title: Circulating species of Leishmania at microclimate area of Boulemane Province, Morocco: impact of environmental and human factors.
abstract: Cutaneous leishmaniasis (CL) is widely distributed in Morocco where its geographical range and incidence are related to environmental factors. This study aimed to examine the impact of several factors on the distribution of CL in Boulemane Province, which is characterized by several microclimates, and to identify the Leishmania species circulating in these areas.
  
  
  
  Ordinary least squares regression (OLSR) analysis was performed to study the impact of poverty, vulnerability, population density, urbanization and bioclimatic factors on the distribution of CL in this province. Molecular characterization of parasites was performed using a previously described PCR-RFLP method targeting the ITS1 of ribosomal DNA of Leishmania.
  
  
  
  A total of 1009 cases were declared in Boulemane Province between the years 2000 and 2015 with incidences fluctuating over the years (P = 0.007). Analyzing geographical maps of the study region identified four unique microclimate areas; sub-humid, semi-arid, arid and Saharan. The geographical distribution and molecular identification of species shows that the Saharan microclimate, characterized by the presence of Leishmania major was the most affected (47.78%) followed by semi-arid area where Leishmania tropica was identified in three districts. Among several environmental factors included in the study, poverty had the greatest influence on the spatial extension of the disease in this province.
  
  
  
  The incidence of CL in Boulemane Province varies between microclimate areas, and environmental factors partly explain this variation. However, the existence of CL in the most affected districts is mainly related to poverty, population movement and human behavior. To our knowledge, this the first study utilizing molecular techniques to confirm L. tropica and L. major as the causative agents of CL in Boulemane Province. Our findings indicate that the spatial and temporal distribution of CL in Boulemane Province is strongly related to poverty and population movement.
authors.affiliation: National Reference Laboratory of Leishmaniasis, National Institute of Hygiene, Rabat, Morocco. asmae.hmamouch@gmail.com.|Laboratory of Microbial Biotechnology, Sciences and Techniques Faculty, Sidi Mohammed Ben Abdellah University, Fez, Morocco. asmae.hmamouch@gmail.com.
authors.forename: Asmae
authors.initials: A
authors.lastname: Hmamouch
authors.affiliation: National Reference Laboratory of Leishmaniasis, National Institute of Hygiene, Rabat, Morocco.|Laboratory of Zoology and General Biology, Faculty of Sciences, Mohammed V University, Rabat, Morocco.
authors.forename: Mahmoud Mohamed
authors.initials: MM
authors.lastname: El Alem
authors.affiliation: National Reference Laboratory of Leishmaniasis, National Institute of Hygiene, Rabat, Morocco.|Laboratory of Zoology and General Biology, Faculty of Sciences, Mohammed V University, Rabat, Morocco.
authors.forename: Maryam
authors.initials: M
authors.lastname: Hakkour
authors.affiliation: Institute of Nursing Professions and Health Techniques, Casablanca, Morocco.
authors.forename: Fatima
authors.initials: F
authors.lastname: Amarir
authors.affiliation: Delegation of Ministry of health, Provincial Laboratory of Parasitic Diseases, Boulemane, Morocco.
authors.forename: Hassan
authors.initials: H
authors.lastname: Daghbach
authors.affiliation: Faculty of Sciences and Techniques, Sultan Moulay Slimane University, Beni Mellal, Morocco.
authors.forename: Khalid
authors.initials: K
authors.lastname: Habbari
authors.affiliation: National Reference Laboratory of Leishmaniasis, National Institute of Hygiene, Rabat, Morocco.|Laboratory of Zoology and General Biology, Faculty of Sciences, Mohammed V University, Rabat, Morocco.
authors.forename: Hajiba
authors.initials: H
authors.lastname: Fellah
authors.affiliation: Laboratory of Microbial Biotechnology, Sciences and Techniques Faculty, Sidi Mohammed Ben Abdellah University, Fez, Morocco.
authors.forename: Khadija
authors.initials: K
authors.lastname: Bekhti
authors.affiliation: National Reference Laboratory of Leishmaniasis, National Institute of Hygiene, Rabat, Morocco.|Faculty of Sciences and Techniques, Sultan Moulay Slimane University, Beni Mellal, Morocco.
authors.forename: Faiza
authors.initials: F
authors.lastname: Sebti
mesh_terms: D016054:DNA, Protozoan / Q000737:chemistry / Q000235:genetics; D021903:DNA, Ribosomal Spacer / Q000737:chemistry / Q000235:genetics; D006801:Humans; D015994:Incidence; D007891:Leishmania / Q000145:classification* / Q000302:isolation & purification*; D016773:Leishmaniasis, Cutaneous / Q000453:epidemiology* / Q000469:parasitology*; D008834:Microclimate; D009018:Morocco / Q000453:epidemiology; D010802:Phylogeny; D016133:Polymerase Chain Reaction; D012150:Polymorphism, Restriction Fragment Length; D012307:Risk Factors; D062211:Spatio-Temporal Analysis; D019371:Topography, Medical
chemical_list: D016054:DNA, Protozoan; D021903:DNA, Ribosomal Spacer
keywords: Boulemane; Environmental factors; Leishmania major; Leishmania tropica; Morocco; OLSR