaniasis in Algeria, diagnosed in an immunocompetent 42-year-old man exhibiting an infiltrated and ulcerated plaque leading to macrocheilitis of the entire lower lip. He was a police officer who lived in a village in Ain El Hammam (Kabylie region, known as an active focus of zoonotic visceral leishmaniasis) without any history of travel for the previous 3 years. He suffered from cutaneous lesions for 22 months due to the misdiagnosis of a skin lesion resembling other diseases such as Crohn disease or sarcoidosis. A compilation of clinical, histopathological, parasitological, and molecular examinations revealed Leishmania infantum as the etiologic agent. The patient was treated with meglumine antimoniate, which resulted in the complete disappearance of the lesion 4 months after treatment.

Candida tropicalis is the most prevalent yeast species causing candidemia in Algeria: the urgent need for antifungal stewardship and infection control measures.

BACKGROUND: Despite being associated with a high mortality and economic burden, data regarding candidemia are scant in Algeria. The aim of this study was to unveil the epidemiology of candidemia in Algeria, evaluate the antifungal susceptibility pattern of causative agents and understand the molecular mechanisms of antifungal resistance where applicable. Furthermore, by performing environmental screening and microsatellite typing we sought to identify the source of infection. METHODS: We performed a retrospective epidemiological-based surveillance study and collected available blood yeast isolates recovered from the seven hospitals in Algiers. To identify the source of infection, we performed environmental screening from the hands of healthcare workers (HCWs) and high touch areas. Species identification was performed by API Auxa-Color and MALDI-TOF MS and ITS sequencing was performed for species not reliably identified by MALDI-TOF MS. Antifungal susceptibility testing followed CLSI M27-A3/S4 and included all blood and environmental yeast isolates. ERG11 sequencing was performed for azole-resistant Candida isolates. Microsatellite typing was performed for blood and environmental Candida species, where applicable. RESULTS: Candida tropicalis (19/66) was the main cause of candidemia in these seven hospitals, followed by Candida parapsilosis (18/66), Candida albicans (18/66), and Candida glabrata (7/66). The overall mortality rate was 68.6% (35/51) and was 81.2% for C. tropicalis-infected patients (13/16). Fluconazole was the main antifungal drug used (12/51); 41% of the patients (21/51) did not receive any systemic treatment. Candida parapsilosis was isolated mainly from the hands of HCWs (7/28), and various yeasts were collected from high-touch areas (11/47), including Naganishia albida, C. parapsilosis and C. glabrata. Typing data revealed interhospital transmission on two occasions for C. parapsilosis and C. glabrata, and the same clone of C. parapsilosis infected two patients within the same hospital. Resistance was only noted for C. tropicalis against azoles (6/19) and fluconazole-resistant C. tropicalis isolates (≥8 µg/ml) (6/19) contained a novel P56S (5/6) amino acid substitution and a previously reported one (V234F; 1/6) in Erg11p. CONCLUSIONS: Collectively, our data suggest an urgent need for antifungal stewardship and infection control strategies to improve the clinical outcome of Algerian patients with candidemia. The high prevalence of C. tropicalis joined by fluconazole-resistance may hamper the therapeutic efficacy of fluconazole, the frontline antifungal drug used in Algeria.

Evaluation of Fasciola hepatica Infections in Cattle in Northeastern Algeria and the Effects on Both Enzyme and Hepatic Damage, Confirmed by Scanning Electron Microscopy.

PURPOSE: The aim of our study is to establish the presence of Fasciola hepatica on farms in northeastern Algeria. METHODS: 143 blood and coprological samples of 15 males and 128 females of different breeds and ages were analysed. RESULTS: Our study indicates a heterogeneous level of the anti-f2 antibodies to Fasciola hepatica in response to the infection. The overall seroprevalence was about 22.37%, and 9 out of 13 investigated farms were infected, with rates varying from 5.88% to 70%. To explain the intrinsic variability of the infection, we identified age, sex and breed as potential risk factors. Based on this, we collected information about their relevance. There was a significant difference for age (p = 0.018) and coprology (p < 0.0001). Independently, sex and breed had no impact on the infection, although males were more infected (27%) than females (22%). Of the five investigated breeds, Holstein cattle (31.11%) were most affected, followed by Montbeliard (20.27%) and crossed breed (13.64%). Multivariate comparisons showed that the presence of faecal eggs reflects the active infectious status of cattle (p < 0.0001), while age (p = 0.011) and sex (p = 0.040) significantly impact the chance of acquiring the infection. To evaluate liver parenchyma integrity and its functionality, hepatic enzymes were examined and showed relatively low levels of aminotransferases, excluding cytolisis. Although sensitive to distomatosis, γGT and PAL values were inconsistent with the infection rate. The relatively high levels of proteins and albumin eliminate hepatic insufficiency. CONCLUSION: Our results suggest a chronic fasciolosis, confirmed by histology and SEM.

Large-scale evaluation of a rapid diagnostic test for human cystic echinococcosis.

Cystic echinococcosis (CE) is a neglected zoonotic disease, diagnosed through clinical findings, imaging techniques, and serology, for which many serological tests are available. Here we report a rapid unit assay, the immunochromatographic VIRapid® HYDATIDOSIS test (Vircell, Granada, Spain), potentially suitable for laboratories in low-prevalence or poorly equipped areas. This test was evaluated with a large retrospective cohort (224 sera), including patients suffering from CE or from other parasitic or liver diseases. The test was also assessed in routine conditions with a prospective cohort (115 sera) in areas where both cystic and alveolar echinococcoses have been diagnosed. Its performance (in terms of sensitivity, specificity, and both positive and negative likelihood ratios) was similar to an ELISA based on a crude antigen. Our study shows that this test performs adequately in the diagnostic process, when used with caution, especially regarding cross-reactivity with other parasitic diseases.

Molecular characterization of Echinococcus granulosus sensu stricto and Echinococcus canadensis in humans and livestock from Algeria.

In Algeria, previous studies investigated genotypes of Echinococcus granulosus sensu lato in animals and identified E. granulosus sensu stricto (s.s.) genotypes G1 and G3 whereas Echinococcus canadensis genotype G6 was only reported from dromedary cysts. Molecular data on human cystic echinococcosis (CE) were limited. We implemented a large genotyping study of hydatid cysts from humans and livestock animals to specify CE's molecular epidemiology and the genetic diversity in Algeria. Fifty-four human CE cysts from patients predominantly admitted in surgical units from Mustapha Hospital, Algiers, and 16 cysts from livestock animals gathered in two geographically distinct slaughterhouses, Tiaret and Tamanrasset, were collected. Molecular characterization was performed using sequencing of two mitochondrial genes, cytochrome c oxidase subunit I (COI) and NADH dehydrogenase subunit I (NDI). In humans, G1 of E. granulosus s.s. was the main genotype (90.7 %); four samples (7.4 %) were characterized as E. granulosus s.s. G3 and one cyst as E. canadensis G6 (1.8 %). This molecular confirmation of E. canadensis G6 human infection in Algeria was observed in a Tuareg female living in a desertic area in Tamanrasset. All cysts from sheep, cattle, and goat were identified as E. granulosus s.s. G1 and the two cysts originating from dromedary as E. canadensis G6. Twenty concatenated haplotypes (COI + NDI) were characterized. Among E. granulosus s.s., one haplotype (HL1) was highly predominant in both humans and animals cysts (71.6 %). This study revealed main occurrence of E. granulosus s.s. in humans and livestock animals, with description of a predominant shared haplotype corresponding to the main worldwide observed haplotype E.granulosus s.s. G1. E. canadensis G6 was limited to South Algeria, in dromedary as well as in human.

First detection of Leishmania infantum DNA in Phlebotomus longicuspis Nitzulescu, 1930 from visceral leishmaniasis endemic focus in Algeria.

Two clinico-epidemiological forms of leishmaniasis caused by Leishmania infantum complex are endemic in Algeria: human visceral leishmaniasis (HVL) and sporadic cutaneous leishmaniasis. In the northern part of the country, the Kabylian region is the main endemic HVL focus with more than 200 cases recorded annually. During the summer of 2009, an entomological study was performed in Larbaa Nath Irathen with the aim to identify the vectors of Leishmania and of phleboviruses. In the present paper, we report the results of the Leishmania vectors. In the field, female sand flies, which were alive at collection time, were morphologically identified and examined for the presence of promastigotes. The remaining sandflies (males and dead females) were carried to the laboratory for morphological identification and molecular analysis. Total DNA was extracted from each female sandfly, and ITS2 Leishmania was amplified by PCR. A total of 883 sandfly specimens were collected. Ten distinct species were morphologically identified: one species belonged to the Sergentomyia genus and nine to the Phlebotomus genus. L. infantum DNA was amplified in 1/169 (0.6%) dissected dead females, one Phlebotomus longicuspis. Our data support the Parrot's hypothesis raised in 1941 concerning the role of P. longicuspis in the transmission of L. infantum.

Molecular and serological evidence for the presence of novel phleboviruses in sandflies from northern algeria.

During summer 2007, a total of 785 phlebotomine flies were trapped in northern Algeria, identified morphologically, organised as monospecific pools and tested for the presence of phlebovirus RNA using degenerate primers. Three pools were positive, and the corresponding PCR products were cloned and sequenced. Viral sequences corresponding to two phleboviruses distinct from each other were detected in sandflies circulating in two close locations (140 km apart) in Northern Algeria. The 3 sequences were aligned with homologous polymerase sequences retrieved from the Genbank database, in order to examine their phylogenetic relationships. One viral sequence (from Phlebotomus papatasi) was closely related to but distinct from a sequence obtained from Phlebotomus ariasi sandflies trapped in Algeria in 2006. The two other viral sequences (from Phlebotomus longicuspis) were genetically distantly related to sequences corresponding to virus members of the Sandfly fever Naples virus species and although falling within the same group, this clearly represents a second distinct novel lineage. These results are indicative of a high genetic heterogeneity within sandflies trapped in a relatively small geographic area. Seroprevalence studies conducted on sera from populations living in the same areas indicated that humans can be infected by these viruses.

Sandfly fever Sicilian virus, Algeria.

To determine whether sandfly fever Sicilian virus (SFSV) is present in Algeria, we tested sandflies for phlebovirus RNA. A sequence closely related to that of SFSV was detected in a Phlebotomus ariasi sandfly. Of 60 human serum samples, 3 contained immunoglobulin G against SFSV. These data suggest SFSV is present in Algeria.