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Leishmaniases are a vector-borne parasitic diseases with diverse clinical manifestations involving multiple Leishmania species and animal hosts. While most leishmaniasis cases are caused by a few well characterized Leishmania species, reports describe infections by unconventional or emerging Leishmania taxa, atypical clinical presentations from classical species, and occurrences of atypical Leishmania in animal hosts. These underrecognized infections present diagnostic and therapeutic challenges and are rarely reflected in surveillance systems or clinical guidelines. A systematic mapping of this evolving landscape is needed to guide future diagnostics, policy, and research priorities. Following the Joanna Briggs Institute (JBI) methodology and PRISMA-ScR guidelines, we will search PubMed, Embase, Cochrane Library (CENTRAL), PROSPERO, Web of Science, and Global Index Medicus, as well as relevant grey literature. Eligible studies will include human cases with clinical presentations that diverge from those typically associated with well-characterized Leishmania species, reports involving unconventional or emerging Leishmania species, and animal cases of veterinary relevance caused by non-classical species, regardless of study design. Dual independent screening of records and data extraction using a standardized charting form will be conducted. Discrepancies between reviewers will be resolved by consensus. Data will be summarized descriptively through tables, figures, and thematic synthesis. Research gaps will be identified to inform future studies and public health strategies. This review will use data from published sources and findings will be disseminated through publication in a peer-reviewed journal, presentations at scientific conferences, and sharing with relevant stakeholders. The results are intended to inform clinicians, researchers, and policymakers about the evolving landscape of leishmaniasis and to highlight priorities for future research and surveillance.

Given the significance of leishmaniasis as a neglected parasitic disease—ranking second in mortality and fourth in morbidity among vector-borne diseases—and the prominence of the Mediterranean and Middle East regions as key areas for leishmaniasis incidence, the study and precise morphological identification of sand flies, the proven vectors of the disease, is crucial. Unfortunately, despite this importance, there are few reliable references or identification keys for the morphological identification of sand flies in the Middle East and Mediterranean regions. Some are outdated and no longer valid or remain local (restricted to a country). To date, no comprehensive study has been conducted on the sand fly fauna and their morphological characterization across these regions. In response to this gap, we present a comprehensive pictorial identification key for male and female Phlebotomus species of Middle East and Mediterranean areas. The key includes 720 selected photos and illustrations demonstrating discriminative morphological features out of 2,000 collected. Furthermore, a collection including descriptive morphological criteria of sand flies, first description of Phlebotomus species, a comprehensive checklist of Phlebotomus species accompanied by their distribution map across Middle Eastern and Mediterranean countries, as well as extensive information on their morphometry, ecology, medical relevance, synonymy, atypical forms and morphology of female Adlerius species are given. Finally, we provide an online pictorial dichotomous key to facilitate field application.

Background Phlebotomus papatasi is considered the primary vector of Leishmania major parasites that cause zoonotic cutaneous leishmaniasis (ZCL) in the Middle East and North Africa. Phlebotomus papatasi populations have been studied extensively, revealing the existence of different genetic populations and subpopulations over its large distribution range. Genetic diversity and population structure analysis using transcriptome microsatellite markers is important to uncover the vector distribution dynamics, essential for controlling ZCL in endemic areas. Methods In this study, we investigated the level of genetic variation using expressed sequence tag-derived simple sequence repeats (EST-SSRs) among field and colony P. papatasi samples collected from 25 different locations in 11 countries. A total of 302 P. papatasi sand fly individuals were analyzed, including at least 10 flies from each region. Results The analysis revealed a high-level population structure expressed by five distinct populations A through E, with moderate genetic differentiation among all populations. These genetic differences in expressed genes may enable P. papatasi to adapt to different environmental conditions along its distribution range and likely affect dispersal. Conclusions Elucidating the population structuring of P. papatasi is essential to L. major containment efforts in endemic countries. Moreover, the level of genetic variation among these populations may improve our understanding of Leishmania –sand fly interactions and contribute to the efforts of vaccine development based on P. papatasi salivary proteins. Graphical Abstract

Background: Phlebotomus sergenti, the proven vector of Leishmania tropica, the causative agent of anthroponotic cu­taneous leishmaniasis, is widely distributed in Morocco. Previous works using molecular markers (Internal Transcribed Spacer 2 rDNA and Cytochrome B mtDNA) hypothesized the existence of multiple closely related populations of sand fly species (cryptic species) that would exhibit distinct vectorial capacities. This work studies morphotypic diversity using traditional and geometric morphometry analyses carried out on Ph. sergenti's wings from central Morocco, where active L. tropica transmission occurs for 30 years. Methods: Descriptive characteristics (size and shape) of the right wings were measured in Ph. sergenti’s specimens collected from fourteen stations in central Morocco. Both traditional and geometric morphometry methods were used to analyse geographic variations in Ph. sergenti wing’s size and shape. Results: These analyses support the existence of distinct Ph. sergenti populations, enlightening significant phenotypic variations of Ph. sergenti’s wings, regarding their size and shape, depending on geographic origin. In addition, tradi­tional and geometric morphometric analyses of the wing’s length, centroid size, β, ɵ, and γ distances allowed clear dis­crimination of Ph. sergenti sub-populations. Conclusion: These data pinpoint the adaptative ability of Ph. sergenti to local environmental conditions. Additional studies are now required to further shed light on the genetic structure of Ph. sergenti populations in Morocco.  

Zoonotic cutaneous leishmaniasis (ZCL) caused by Leishmania major Yakimoff & Shokhor and transmitted by Phlebotomus papatasi (Scopoli) is a public health concern in Morocco. The disease is endemic mainly in pre-Saharan regions on the southern slope of the High Atlas Mountains. The northern slope of the High Atlas Mountains and the arid plains of central Morocco remain non-endemic and are currently considered high risk for ZCL. Here we investigate and compare the population genetic structure of P. papatasi populations sampled in various habitats in historical foci and non-endemic ZCL areas. A fragment of the mtDNA cytochrome oxidase I (COI) gene was amplified and sequenced in 59 individuals from 10 P. papatasi populations. Haplotype diversity was probed, a median-joining network was generated (FST) and molecular variance (AMOVA) were analyzed. Overall, we identified 28 haplotypes with 32 distinct segregating sites, of which seven are parsimony informative. The rate of private haplotypes was high; 20 haplotypes (71.4%) are private ones and exclusive to a single population. The phylogenetic tree and the network reconstructed highlight a genetic structuration of these populations in two well defined groups: Ouarzazate (or endemic areas) and Non-Ouarzazate (or nonendemic areas). These groups are separated by the High Atlas Mountains. Overall, our study highlights differences in terms of population genetics between ZCL endemic and non-endemic areas. To what extent such differences would impact the transmission of L. major by natural P. papatasi population remains to be investigated.

Cutaneous leishmaniasis is a vector-borne disease transmitted to humans by sandflies. In this paper, we develop a mathematical model which takes into account the seasonality of the vector population and the distribution of the latent period from infection to symptoms in humans. Parameters are fitted to real data from the province of Chichaoua, Morocco. We also introduce a generalization of the definition of the basic reproduction number R (0) which is adapted to periodic environments. This R (0) is estimated numerically for the epidemic in Chichaoua; approximately 1.94. The model suggests that the epidemic could be stopped if the vector population were reduced by a factor approximately 3.76.

Cutaneous leishmaniasis is a vector-borne disease transmitted to humans by sandflies. In this paper, we develop a mathematical model which takes into account the seasonality of the vector population and the distribution of the latent period from infection to symptoms in humans. Parameters are fitted to real data from the province of Chichaoua, Morocco. We also introduce a generalization of the definition of the basic reproduction number R sub(0) which is adapted to periodic environments. This R sub(0) is estimated numerically for the epidemic in Chichaoua; [ approximately equal to ] 1.94. The model suggests that the epidemic could be stopped if the vector population were reduced by a factor (R sub(0)) super(2) [ approximately equal to ] 3.76.

The wing shape and size morphology of populations of the medically important phlebotomine sand fly, Phlebotomus papatasi, were examined in two endemic (south of the Atlas Mountains) and nonendemic (north of the Atlas Mountains) foci of cutaneaous leishmaniasis by using geometric morphometrics in Morocco. Although it is present in all of Morocco, P. papatasi is the main vector of Leishmania major in only southern part of the Atlas Mountains. There are four major mountain ranges that serve as geographical barriers for species distribution in the study area and at least four gaps were recognized among these barriers. We found statistically significant differences in wing shape morphology between southern and northern populations. Analysis clearly recognized two main groups of populations on both sides of the mountains. The graphical depiction of Principal Component Analysis (PCA) and Canonical Variates Analysis (CVA) confirmed our morphometric study suggesting that the difference in wing morphology between the populations indicates that the population of P. papatasi shows phenotypic plasticity in the study area. According to centroid size analyses, which were used as measures of wing size differences among different sites, the north population of P. papatasi had relatively larger wings than the south population.