Forms Of Cutaneous Leishmaniasis Research Articles

Demographic characteristics and clinical features of patients presenting with different forms of cutaneous leishmaniasis, in Lay Gayint, Northern Ethiopia.

Cutaneous leishmaniasis (CL) is a neglected tropical disease caused by Leishmania parasites, that can cause long-term chronic disabilities. The clinical presentation of CL varies in both type and severity. CL presents as three main clinical forms: localised lesions (localised cutaneous leishmaniasis, LCL); mucocutaneous leishmaniasis (MCL) that affects the mucosa of the nose or the mouth; or as disseminated not ulcerating nodules (diffuse cutaneous leishmaniasis, DCL). Here we recruited a cohort of CL patients in a newly established leishmaniasis treatment centre (LTC) in Lay Gayint, Northwest Ethiopia, and collected detailed demographic and clinical data. The results of our study show that more males than females present to the LTC to seek diagnosis and treatment. 70.2% of CL patients presented with LCL and 20.8% with MCL. A small number of patients presented with DCL, recidivans CL (a rare form of CL where new lesions appear on the edges of CL scars) or with a combination of different clinical presentations. The duration of illness varied from 1 month to 180 months. Over a third of CL patients had additional suspected CL cases in their household. Despite the majority of CL patients having heard about CL, only a minority knew about its transmission or that it could be treated. Most CL patients lived in areas where environmental factors known to be associated with the transmission of CL were present. This work highlights that CL is an important public health problem in Lay Gayint and emphasises the urgent need for more CL awareness campaigns, better health education and better disease management practices.

ABC transporter inhibition by beauvericin partially overcomes drug resistance in Leishmania tropica.

Leishmaniasis is a neglected tropical disease infecting the world's poorest populations. Miltefosine (ML) remains the primary oral drug against the cutaneous form of leishmaniasis. The ATP-binding cassette (ABC) transporters are key players in the xenobiotic efflux, and their inhibition could enhance the therapeutic index. In this study, the ability of beauvericin (BEA) to overcome ABC transporter-mediated resistance of Leishmania tropica to ML was assessed. In addition, the transcription profile of genes involved in resistance acquisition to ML was inspected. Finally, we explored the efflux mechanism of the drug and inhibitor. The efficacy of ML against all developmental stages of L. tropica in the presence or absence of BEA was evaluated using an absolute quantification assay. The expression of resistance genes was evaluated, comparing susceptible and resistant strains. Finally, the mechanisms governing the interaction between the ABC transporter and its ligands were elucidated using molecular docking and dynamic simulation. Relative quantification showed that the expression of the ABCG sub-family is mostly modulated by ML. In this study, we used BEA to impede resistance of Leishmania tropica. The IC50 values, following BEA treatment, were significantly reduced from 30.83, 48.17, and 16.83 µM using ML to 8.14, 11.1, and 7.18 µM when using a combinatorial treatment (ML + BEA) against promastigotes, axenic amastigotes, and intracellular amastigotes, respectively. We also demonstrated a favorable BEA-binding enthalpy to L. tropica ABC transporter compared to ML. Our study revealed that BEA partially reverses the resistance development of L. tropica to ML by blocking the alternate ATP hydrolysis cycle.

Monitoring of leishmaniasis of dogs in the republic of Armenia

The authors analyzed the available literature data and statistics, and results can be found for leishmaniasis in Armenia. Between June 2019 and December 2021, 375 different breeds were deployed. 135 animals were subjected to a comprehensive study with laboratory diagnostics of blood serum for the detection of Leishmania infantum antigen. In 68 dogs, antigens were detected using the VetExpert Leishmania Ab immunochromatographic instrumentless test system. In the publication of the authors Yerevan and other cities of the republic. In the studies in animals affected by leishmaniasis, the cutaneous form of leishmaniasis (CL) prevailed, which was recorded in 85.3% of cases, and the visceral form of leishmaniasis (VL) was recorded in 14.7% of cases. Sexual and breed predisposition of the studied dogs to the disease with leishmaniasis was not found by the authors. The visceral form of leishmaniasis (VL) in the studies was recorded in dogs over the age of 4 years. The authors believe that in the near future it is necessary to conduct epidemiological, epizootological and entomological studies to continuously monitor the situation of leishmaniasis in the Republic of Armenia.

Effect of topical berberine in murine cutaneous leishmaniasis lesions.

ObjectivesMore effective topical treatments remain an unmet need for the localized forms of cutaneous leishmaniasis (CL). The aim of this study was to evaluate the efficacy and safety of a topical berberine cream in BALB/c mice infected with Leishmania major parasites.MethodsA cream containing 0.5% berberine-β-glycerophosphate salt and 2.5% menthol was prepared. Its physicochemical and stability properties were determined. The cream was evaluated for its capacity to reduce lesion size and parasitic load as well as to promote wound healing after twice-a-day administration for 35 days. Clinical biochemical profile was used for estimating off-target effects. In vitro time-to-kill curves in L. major-infected macrophages and skin and plasma pharmacokinetics were determined, aiming to establish pharmacokinetic/pharmacodynamic relationships.ResultsThe cream was stable at 40°C for 3 months and at 4°C for at least 8 months. It was able to halt lesion progression in all treated mice. At the end of treatment, parasite load in the skin was reduced by 99.9% (4 log) and genes involved in the wound healing process were up-regulated compared with untreated mice.The observed effects were higher than expected from in vitro time-to-kill kinetic and plasma berberine concentrations, which ranged between 0.07 and 0.22 μM.ConclusionsThe twice-a-day administration of a topical berberine cream was safe, able to stop parasite progression and improved the appearance of skin CL lesions. The relationship between drug plasma levels and in vivo effect was unclear.

In vitro growth inhibitory activity of Medicines for Malaria Venture pathogen box compounds against Leishmania aethiopica

IntroductionLeishmania aethiopica (L. aethiopica) is responsible for different forms of cutaneous leishmaniasis (CL) in Ethiopia. Treatment heavily depends on limited drugs, together with drawbacks like toxicity and microbial resistance. The current research aimed to investigate in vitro growth inhibitory activity of Medicines for Malaria Ventures - Pathogen Box (MMV - PB) compounds against L. aethiopica clinical isolate.MethodologyFour hundred MMV – PB compounds were screened against L. aethiopica using resazurin based colourimetric assay. Compounds with > 70% inhibition were further tested using macrophage based intracellular amastigote assay. Cytotoxic and hemolytic activity of candidate hits were assessed on THP1- cells and sheep red blood cells (RBCs), respectively. In vitro drug interaction study was also conducted for the most potent hit using the combination index method.ResultsAt the test concentration of 1 μM, twenty-three compounds showed > 50% inhibition of promastigotes parasite growth, of which 11 compounds showed > 70% inhibition. The 50% growth inhibition (IC50) of the 11 compounds was ranged from 0.024 to 0.483 μM in anti-promastigote assay and from 0.064 to 0.899 μM in intracellular amastigote assay. Candidate compounds demonstrated good safety on sheep RBCs and THP-1 cell lines. MMV688415 demonstrated a slight hemolytic activity on sheep RBC (5.3% at 25 μM) and THP-1 cell line (CC20 = 25 μM) while MMV690102 inhibited half of THP-1 cells at 36.5 μM (selectivity index = 478). No synergistic activity was observed from the combinations of MMV690102 and amphotericin B (CI > 1), and MMV690102 and Pentamidine (CI > 1) at lower and higher combination points.ConclusionThe present study identified a panel of compounds that can be used as a novel starting point for lead optimization. MMV690102 appears to be the most potent inhibitor against L. aethiopica promastigotes and amastigotes. Future works should investigate the antileishmanial mechanism of action and in vivo antileishmanial activities of identified hits.

Trend Analysis of Cutaneous Leishmaniasis Incidence in Izeh County During 2014-2019

Background: A cutaneous form of leishmaniasis (cutaneous leishmaniasis, CL) is becoming increasingly common, and this study was conducted to investigate the epidemiological features of CL in the county of Izeh in Khuzestan province. Materials and Methods: This retrospective cross-sectional research was performed during 2014- 2019. Basic demographic and clinical information was gathered from patients with CL referring to Izeh health centre and then processed using SPSS software, version 25.0. Results: Overall, data related to 131 patients were recorded from 2014 to 2019. The incidence of CL showed a decrease from 16.207 to 5.028 per 100000 individuals in Izeh. Based on the analysis of CL incidence in Izeh county, a statistically significant difference was observed through the mentioned six-year study (P<0.05). Male patients with a frequency rate of 65.6% demonstrated a statistically significant association in the CL and the type of gender compared to 34.4% of females (P<0.05). The age group of 20-29 years old (32.1%) had a higher frequency of CL in the age groups. Finally, there was a statistically considerable discrepancy in the frequencies of infected people with CL related to age groups (P<0.05). Conclusion: Based on the findings and other epidemiological characteristics, Izeh does not seem to be an endemic focus of CL. Nonetheless, it is a concerning situation, and proper preparation is strongly advised for disease control and prevention.

Leishmania-Induced Dendritic Cell Migration and Its Potential Contribution to Parasite Dissemination.

Leishmania, an intracellular parasite species, causes lesions on the skin and in the mucosa and internal organs. The dissemination of infected host cells containing Leishmania is crucial to parasite survival and the establishment of infection. Migratory phenomena and the mechanisms underlying the dissemination of Leishmania-infected human dendritic cells (hDCs) remain poorly understood. The present study aimed to investigate differences among factors involved in hDC migration by comparing infection with visceral leishmaniasis (VL) induced by Leishmania infantum with diverse clinical forms of tegumentary leishmaniasis (TL) induced by Leishmania braziliensis or Leishmania amazonensis. Following the infection of hDCs by isolates obtained from patients with different clinical forms of Leishmania, the formation of adhesion complexes, actin polymerization, and CCR7 expression were evaluated. We observed increased hDC migration following infection with isolates of L. infantum (VL), as well as disseminated (DL) and diffuse (DCL) forms of cutaneous leishmaniasis (CL) caused by L. braziliensis and L. amazonensis, respectively. Increased expression of proteins involved in adhesion complex formation and actin polymerization, as well as higher CCR7 expression, were seen in hDCs infected with L. infantum, DL and DCL isolates. Together, our results suggest that hDCs play an important role in the dissemination of Leishmania parasites in the vertebrate host.

Maintenance and Productivity of a Lutzomyia longipalpis (Diptera: Psychodidae) Colony from an Area Endemic for Visceral and Cutaneous Leishmaniasis in Northeastern Brazil.

Studies on experimental sand fly infection require the availability of colonies and laboratory conditions. In Brazil, Lutzomyia longipalpis (Diptera: Psychodidae) (Lutz and Neiva 1912) is responsible for the highest infection rates by Leishmania spp. and this species is one of the most suitable species for laboratory colonization. In this study, we describe a method for growing Lu. longipalpis in laboratory conditions (10 generations) from natural populations sampled from a region of high endemicity for visceral leishmaniasis in the state of Maranhão, Northeastern Brazil. Using two methods (individualized or grouped females), the colony's highest productivity occurred in the first four generations, where all stages presented with high frequency. Nonviable eggs represented more than 50% of the total eggs produced by engorged females, while pupae were more resistant to fungal contamination, with a mortality rate of only 2%. In both methods, there was a predominance of female emergence; however, the ratio between males and females did not show significant differences, IF (P = 0.8023) and GF (P = 0.1831). Using the method of individualized females, the F4 generation took the longest to appear (234 d; 64 ± 57 d); by grouped females, F3 took the longest to appear (102 d; 47 ± 20 d). This method provides sufficient numbers of insects to perform vector competence tests for Leishmania spp. that cause the cutaneous form of leishmaniasis, usually found in Lu. longipalpis sampled from the study location.

A multicentric evaluation of dipstick test for serodiagnosis of visceral leishmaniasis in India, Nepal, Sri Lanka, Brazil, Ethiopia and Spain

Visceral leishmaniasis (VL) is one of the leading infectious diseases affecting developing countries. Colloidal gold-based diagnostic tests are rapid tools to detect blood/serum antibodies for VL diagnosis. Lack of uniformity in the performance of these tests in different endemic regions is a hurdle in early disease diagnosis. This study is designed to validate a serum-based dipstick test in eight centres of six countries, India, Nepal, Sri Lanka, Brazil, Ethiopia and Spain with archived and fresh sera from 1003 subjects. The dipstick detects antibodies against Leishmania donovani membrane antigens (LAg). The overall sensitivity and specificity of the test with 95% confidence intervals were found to be 97.10% and 93.44%, respectively. The test showed good sensitivity and specificity in the Indian subcontinent (>95%). In Brazil, Ethiopia, and Spain the sensitivity and specificity of the dipstick test (83.78–100% and 79.06–100%) were better as compared to the earlier reports of the performance of rK39 rapid test in these regions. Interestingly, less cross-reactivity was found with the cutaneous form of the disease in Spain, Brazil, and Sri Lanka demonstrating 91.58% specificity. This dipstick test can therefore be a useful tool for diagnosing VL from other symptomatically similar diseases and against cutaneous form of leishmaniasis.

КЛИНИКО-ИММУНОЛОГИЧЕСКИЕ ОСОБЕННОСТИ ОСТРОНЕКРОТИЗИРУЮЩЕЙСЯ ФОРМЫ КОЖНОГО ЛЕЙШМАНИОЗА

Objective: To study immunological disorders in patients with a rural (acute necrotizing) form of Cutaneous Leishmaniasis (CL). Methods: 80 patients were found under the observation in a rural (acute necrotizing) form of CL, including 23 (28.8%) men and 57 (71.2%) of women. The age of patients fluctuated from 16 to 60 years and over Results: The data showed that the oppression of the activity of the cellular immunity in patients with CL in comparison with healthy people, which indicates the significant of absolute and comparative numbers of CD3 lymphocytes (by 20%, p 0.01), the tendency of falling of absolute and comparative numbers of CD4 (T helper-inducers) and CD8 (T-cytotoxic) lymphocytes (correspondingly to 12% and 18%), as well as the absolute and comparative number of lymphocytes (by 12%) of peripheral blood. Conclusion: Thereby, in patients with acute necrotizing form of CL observes immunological disorders both in cellular and humoral components of immunity, which was depended on prescription of the process and the presence of complications. Keywords: Acute necrotizing cutaneous leishmaniasis, clinical and immunological features.

Production of DNA, Protein and DNA/Protein vaccines against Leishmania infantum and L.tropica

Abstract Leishmaniasis is a neglected tropical disease caused by obligate intracellular protozoan Leishmania parasites. Especially cutaneous form of leishmaniasis has an increasing importance in Turkey because of immigration. The aims of this study that is supported by the Scientific and Technological Research Council of Turkey (TUBITAK project number 213S149) are to produce Leishmania infantum and L.tropica activated C kinase receptor (LACK) gene based DNA and protein vaccines and to investigate the effectiveness of these vaccines by prime-boost method alone and combined with two adjuvants in-vivo on mice model. Methodological steps in this study are to culture L.infantum and L.tropica promastigotes in NNN medium, total genomic DNA isolation from culture, cloning activated C kinase receptor (LACK) gene with specific primers, ligation of PCR product into plasmid, amplifying recombinant plasmid in competent cells, producing endotoxin free DNA vaccine, producing endotoxin free LACK recombinant protein, combining DNA and protein vaccines with MPL-SE and CpG-ODN adjuvants and to investigate the effectiveness of this vaccines in-vivo on mice model. As a result L.infantum and L.tropica LACK gene based DNA and protein vaccines was produced and ready to immunization. Th-1 and Th-2 immunologic responses are going to be investigated after two week intervals three time vaccination against L.tropica and L.infantum infections on BALB/c mice.

Rapid Sequestration of Leishmania mexicana by Neutrophils Contributes to the Development of Chronic Lesion.

The protozoan Leishmania mexicana parasite causes chronic non-healing cutaneous lesions in humans and mice with poor parasite control. The mechanisms preventing the development of a protective immune response against this parasite are unclear. Here we provide data demonstrating that parasite sequestration by neutrophils is responsible for disease progression in mice. Within hours of infection L. mexicana induced the local recruitment of neutrophils, which ingested parasites and formed extracellular traps without markedly impairing parasite survival. We further showed that the L. mexicana-induced recruitment of neutrophils impaired the early recruitment of dendritic cells at the site of infection as observed by intravital 2-photon microscopy and flow cytometry analysis. Indeed, infection of neutropenic Genista mice and of mice depleted of neutrophils at the onset of infection demonstrated a prominent role for neutrophils in this process. Furthermore, an increase in monocyte-derived dendritic cells was also observed in draining lymph nodes of neutropenic mice, correlating with subsequent increased frequency of IFNγ-secreting T helper cells, and better parasite control leading ultimately to complete healing of the lesion. Altogether, these findings show that L. mexicana exploits neutrophils to block the induction of a protective immune response and impairs the control of lesion development. Our data thus demonstrate an unanticipated negative role for these innate immune cells in host defense, suggesting that in certain forms of cutaneous leishmaniasis, regulating neutrophil recruitment could be a strategy to promote lesion healing.

Altercating Leishmaniasis: Cultivating Improved Vaccines

The exponentially rising cases of Leishmaniasis over the past decades, has attracted scientists and clinicians to mitigate the contagious infection by modern treatments and new generation vaccinations. Leishmania, the causative pathogen of this infection predominantly expresses its diseased condition in form of cutaneous leishmaniasis. Although systemic leishmaniasis, is a more deadly form, but cases of its manifestation are limited; thereby staging the focus onto more intricate study of cutaneous leishmaniasis. Designing a vaccine against Leishmania has witnessed more than two generations of vaccine, but each attempt has failed more than it’s cases of success. The proposed drawbacks root to the difficulty in ensuring an efficient transition of research from simple laboratory experiments carried out in-vitro/in-vivo in small animals to that of the humans. There have been extensive case studies of this disease and thus every immunological aspect has been our focus. This paper is an attempt to decipher the ideas and methodologies adopted till date and further target the genetic spans and molecular moieties, for crafting an alternative vaccine based on efforts to mock the pathogenic pathways.

Comparison of Diagnostic Methods in Cutaneous Leishmaniasis in Iraq

Sixty -four specimens collected passively from patients with cutaneous ulcers suggestive of leishmaniasis attending hospital and health centres in all parts of Iraq for diagnosis were included in the study. The present study was conducted from June to December 2012 in Al-Karamah Teaching Hospital in Wasit Province, Iraq. Dermal scrapings were analysed both by parasitological (examination of Giemsa-stained smears and in vitro cultivation) methods and by a genus-specific PCR detection. Microscopy revealed amastigotes in 38 samples (59.4%) and in vitro cultivation gave positive results in 19 cases (29.7%), whereas PCR detected Leishmania in 44 samples (68.75 %). There are two forms of Cutaneous leishmaniasis (CL) in Iraq are caused by two species of Leishmania . Of 44 well-documented cases in our study ; 28 (63.6 %) were caused byLeishmania major and 16 (36.4 %) by Leishmania tropica.

Cutaneous Leishmaniasis of the Eyelid: A Case Report

Cutaneous leishmaniasis is endemic in certain areas of Iran, and in recent years, there has been an increase in the number of reports for rare and new forms of cutaneous leishmaniasis. We describe one unusual clinical form of cutaneous leishmaniasis. In a 27-year-old man, who noted a pimple on the upper eyelid 4 months before. The lesion was nodular and measured 1 cm × 1 cm in diameter. A diagnosis of eyelid cutaneous leishmaniasis was made, and treatment was started with intramuscular meglumine antimonate. He showed a dramatic response, and the lesion almost completely disappeared.

Caractérisation comparative des trois formes de leishmaniose cutanée endémiques en Tunisie

The recent spread in the geographical distribution of the three forms of cutaneous leishmaniasis (CL) endemic in Tunisia has resulted in the coexistence of more than one species of Leishmania (L.) in some foci, rendering characterization on the basis of geographical criteria alone more difficult. The aim of the study was to establish clinical criteria associated with these noso-geographic forms, namely sporadic CL (SCL) due to L. infantum, zoonotic CL (ZCL) due to L. major and chronic CL (CCL) due to L. tropica. One hundred and twelve patients with biologically confirmed CL were involved in the study. Leishmania species was systematically identified by iso-enzyme analysis and/or PCR-RFLP. Details of the number, the location, the morphological aspect and the month of outbreak of the lesions were noted for each patient. SCL lesions appeared later than ZCL lesions (53.8% of cases appeared from December onwards vs. 23.6%, P<0.001). ZCL lesions were often multiple (75%) and situated on the limbs (84.7%, P<0.001), whereas SCL lesions were single (92.3%, P<0.001) and located on the face (84.6%, P<0.001). CCL lesions were also single (78.6%) and located on the face (71.4%). The classical ulcerous presentation with scabs was mainly observed in ZCL patients (69.4%) and the erythematous presentation was described more frequently in SCL patients (75%; P<0.001). The number, site, morphological aspect and month of outbreak of lesions could be considered as useful criteria that help differentiate between the three noso-geographical forms of CL prevailing in Tunisia. Such characterization is useful for the individual management of patients and for optimizing the combat against the disease.

Imaging of a Marjolin's Ulcer: A Case Report

“Marjolin’s ulcer”refers to malignancies that developed in chronic venous ulcers, scars, or sinuses (1, 2). These malignancies also arise from various scars, including chronic ulcerations, inflammation, and fistulas after a long period of latency. Malignant transformation takes approximately 35 years. The incidence of malignant skin tumors that developed from scar tissue is 0.1-2.5%. Burn scars are the most common lesion causing this malignancy (3). The most common malignancy that arises from a Marjolin’s ulcer is squamous cell carcinoma, whereas basal cell carcinomas are rare. The malignancy is frequently multiple in the floor of an ulcer (3). The pathogenesis of a Marjolin’s ulcer is controversial (1, 3). Ulcer osteomas develop as a result of the heaping up of periosteum and associated subperiosteal sclerosis, and were seen as a knob-like mass protruding from the bone surface (1). These masses are rare in patients with chronic ulcers (1); however, they are frequently seen in patients with tropical ulcers, occurring in form of cutaneous leishmaniasis, which is a skin infection caused by a single-celled parasite that is transmitted by sandfly bites (4). A previous report described gadopentetate dimeglumine-enhanced magnetic resonance imaging (MRI) as a useful tool for evaluating a Marjolin’s ulcer (2). A multidisciplinary approach using three-dimensional computed tomography (CT) and positron emission tomography J Korean Soc Radiol 2011;64:593-598

Lutzomyia Sand Fly Diversity and Rates of Infection by Wolbachia and an Exotic Leishmania Species on Barro Colorado Island, Panama

BackgroundSand flies (Diptera, Psychodidae, Phlebotominae) in the genus Lutzomyia are the predominant vectors of the protozoan disease leishmaniasis in the New World. Within the watershed of the Panama Canal, the cutaneous form of leishmaniasis is a continuous health threat for residents, tourists and members of an international research community. Here we report the results of screening a tropical forest assemblage of sand fly species for infection by both Leishmania and a microbe that can potentially serve in vector population control, the cytoplasmically transmitted rickettsia, Wolbachia pipientis. Knowing accurately which Lutzomyia species are present, what their evolutionary relationships are, and how they are infected by strains of both Leishmania and Wolbachia is of critical value for building strategies to mitigate the impact of this disease in humans.Methodology and FindingsWe collected, sorted and then used DNA sequences to determine the diversity and probable phylogenetic relationships of the Phlebotominae occurring in the understory of Barro Colorado Island in the Republic of Panama. Sequence from CO1, the DNA barcoding gene, supported 18 morphology-based species determinations while revealing the presence of two possible “cryptic” species, one (Lu. sp. nr vespertilionis) within the Vespertilionis group, the other (Lu. gomezi) within the Lutzomyia-cruciata series. Using ITS-1 and “minicircle” primers we detected Leishmania DNA in 43.3% of Lu. trapidoi, 26.3% of Lu. gomezi individuals and in 0% of the other 18 sand fly species. Identical ITS-1 sequence was obtained from the Leishmania infecting Lu. trapidoi and Lu. gomezi, sequence which was 93% similar to Leishmania (viannia) naiffi in GenBank, a species previously unknown in Panama, but recognized as a type of cutaneous leishmaniasis vectored broadly across northern and central South America. Distinct strains of the intracellular bacterium Wolbachia were detected in three of 20 sand fly species, including Lu. trapidoi, in which it frequently co-occurred with Leishmania.ConclusionsBoth morphological and molecular methods were used to examine an assemblage of 20 sand fly species occurring in the forests of the Panama Canal area. Two of these species, members of separate clades, were found to carry Leishmania at high frequency and hence are likely vectors of leishmaniasis to humans or other mammal species. A single Leishmania species, identified with high confidence as Le. naiffi, was carried by both species. That Le. naiffi is known to cause cutaneous lesions in South America but has hitherto not been reported or implicated in Panama opens the possibility that its range has recently expanded to include the Isthmus or that it occurs as a recent introduction. The occurrence of Leishmania and Wolbachia in Lu. trapidoi identifies one important vector of the disease as a potential target for gene introductions using Wolbachia population sweeps.

Disseminated leishmaniasis caused by Leishmania tropica in HIV-positive patients in the Islamic Republic of Iran

Both cutaneous and visceral forms of leishmaniasis are prevalent in some parts of the Islamic Republic of Iran [1,2]. The Mediterranean type of visceral leishmaniasis (VL) is also reported sporadically throughout the country [3] with canines being the main animal reservoir hosts [4]. The cutaneous form of leishmaniasis is seen in 2 forms: anthroponotic and zoonotic. Anthroponotic cutaneous leishmaniasis (ACL) is caused by Leishmania tropica and is prevalent in many largeand medium-sized cities in the country [1,5]. Zoonotic cutaneous leishmaniasis (ZCL) is caused by L. major and is endemic in many foci in the north, east and south of the country [6]. Some studies have implicated L. tropica as another agent of VL in humans and dogs in reports from the north-west and south of the country [4,7,8]. Few data are available, however, about host immunological response and parasite destruction when leishmaniasis is associated with immunosuppressants. At present, the majority of cases of HIV– leishmaniasis co-infection reported in the Mediterranean basin were caused by L. infantum [9]. Disseminated leishmaniasis caused by L. tropica in patients with HIV infection is uncommon. Here, we report on 2 patients with HIV–leishmaniasis co-infection caused by L. tropica with generalized and multiple skin lesions and visceral involvement. This is the first such report from the Islamic Republic of Iran.

Cutaneous and mucocutaneous leishmaniasis in Tigray, northern Ethiopia: clinical aspects and therapeutic concerns

Leishmaniasis is a worldwide disease, but due to the absence of surveillance systems is under-reported from low- and middle-income countries. In Ethiopia, the disease is found in the rural highlands and the incidence of Leishmania/HIV co-infection is increasing. Although some studies have been carried out in areas of the country with a similar disease/ecological profile this report is, to our knowledge, the first aimed at elucidating the clinical-epidemiological features of cutaneous and mucocutaneous leishmaniasis in Tigray, northern Ethiopia. This study enrolled 167 patients presenting different forms of cutaneous leishmaniasis over an 18 month period, of which 5.6% tested HIV positive. Patients were initially treated with meglumine antimonate and resistant cases with pentamidine isethionate. There was a high rate of resistance to meglumine antimonate (28%) and a less than optimal response to prolonged systemic treatment in relapsed cases. Eight patients affected by severe and resistant forms were treated with pentamidine isethionate, with a cure rate of 87.5% after 6 months. Many atypical and severe presentations were seen, and a poor response to first-line antileishmanial drugs was observed. Resistance to antimonials is of concern and cost-effective therapeutic schemes need to be developed. The cost-effectiveness of pentamidine isethionate has to be determined in a larger population.