A nine-year evaluation of cutaneous leishmaniasis patients in Diyarbakir Training and Research Hospital, Turkey

Abstract

Leishmaniasis, which is a zoonotic disease caused by obligate intracellular parasites namely Leishmania spp., may present as visceral, cutaneous and mucocutaneous forms. Turkey is accepted as an endemic region for leishmaniasis. Cutaneous forms are more frequent in South and Southeastern Anatolia regions while visceral forms are more frequent in Aegean and Mediterranean regions. The aim of this study was to evaluate the cutaneous leishmaniasis (CL) cases identified in Diyarbakir Training and Research Hospital, retrospectively in a nine-year period, calling attention to the increase of cases in 2013, in our region. A total of 128 patients aged between 0-75 years, who were clinically diagnosed as CL in the dermatology outpatient clinic of our hospital between January 2005-August 2013 were evaluated in the study. Parasitologic diagnosis was based on the identification of Leishmania amastigote forms inside and outside the macrophages observed in Giemsa stained smears of serous liquid samples appropriately obtained from cutaneous lesions by scraping the edge of the ulcer or slightly removing the scab. Parasites were microscopically detected in 56 of 128 (43.7%) patients who were clinically pre-diagnosed as CL. Of those patients, 41 (73.2%) were female, 15 (26.8%) were male, and 34 (60.7%) were in 0-20, 10 (17.9%) were 21-41, and 12 (21.4%) were ≥ 42 years age group. In positive cases, lesions were found to be at the facial area of 34, arms and hands of 14, legs and feet of eight patients. Besides, 21 of 56 (37.5%) patients were detected with lesions on their various anatomic areas as hand and face or face and legs. When evaluating the distribution of 56 confirmed CL cases according to the study years, the case numbers were low in 2005 (n= 1; 2%) and 2006 (n= 2; 4%), there were no admission to our hospital in the period of 2007 to 2009, however the case numbers showed an increasing trend after 2010 [4 (7%) cases in 2010; 3 (5%) in 2011; 4 (7%) in 2012], reaching unusual number in 2013 (n= 42; 75%). When evaluating the CL cases according to their locations, 51 were from center and towns/villages of Diyarbakir, and five were from neighbouring countries (Mardin: 2, Urfa: 2, Adana: 1). It was noted that nine (37.5%) of the 24 cases detected in the city center of Diyarbakir were children of Syrian refugees. In conclusion, immigrations to endemic regions of Turkey from neighbouring countries where CL incidence is higher may lead to severe increases in case numbers, thus more powerful protective measures should be taken in those endemic areas.