Abstract
BackgroundDeterminants of the clinical presentation of the leishmaniases are poorly understood but Leishmania species and strain differences are important. To examine the relationship between clinical presentation, species and isoenzyme polymorphisms, 56 Leishmania isolates from distinct presentations of American tegumentary leishmaniasis (ATL) from Ecuador were analyzed.MethodsIsolates were characterized by multilocus enzyme electrophoresis for polymorphisms of 11 isoenzymes. Patients were infected in four different ecologic regions: highland and lowland jungle of the Pacific coast, Amazonian lowlands and Andean highlands.ResultsSix Leishmania species constituting 21 zymodemes were identified: L. (Viannia) panamensis (21 isolates, 7 zymodemes), L. (V.) guyanensis (7 isolates, 4 zymodemes), L. (V.) braziliensis (5 isolates, 3 zymodemes), L. (Leishmania) mexicana (11 isolates, 4 zymodemes), L. (L.) amazonensis (10 isolates, 2 zymodemes) and L. (L.) major (2 isolates, 1 zymodeme). L. panamensis was the species most frequently identified in the Pacific region and was associated with several clinical variants of cutaneous disease (CL); eight cases of leishmaniasis recidiva cutis (LRC) found in the Pacific highlands were associated with 3 zymodemes of this species. Mucocutaneous leishmaniasis found only in the Amazonian focus was associated with 3 zymodemes of L. braziliensis. The papular variant of CL, Uta, found in the Andean highlands was related predominantly with a single zymodeme of L. mexicana.ConclusionOur data show a high degree of phenotypic variation within species, and some evidence for associations between specific variants of ATL (i.e. Uta and LRC) and specific Leishmania zymodemes. This study further defines the geographic distribution of Leishmania species and clinical variants of ATL in Ecuador.
Highlights
Determinants of the clinical presentation of the leishmaniases are poorly understood but Leishmania species and strain differences are important
None of the Leishmania zymodemes present in Ecuador of L. braziliensis, L. mexicana and L. major were identical to the Leishmania WHO reference strains and, none of the Ecuadorian stocks were matched to the WHO reference strains for L. (V.) peruviana, L. (V.) naiffi or L. (L.) chagasi (Figure 2A and 2B)
The present study provides evidence that some of the distinct clinical forms of American tegumentary leishmaniasis (ATL) are associated with specific Leishmania species and some may be related with a restricted number of zymodemes
Summary
Determinants of the clinical presentation of the leishmaniases are poorly understood but Leishmania species and strain differences are important. To examine the relationship between clinical presentation, species and isoenzyme polymorphisms, 56 Leishmania isolates from distinct presentations of American tegumentary leishmaniasis (ATL) from Ecuador were analyzed. Ecuador straddles the Andes and is crossed by the Equator and is home to extremely diverse ecologic conditions. American tegumentary leishmaniasis (ATL) in Ecuador occurs throughout the tropical Amazon and Pacific coastal regions and in some inter-Andean valleys. According to the Ecuadorian Ministry of Health, human cases have been reported from 20 of the country's 22 provinces and an estimated 3.1 to 4.5 million people are considered to be at risk of infection with 3,000–4,500 new cases occurring annually [1]
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