Retrospective Study of Tegumentary Leishmaniasis in Burkina Faso, from 2012 to 2016

Retrospective Study of Tegumentary Leishmaniasis in Burkina Faso, from 2012 to 2016 Patindoilba Marcel Sawadogo1,2*, Kiswendsida Thierry Guiguemdé2,4, Adama Zida1,2, Nina korsaga/Somé2,3, Ibrahim Sangaré5,6, Sanata Bamba5,6, Salimata Kiemdé1, Rasmata Ouédraogo/Traoré2,4 1Parasitology-Mycology Service, Yalgado Ouédraogo University Hospital Center, Ouaga, Burkina Faso 2Training and Research Unit in Health Sciences, Ouaga University 1 Professor Joseph Ki-Zerbo (UO1 / PrZKZ), Ouagadougou, Burkina Faso 3Dermatology-Venereology service, Yalgado Ouédraogo University Hospital Center, Ouaga, Burkina Faso 4Parasitology-Mycology Service, Charles de Gaulle University Hospital Center, Ouagadougou, Burkina Faso 5Institute of Health Sciences, Nazi Boni University, Bobo Dioulasso, Burkina Faso 6Parasitology-Mycology Service, Souro Sanou University Hospital Center, Bobo Dioulasso, Burkina Faso


Introduction
Leishmaniasis are infectious diseases caused by the parasitism of mononuclear phagocyte system cells by flagellate protozoa belonging to the genus Leishmania. These parasites are transmitted by dipteran insects of genus of Phlebotomus in the Old World and Lutzomyia in the New World 1,2 . In Ouagadougou, the leishmania specie encountered in cutaneous leishmaniasis is Leishmania major. The vector sandfly species has still not been identified 3,4 . Clinically there are three types of Leishmaniasis depending on the parasite species and the immune status of the host: visceral Leishmaniasis, cutaneous Leishmaniasis, mucocutaneous Leishmaniasis. Leishmaniasis occur in tropical and subtropical areas of 98 countries, including 72 developing countries and 350 million people are at risk of contracting the disease 5,6,7 . Leishmaniasis is a global public health problem, with an estimated prevalence of 12 million cases 8,9 . The annual incidence as for it, is increasing in the world and would be between 1.5 to 2 million 6 . According to WHO, Leishmaniasis ranks ninth among the thirteen most important tropical diseases.
In Burkina Faso, the first cases were notified in 1960 by Oddou 1  The last study on cutaneous Leishmaniasis in the city of Ouagadougou was conducted by Sawadogo in 2012, where 2,608 cases were recorded for the period from 2006 to 2012 3 . Since this last study in 2012, there is a lack of updated knowledge on tegumentary Leishmaniasis in the city of Ouagadougou. However, the disease seems to be experiencing an upsurge as evidenced by the numerous requests for laboratory examinations and multiple relapses. It is in this context that we conducted this study to update the data on tegumentary Leishmaniasis since 2012.

Methods
The aim was to evaluate the current state of the disease in the city of Ouagadougou from 2012 to 2016. The city of Ouagadougou is the administrative capital of Burkina Faso. Located in the heart of Kadiogo province, Ouagadougou is an urban agglomeration that covers an area of 51,800-hectare, 1 915 102 inhabitants (2012 estimate) 12 . the city has three third level centers and 5 health districts. The study concerned all health centers in the city where the clinical and laboratory diagnosis of tegumentary Leishmaniasis is made. The data were located in all the 5 health districts and 3 public or semipublic referral centers and provided a general overview of the state of the tegumentary Leishmaniasis of the city of Ouagadougou. The factors explaining the LC epidemics in Ouagadougou are still at the stage of hypotheses. The role of displacement of urban populations to peripheral areas has also been implicated in the epidemic 3 . Rodents of the genus Mastomys sp, Taterillus sp have been captured infected, suggesting their role as reservoir of parasites in epidemiology 3 .

Patients of the study
The study population consisted of suspected patients of tegumentary Leishmaniasis who consulted in the health centers concerned by the study between 2012 and 2016. Only microscopically confirmed cases were taken into consideration for the study.

Inclusion criteria
All suspected cases of integumentary leishmaniasis were included, regardless of sex, age and ethnicity, having undergone a biological diagnosis at the Parasitology-Mycology laboratories of the CHU-YO and Sainte Elisabeth.

Data collection process
We performed a full collection of data on tegumentary leishmaniasis contained in the existing records of the referred health centers and laboratories consulted Data collection sources consisted of: Clinical records of patients, records of consultations and hospitalizations, hard disks containing electronic patient records, laboratory records.
The collection was carried out in two stages: the first stage is carried out in the laboratories of hospitals Parasitology concerned, and was to collect all suspected cases of tegumentary leishmaniasis having been confirmed by an parasitological examination between 2012 and 2016. The second stage took place in the Dermatology-Venerology departments of the concerned hospitals. In these services, clinical and sociodemographic characteristics of the patients were collected from clinical records.

Data analysis
The collected data were analyzed and processed using the software Epi Info version 7.2.1.0 and Microsoft Excel 2016.

Results
From 2012-2016, 213 patients were considered suspicious and 96 were parasitologically confirmed. Of the 96 confirmed cases, the sex ratio was 1.4 (Male/female). Age was mentioned in 84 patients. The average age was 30.82 ± 21 years with extremes of 1 to 82 years. The

Distribution of confirmed tegumentary leishmaniasis cases from from 2012 to 2016
The distribution of the number of tegumentary Leishmaniasis is shown in Figure 1. The highest number was observed in 2012 with 32/96 (33.33%) and the smallest number was noted in 2016 with 13 cases.

Evolution of leishmaniasis lesions after treatment
Progression was favorable in 19/42 (45.24%) of

Discussion
The fact that our study was retrospective, did not allow us to find, in some cases, all the data of the interrogation, the physical examination. To this is added the lack of parasitological confirmation of some cases, hence the reduction of the sample size to 96 confirmed cases. In addition, confirmation in the laboratory was limited to demonstrating the amastigote form without identification of the Leishmania species.
We found a sex ratio of 1.  14 . Two main factors could explain the male predominance. On the one hand, this is the predominance of men in the population of Ouagadougou 12 and on the other hand, the heavy nighttime use of public spaces by men exposes them to the bite of sandflies. The average age of our patients was 30.82 ± 21 years, with extremes of 1 year to 82 years. This finding was similar to that of Hajji in 2010 in Morocco, which noted an average age of 32 years with extremes ranging from 1 year to 85 years. The age groups of 10-14 and 15-49 years were the most represented 15 . Indeed, the population of this age group is the most active population, therefore the most exposed to vector transmission of the disease. However, it should be noted that despite the decrease in the number of cases, tegumentary leishmaniasis continues to be endemic in Ouagadougou. This persistence in Ouagadougou is believed to be due to several factors, which are: the absence of national guidelines to fight this disease. In fact, although the control of leishmaniasis is integrated into the vast program of neglected tropical diseases control, no strategy to control leishmaniasis has yet been implemented in Burkina Faso 3 . There is also the importance of the rodent population, a reservoir of leishmania, in the outskirts of the city of Ouagadougou due to the high urbanization of the city. Finally, the precarious sanitation of the city promotes the proliferation of sandflies, and thereby the transmission of the disease. The role of displacement of urban populations to peripheral areas has also been implicated in the epidemic 3 .
We identified twelve (12) 9 , who noted the use of meglumine antimoniate (Glucantime®) as first-line therapy. This shows that there has been very little change in Leishmaniasis therapy 21 . Meglumine antimoniate is the standard treatment for tegumentary Leishmaniasis. However, this treatment exposes many side effects and resistance is increasingly reported in several countries 21 .
Progression under treatment was not emphasized in 47% of patients. It was favorable in 19/42 (45.24%) of the cases and was marked by recurrence under treatment with Glucantime® in 3/42 cases (7.14%) thus raising probable cases of resistance of some of tegumentaire with antimonies. Cases of recurrence were mentioned by Nikiéma in Burkina Faso in 2002 (4 cases) 16 .

Conclusion
At the end of our retrospective study on tegumentary leishmaniasis in the city of Ouagadougou from 2012 to 2016, it appears that the disease is still quite frequently encountered in Ouagadougou. Although the number of cases is significantly lower in the early 2000s, the fluctuating evolution of the number of cases from 2012 to 2016 raises fears of an epidemic outbreak of the disease. Precautions must be taken to avoid a new epidemic of tegumentary leihsmaniasis in Ouagadougou.