Abstract
To obtain further insight into geographic distribution of Leishmania species in Peru, a countrywide survey, including central to southern rainforest areas where information on causative parasite species is limited, was performed based on cytochrome b (cyt b) and mannose phosphate isomerase (mpi) gene analyses. A total of 262 clinical samples were collected from patients suspected of cutaneous leishmaniasis (CL) in 28 provinces of 13 departments, of which 99 samples were impregnated on FTA (Flinders Technology Associates) cards and 163 samples were Giemsa-stained smears. Leishmania species were successfully identified in 83 (83.8%) of FTA-spotted samples and 59 (36.2%) of Giemsa-stained smear samples. Among the 142 samples identified, the most dominant species was Leishmania (Viannia) braziliensis (47.2%), followed by L. (V.) peruviana (26.1%), and others were L. (V.) guyanensis, L. (V.) lainsoni, L. (V.) shawi, a hybrid of L. (V.) braziliensis and L. (V.) peruviana, and Leishmania (Leishmania) amazonensis. Besides the present epidemiological observations, the current study provided the following findings: 1) A hybrid of L. (V.) braziliensis and L. (V.) peruviana is present outside the Department of Huanuco, the only place reported, 2) Many cases of CL due to L. (V.) lainsoni, an uncommon causative species in Peru, were observed, and 3) L. (V.) shawi is widely circulating in southern Amazonian areas in Peru.
Highlights
Leishmaniasis, caused by an intracellular protozoa of the genus Leishmania, is a neglected tropical disease widely distributed worldwide, especially in tropical and subtropical areas, affecting at least 12 million people in 96 countries [1]
One case each of L. (V.) shawi infection was reported from the Departments of Junin and Madre de Dios, while clinical cases due to the hybrid of L. (V.) braziliensis and L. (V.) peruviana were recorded only in the Department of Huanuco
In addition to current epidemiological observations, the current study revealed that 1) A hybrid of L. (V.) braziliensis and L. (V.) peruviana was identified, for the first time, outside the Department of Huanuco, 2) L. (V.) lainsoni, an uncommon cutaneous leishmaniasis (CL)-causative species in Peru, was predominantly found in the Department of Puno, where causative Leishmania species are not well-studied, and 3) New endemic foci of L. (V.) shawi were identified in central to southern rainforest areas of Peru
Summary
Leishmaniasis, caused by an intracellular protozoa of the genus Leishmania, is a neglected tropical disease widely distributed worldwide, especially in tropical and subtropical areas, affecting at least 12 million people in 96 countries [1]. 20 Leishmania species belonging to the subgenera Leishmania (Leishmania), Leishmania (Viannia) and recently, Leishmania (Mundinia) are known to be pathogenic to humans and cause cutaneous, mucocutaneous and visceral disorders in infected individuals [1, 2]. Since infected parasite species are known to be the major determinant of clinical outcomes and may be associated with the response to treatments in leishmaniasis [1], identification of the infected parasite is important for appropriate treatment and prognosis. Peru is one of the most highly endemic countries for cutaneous leishmaniasis (CL) [1]. Other than the three dominant species, distribution of L. (V.) lainsoni and
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