Presentation Of Cutaneous Leishmaniasis Research Articles

Investigation of parasite genetic variation and systemic immune responses in patients presenting with different clinical presentations of cutaneous leishmaniasis caused by Leishmania aethiopica

BackgroundCutaneous leishmaniasis (CL) is a neglected tropical skin disease, caused by the protozoan parasite Leishmania. In Ethiopia, CL is mainly caused by Leishmania aethiopica and can present in different clinical forms. The aim of this study was to assess whether these different forms are associated with differences in parasite genetic and host systemic immune signatures.MethodsHere we analysed the whole genome sequence data for 48 clinical parasite isolates and the systemic immune signature from a cohort of CL patients, who were recruited in Nefas Mewcha, Northern Ethiopia, from January 2019 to January 2022.ResultsOur results show that parasites from CL cases with different presentations in a single Ethiopian setting are from the same genetic population based on a permutation test of genome-wide similarity. Furthermore, a logistic regression test for genome wide association did not identify any individual genetic variants significantly associated with disease presentation. We also measured plasma chemokine and cytokine levels of 129 CL patients presenting with different forms of CL. None of the chemokine [eotaxin, eotaxin-3, interleukin (IL)-8, interferon (IFN)-γ-induced protein-10 (IP-10), monocyte chemoattractant protein (MCP)-1, MCP-4, macrophage-derived chemokines (MDC), macrophage inflammatory protein (MIP)-1α, MIP-1β and thymus- and activation-regulated chemokine (TARC)] or cytokine (IFN-γ, IL-1β, interleukin-2, IL-4, IL-6, IL-10, IL-12p70, IL-13, tumor necrosis factor-α) levels measured were significantly different between the different clinical presentations of CL, as measured by Kruskal–Wallis test. We also compared those with healthy nonendemic controls: our results show a chemokine (IP-10, MCP-1, MCP-4, MDC, MIP-1α, MIP-1β and TARC) but not a cytokine immune signature in patients with CL as compared to healthy nonendemic controls, as measured by Mann-Whitney test.ConclusionsThe results of our study did not identify a systemic immune signature or parasite genetic factors associated with different clinical presentation of CL.Graphical abstract

Many faces of cutaneous leishmaniasis.

Our objective in this study is to determine the atypical clinical presentations of cutaneous leishmaniasis (CL) patients diagnosed in Şanlıurfa province. This retrospective study included 213 patients with atypical clinical presentations among 1751 patients diagnosed with CL between October 2019 and August 2022 in Şanlıurfa Oriental Boil Diagnosis and Treatment Center located in an endemic region for CL. We found the prevalence of atypical CL to be 12.1%. The most common atypical lesions were lupoid 21 (9.8%), erysipeloid 16 (7.5%), impetiginous 16 (7.5%), recidivan 15 (7%), eczematous 15 (7%), ecthyma-like 13 (6.1%), pyoderma gangrenous-like 12 (5.6%), and sporotrichoid 12 (5.6%). Other lesions with atypical clinical presentations: chalazion-like, verrucous, dental sinus-like, psoriasiform, zosteriform, lymphoma-like, juvenile xanthogranuloma-like, volcano-like, paronychial, basal cell carcinoma-like, squamous cell carcinoma-like, herpes labialis-like, keratoacanthoma-like, chancriform, annular, lichenoid, mastocitoma-like, keloidal, epidermoid cyst-like, kaposi sarcoma-like, scar leishmaniasis, granulomatous cheilitis-like, mycetoma-like, molluscum contagiosum-like, discoid lupus erythematosus-like, and dermatofibroma-like. In addition to the atypical clinical presentations previously reported, we also defined dermatofibroma-like, Kaposi sarcoma-like, dental sinus-like, juvenile xanthogranuloma-like, mastocytoma-like, and epidermoid cyst-like. It should be kept in mind that CL can clinically mimic many infectious, inflammatory, and neoplastic diseases, which should be considered in the differential diagnosis of long-term non-healing lesions, especially in endemic areas. Key message What is already known on this subject: CL is known as the great imitator disease in dermatology. What this study adds: In addition to the atypical clinical presentations previously reported, we also defined dermatofibroma-like, Kaposi sarcoma-like, dental sinus-like, juvenile xanthogranuloma-like, mastocytoma-like, and epidermoid cyst-like. How this study might affect research, practice, or policy: CL can clinically mimic many infectious, inflammatory and neoplastic diseases, which should be considered in the differential diagnosis of long-term non-healing lesions, especially in endemic areas.

Cutaneous Leishmaniasis Presenting as an Atypical Hand Lesion

Cutaneous Leishmaniasis Presenting as an Atypical Hand Lesion

Atypical presentation of cutaneous leishmaniasis in a pregnant woman

Atypical presentation of cutaneous leishmaniasis in a pregnant woman

Cutaneous Leishmaniasis presenting as an exuberant forehead lesion.

Cutaneous Leishmaniasis presenting as an exuberant forehead lesion.

Atypical presentation of cutaneous leishmaniasis in a patient with kidney transplant : approach and management based on a case report

La leishmaniasis es una zoonosis adquirida por la picadura de un flebótomo hembra, que introduce los promastigotes de leishmania al torrente sanguíneo. La leishmaniasis, variedad cutánea, es una entidad rara después del trasplante de órgano sólido. Las manifestaciones clínicas están determinadas por la inmunidad del huésped, y van desde una forma localizada a una diseminada. Se han identificado a la fecha, varios géneros de flebotomíneos, siendo, Phlebotomus (Viejo Mundo) y Lutzomyia (Nuevo Mundo) los más importantes para la transmisión de Leishmania spp. El diagnóstico requiere demostración del parásito en una muestra obtenida de una lesión sospechosa utilizando métodos como PCR, tinción de Giemsa, cultivo, entre otros. El manejo de la leishmaniasis depende de la presentación y causa subyacente. Se presenta un caso de leishmaniasis cutánea asociado a trasplante renal, destacando los aspectos de su clínica, manifestaciones, hallazgos histopatológicos, resultado y tratamiento.

Household knowledge, practice and treatment seeking behaviors towards cutaneous leishmaniasis in the endemic rural communities of Ganta- afeshum district, Tigrai, northern Ethiopia, 2019: a cross-sectional study

BackgroundCutaneous leishmaniasis is endemic to Ethiopia. However, the prevention and control efforts of leishmaniasis remain unfocused with clear knowledge and practice gaps within the country. Thus, a house to house survey has been carried out to assess the knowledge, practice and treatment-seeking behavior of households towards cutaneous leishmaniasis in the rural communities of Tigrai region, northern Ethiopia.MethodsA community-based cross-sectional house-to-house survey was conducted in two selected rural villages of Ganta-afeshum district, Tigrai, northern Ethiopia in 2019. A simple random sampling technique was employed to select the participants. Household heads were interviewed using a pre-tested semi-structured questionnaire. Epi info version 7.0 was used for data entry and the data were imported to SPSS version 23 for analysis. Chi-square test (χ2) was used to test the association between the independent variables and the knowledge and practice status of the study participants. P-value < 0.05 was used to declare a statistically significant association among the variables.ResultsIn our study, most of the participants (78%) stated that cutaneous leishmaniasis is a health problem in the area. Three hundred eighty (99.5%) participants responded that the most common clinical presentation of cutaneous leishmaniasis is a lesion on the face. All of the study participants did not know the mode of cutaneous leishmaniasis transmission, and had never heard of the sand fly. A majority of the participants were unaware of the main prevention methods for cutaneous leishmaniasis. Lastly, traditional medicine was used in 90% of the study households with a previous history for cutaneous leishmaniasis.ConclusionThere is a lack of awareness regarding the transmission of cutaneous leishmaniasis in Ganta-afeshum, Ethiopia, where the majority of individuals are unfamiliar with the sand fly vector. Prevention methods for cutaneous leishmaniasis were unavailable among the community. Therefore, health education programs concerning cutaneous leishmaniasis transmission, prevention, and treatment in the area should be rigorously implemented.

An atypical presentation of cutaneous leishmaniasis

Leishmaniasis is among the neglected tropical diseases, which are known to dominate in poor, rural populations living in tropical and subtropical climates. Recent data have demonstrated that neglected tropical diseases affect more than 1 billion people worldwide. Since we are facing one of the great refugee crises of all time, neglected tropical diseases are currently should be considered as a main public health problem at the global level. Cutaneous leishmaniasis may be confused with many other dermatoses since it is one of ‘the great masquerader diseases’. As dermatologist we are among the first to challenge with perplexing cases of cutaneous leishmaniasis, we should be aware of the full range of clinical presentations of cutaneous leishmaniasis. Here, we have presented a case of atypical cutaneous leishmaniasis in a 32-year-old man.

Upper eyelid cutaneous leishmaniasis: Exceptional and challenging location

Cutaneous leishmaniasis (CL) is one of the most endemic and neglected diseases worldwide, still representing an important public health problem. Its clinical presentations are very polymorphic and sometimes very difficult to diagnose. Among the variants described as “atypical” or “unusual”, eyelids CL is exceptional with a prevalence estimated at only 0.27-0.72% in large series. In most cases, eyelids leishmaniasis is skin-limited disease, but can exceptionally cause serious ocular complications and may lead to blindness. We present an original case of isolated upper left eyelid CL in a 28-years-old Tunisian man. As rare as it is, this atypical clinical presentation of CL deserves to be well known by clinicians, and discussed in front of any palpebral lesion which does not prove itself in patient living or returning from a country endemic for this infection.

Zosteriform Cutaneous Leishmaniasis of the Elbow

Clinical features of cutaneous leishmaniasis (CL) are characterized by a very significant polymorphism making its diagnosis a real challenge for healthcare professionals. Herpes-zoster-like or zosteriform leishmaniasis is exceptional and often misdiagnosed atypical/unusual presentation of CL. Its prevalence is estimated at 0.14-0.17% of all CL and 2.4% of atypical CL, and is often reported as sporadic clinical cases. We present an original case of zosteriform CL at the elbow, in a young immunocompetent Tunisian woman.

Atypical Presentations of Cutaneous Leishmaniasis: A Real Diagnosis Challenge

Cutaneous leishmaniasis (CL) is an infectious dermatosis caused by a parasite (Leishmania spp) and transmitted to humans by the bite of a female sandfly (Phlebotomus spp). It is still endemic in more than 100 countries, representing an important public health problem worldwide. The clinical presentations of this disease are very polymorphic and sometimes very difficult to diagnose. Nearly 17 clinical variants of CL qualified as “atypical†or “unusual†were described; their prevalence is estimated at 2-5% of all CL. As rare as they are, these atypical clinical presentations of CL deserve to be well known by clinicians, particularly those in first line consultations and in endemic areas.

Cutaneous Leishmaniasis Presenting as Macrocheilitis in a Postliver Transplant Pediatric Patient.

Cutaneous Leishmaniasis Presenting as Macrocheilitis in a Postliver Transplant Pediatric Patient.

Zosteriform cutaneous leishmaniasis.

Dear Editor, We would like to discuss on the report on “Zosteriform cutaneous leishmaniasis” [1] Ramot et al. reported that “dermoscopy has proven to be an accessible and easy tool to diagnose such atypical presentation of cutaneous leishmaniasis, and dermatologists in endemic areas should be familiar with its typical dermoscopic features” [1]. In fact, cutaneous leishmaniasis is an important tropical dermatological infection. To diagnose it, the practitioner has to perform laboratory investigation to confirm the diagnosis [2]. The use of “in vivo confocal microscopy” is presently mentioned as a new noninvasive tool to diagnose cutaneous leishmaniasis [3,4]. As noted by Taheri et al., the appearance by dermoscopy of cutaneous leishmaniasis is varied [4]. The “paronychial, annular, palmoplantar, zosteriform, erysipeloid, and sporotrichoid” appearance of cutaneous leishmaniasis is not common and can be easily missed. The limitation in diagnosis seems not due to limitation of the dermoscopy toll but the awareness of the practitioner on the disease, cutaneous leishmaniasis [5]. In endemic areas of cutaneous leishmaniasis, use of dermoscopy in the investigation of any cases of zosteriform cutaneous lesions to rule out cutaneous leishmaniasis is suggested.

Clinical and epidemiological characteristics of cutaneous leishmaniasis in Sri Lanka

BackgroundLeishmaniasis, a vector borne tropical/subtropical disease caused by the protozoan Leishmania is transmitted to humans by sandfly vectors Phlebotomus and Lutzomyia. The principal form found in Sri Lanka is cutaneous leishmaniasis (CL) and is caused by Leishmania donovani. A rising trend in disease prevalence has been observed recently in Sri Lanka and the island is in fact the newest endemic focus in South Asia. Determining the prevalence of smear positivity among clinically suspected CL patients, identifying risk factors and specific clinical presentations of CL in order to implement preventive and early treatment strategies were the objectives of this study.MethodsA sample of 509 clinically suspected cases of CL referred to the Department of Parasitology from all across Sri Lanka between 2005 and 2015 was selected consecutively. Diagnosis was confirmed by microscopic visualization of the Leishmania amastigote from the slit skin smear. A structured questionnaire was used to identify exposure related risk factors and a clinical examination was performed to identify lesion characteristics.ResultsOut of 509 clinical cases, 41.5% (n = 211) were smear positive. The study population ranged from ages 1 to 80 years (mean age = 34.76) and the most affected age group was 40–49. Of the smear positives, 58.85% were males. Majority (47.86%) were from the North Western region (Kurunegala) of the country and were exposed to scrub jungles. Sand fly exposure (p = 0.04) and positive contact history (p = 0.005) were significant risk factors for smear positivity.Erythema (p = 0.02), lack of pruritus (p = 0.02) and scaly appearance (p = 0.003) were significant lesion characteristics in smear positivity. Lesions were commonly found in the exposed areas and the commonest morphological type was papulo-nodular.ConclusionsAn increasing trend in the spread of cutaneous leishmaniasis from endemic to non-endemic areas has become evident. Positive contact history and sandfly exposure were significant risk factors for smear positivity which may indicate the possibility of human reservoir hosts in infection transmission. Lack of pruritus, scaly appearance and erythema were highly significant lesion characteristics associated with Leishmania positive smears which can be used for the clinical diagnosis of CL.

Unusual presentation of cutaneous Leishmaniasis in pregnancy: A case report

Unusual presentation of cutaneous Leishmaniasis in pregnancy: A case report

Clinicopathological presentation of cutaneous leishmaniasis and its diagnostic algorithm

Clinicopathological presentation of cutaneous leishmaniasis and its diagnostic algorithm

An Epidemic Outbreak of Cutaneous Leishmaniasis Presenting as Suppurative Folliculitis: A Study of 6 Cases.

Folliculitis is defined as the inflammation of the follicles. The most common cause of folliculitis is infection. Here, we report an unusual cause of suppurative infundibulitis-which had not yet been described in the literature-due to Leishmania infection, and exemplified by 6 cases that occurred in the setting of an epidemic outbreak. The 6 individuals were immigrants from Morocco. Most of them were men (4 men and 2 women), and most of them were less than 30 years old (apart from one 40-year-old woman). In all cases, a cutaneous biopsy was performed. There was a granulomatous folliculitis with suppurative granulomas in all the cases. All cases showed prominence of plasma cells in the inflammatory infiltrate, and leishmanias were found in all cases. They were mainly seen in the abscessified central areas. The amount of organisms varied from a few to a moderate amount. They were stained by the anti-CD1a antibody (Novocastra) and by a polyclonal homemade anti-leishmania antibody. In addition, in 1 case, microbiological culture was performed, and Leishmania major was demonstrated as the causative agent of the infection.

Sporotrichoid leishmaniasis: a cross-sectional clinical, epidemiological and laboratory study in Rio de Janeiro State, Brazil

ABSTRACTBackground Atypical presentations of cutaneous leishmaniasis include sporotrichoid leishmaniasis (SL), which is clinically described as a primary ulcer combined with lymphangitis and nodules and/or ulcerated lesions along its pathway.Aims To assess the differences between patients with sporotrichoid leishmaniasis and typical cutaneous leishmaniasis (CL).Methods From January 2004 to December 2010, 23 cases of SL (4.7%) were detected among 494 CL patients diagnosed at a reference center for the disease in Rio de Janeiro State, Brazil. These 23 cases were compared with the remaining 471 patients presenting CL.Results SL predominated in female patients (60.9%, p = 0.024), with older age (p = 0.032) and with lesions in upper limbs (52.2%, p = 0.028). CL affected more men (64.5%), at younger age, and with a higher number of lesions exclusively in lower limbs (34.8%).Conclusions Differences in clinical and epidemiological presentation were found between SL patients as compared to CL ones, in a region with a known predominance of Leishmania (Viannia) braziliensis. The results are similar to the features of most of the sporotrichosis patients as described in literature, making the differential diagnosis between ATL and sporotrichosis more important in overlapping areas for both diseases, like in Rio de Janeiro State.

Diffuse cutaneous leishmaniasis presenting as erythroderma

Introduction: Exfoliative Erythroderma syndrome is a serious, at times life-threatening reaction pattern of the skin characterized by generalized and uniform redness and scaling involving the entire skin and often associated with systemic toxicity, lymphadenopathy and fever. Diffuse Cutaneous Leishmaniasisis observed in anergic patients with a low immune response. Case report: We are presenting a case of a 17-year-old patient diagnosed with Diffuse Cutaneous and Visceral recidivial Leishmaniasis, which clinically presented Erythroderma and skin exfoliation. The most common causes of Erythroderma are Psoriasis, Allergic Dermatitis, Drug Reactions, Lymphoma and Pityriasis Rubra Pilaris. Conversely, Diffuse Cutaneous Leishmaniasis is characterized by the presence of non-ulcerative nodules which resemble Lepromatous Leprosy, scattered in in every part of the body.To the best of our knowledge, the present clinical manifestation of Leishmaniasis has not yet been reported in the literature. Conclusion: In the correct clinical and epidemiological scenario, diffuse Cutaneous Leishmaniasis should be suspected in patients presenting Exfoliative Erythroderma and diffuse nodular lesions.

Lip Leishmaniasis in Saudi Arabia: A Typical Presentation of Cutaneous Leishmaniasis

Lip Leishmaniasis in Saudi Arabia: A Typical Presentation of Cutaneous Leishmaniasis