Report Of Cutaneous Leishmaniasis Research Articles

Emergence of imported cutaneous leishmaniasis caused by Leishmania major: a case series from Kerala, India.

Cutaneous leishmaniasis (CL) is often considered a 'great imitator' and is the most common form of leishmaniasis. The Leishmania species responsible for CL varies among countries, as these species exhibit specific distribution patterns. The increased mobility of people across countries has resulted in the imported incidences of leishmaniasis caused by non-endemic species of Leishmania. During 2023, we confirmed three CL cases caused by L. major from Kerala, India, and upon detailed investigation, these were identified to be imported from the Middle East and Kazakhstan regions. This is the first report of CL caused by L. major from Kerala. The lesion morphology, detection of anti-rK 39 antibody and Leishmania parasite DNA from the blood samples were the unique observations of these cases. Kerala, being an emerging endemic zone of visceral leishmaniasis (VL) and CL, the imported incidences of leishmaniasis by non-endemic species can pose a significant threat, potentially initiating new transmission cycles of leishmaniasis caused by non-endemic species.

Entomological, parasitological and molecular investigations in a new focus of cutaneous leishmaniasis in Youssoufia region, Morocco.

Leishmaniasis is a neglected tropical infection caused by Leishmania parasite that affect human and animal. In Morocco, the cutaneous leishmaniasis has spread substantially to the new areas. The surveillance limited to active foci may underestimate the occurrence of cutaneous leishmaniasis (CL). This study aims to investigate the local transmission of CL in rural districts of Youssoufia province, central Morocco, as a potential focus of CL. For this purpose, parasitological, molecular and entomological investigations were carried out in this area. Data collection concerns potential vectors and human cases. Thus, 402 patients were examined for suspected leishmaniasis lesions in three localities of the province of Youssoufia. In these same localities, 983 sand flies were collected by CDC light traps and sticky paper during one-night per month during 6 months. These sand flies were all identified morphologically using the Moroccan identification key. The results showed that among the 25 skin lesions detected in a population of 402 individuals, 18 were confirmed by kDNA nested PCR as CL positive patients, of which only 25% were positive by direct examination. Leishmania tropica and Leishmania major were identified as causative agents of CL in the study area. Direct parasitological examination showed a low sensitivity (27.78%), especially for L. major, although its specificity was evaluated at 100%. Regarding entomological results, both genera of the Moroccan sand fly were collected in the study area: Genus/Phlebotomus (75.28%) and Sergentomyia (24.72%). Phlebotomus (P) papatasi, the proven vector of L. major, was the most abundant species (33.98%), followed by Paralongicollum sergenti (22.58%), the confirmed vector of L. tropica; while Sergentomyia (S) minuta, P. longicuspis, S. fallax and P. kazeruni were collected with, respectively, 17.60%, 16.99%, 7.12% and 1.73%. This study constitutes the first report of CL in the study areas, as well as the coexistence of L. tropica and L. major in these rural localities. Local transmission of CL is highly probable, as indicated by the prevalence of the two proven vectors of L. major and L. tropica. To control the spread of this disease, our results suggest the use of highly sensitive molecular methods to detect CL cases in potential leishmaniasis foci, which will improve surveillance.

First report of cutaneous leishmaniasis caused by Leishmania donovani in Ethiopia

BackgroundLeishmaniasis is a common neglected tropical disease in Ethiopia. Visceral leishmaniasis (VL) caused by Leishmania donovani presents in the lowlands, while cutaneous leishmaniasis (CL) affects people living in the highlands. Although CL is described as being caused by Leishmania aethiopica, there is also evidence of L. tropica and L. major isolated from a patient, sand flies and potential reservoirs. Information on species causing CL in Ethiopia is patchy, and no nation-wide study has ever been done. Understanding which species are causing CL in Ethiopia can have important implications for patient management and disease prevention.MethodsWe analyzed stored routine samples and biobanked DNA isolates from previously conducted studies of CL patients from different centers in the north, center and south of Ethiopia. Species typing was performed using ITS-1 PCR with high-resolution melt (HRM) analysis, followed by HSP70 amplicon sequencing on a selection of the samples. Additionally, sociodemographic, clinical and laboratory data of patients were analyzed.ResultsOf the 226 CL samples collected, the Leishmania species could be determined for 105 (45.5%). Leishmania aethiopica was identified in 101 (96.2%) samples from across the country. In four samples originating from Amhara region, northwestern Ethiopia, L. donovani was identified by ITS-1 HRM PCR, of which two were confirmed with HSP70 sequences. While none of these four patients had symptoms of VL, two originated from known VL endemic areas.ConclusionsThe majority of CL was caused by L. aethiopica, but CL due to L. tropica and L. major cannot be ruled out. Our study is the first to our knowledge to demonstrate CL patients caused by L. donovani in Ethiopia. This should spark future research to investigate where, how and to which extent such transmission takes place, how it differs genetically from L. donovani causing VL and whether such patients can be diagnosed and treated successfully with the currently available tools and drugs.Graphical

Prevalence of Leishmania infection in three communities of Oti Region, Ghana.

BackgroundLeishmaniasis is a neglected tropical disease caused by parasites of the genus Leishmania and is transmitted by various species of female phlebotomine sand flies. The first report of cutaneous leishmaniasis (CL) in Ghana refer to a cluster of cases in 1999–2003 in the Ho municipality of the Volta Region. We conducted an epidemiological assessment in the Oti Region, encouraged by recent reports of potential cases of CL.Methodology/Principal findingsUsing a cross-sectional study design, the exposure to Leishmania was investigated in three communities of the Oti Region based on the leishmanin skin test (LST). LST results for 3,071 participants comprising 1091, 848, and 1132 persons from the communities of Ashiabre, Keri, and Sibi Hilltop, indicated an overall prevalence of exposure to Leishmania infection of 41.8% and individual community prevalence of 39.4%, 55.1%, and 34.2% respectively. Being male [AOR = 1.27; CI: 1.09, 1.49], and living in Keri [AOR = 1.83; CI: 1.43, 2.34] were associated with an increase in the odds of exposure to Leishmania. Being 5–10 years old [AOR = 1.48; CI: 1.06, 2.05], 11–17 years old [AOR = 2.03; CI: 1.45, 2.85], 18–40 years old [AORR = 2.83; CI: 1.81, 4.43] and 41–65 years old [AOR = 5.08; CI: 2.98, 8.68] were also significantly associated with increased odds of being exposed to Leishmania.Conclusions/SignificanceThis study demonstrated exposure to Leishmania in the study communities and also identified associated factors. Future efforts aimed at reducing exposure to Leishmania infection in the study area should take the associated factors into consideration.

Detection of Cutaneous Leishmaniasis Foci in South Ethiopia.

Cutaneous leishmaniasis (CL) is a major public health problem in Ethiopia. The disease is endemic in Ochollo, a village in southern Ethiopia, but there are no reports of CL in the wider area, although it is ecologically very similar. We conducted a rapid assessment survey in the South Ethiopian Rift Valley and found 100 parasitologically confirmed CL cases in 38 villages not reported endemic for CL. Approximately half of the cases were children (57%), and most lesions occurred on the face (78%) and were older than 6 months (77%). Only 2% of the people was aware of the mode of transmission, and 9% sought modern treatment at a hospital. These preliminary data indicate that CL is much more widespread than previously reported and that the disease might have a large psychosocial impact. Hence, this study calls for larger surveys across the Ethiopian highlands. Additionally, health education and treatment capacity need to be implemented.

Lesions of Cutaneous Leishmaniasis Elicited after Local Trauma: A Case Report

In Brazil there is an average of 30,000 cases of Cutaneous Leishmaniasis reported annually, and around the world it happens for about each 20 seconds. Although there are still opportunities to contribute with studies about this disease; supporting the medical community, especially dermatologists, mainly because of the necessity of knowing that a relatively simple procedure can result such a relevant trauma. Female patients presented erythematous plaque in the limb. Lesion appeared days after laser sessions for hair removal. Biopsy showed amastigotes forms and positive culture. After unsuccessful treatment it was managed with N-methyl glucamine 20 mgSbV/kg/day, during 20 days, there was significant improvement of the clinical picture. This study aims to present a case report of Cutaneous Leishmaniasis initiated after local trauma. Literature reports describe primary or secondary lesions of Cutaneous Leishmaniasis elicited after a local trauma. The mechanism used in order to explain these events was the migration of infected macrophages induced by cytokines. Similar events have also been reported as part of the locus minoris resistentiae concept that comprises situations in which microorganisms have a tendency to settle at places of weakened resistance. Considering that Leishmaniasis lesions are usually developed in promastigote forms are inoculated by the Phlebotominae, in this case it was noted that the infection has been favored by the local trauma.

Cutaneous Leishmaniasis Following Local Trauma: A Case Report

In Brazil there is an average of 30,000 cases of Cutaneous Leishmaniasis reported annually, and around the world it happens for about each 20 seconds. Although there are still opportunities to contribute with studies about this disease; supporting the medical community, especially dermatologists, mainly because of the necessity of knowing that a relatively simple procedure can result such a relevant trauma. Female patients presented erythematous plaque in the limb. Lesion appeared days after laser sessions for hair removal. Biopsy showed amastigotes forms and positive culture. After unsuccessful treatment it was managed with N-methyl glucamine 20 mgSbV/kg/day, during 20 days, there was significant improvement of the clinical picture. This study aims to present a case report of Cutaneous Leishmaniasis initiated after local trauma. Literature reports describe primary or secondary lesions of Cutaneous Leishmaniasis elicited after a local trauma. The mechanism used in order to explain these events was the migration of infected macrophages induced by cytokines. Similar events have also been reported as part of the locus minoris resistentiae concept that comprises situations in which microorganisms have a tendency to settle at places of weakened resistance. Considering that Leishmaniasis lesions are usually developed in promastigote forms are inoculated by the Phlebotominae, in this case it was noted that the infection has been favored by the local trauma.

An imported case of cutaneous leishmaniasis caused by Leishmania (Leishmania) donovani in Japan

Leishmaniasis is a major world health problem, and 12million people are estimated to be infected in 88 countries. There have been few reports of leishmaniasis in Japan and all were of foreign origin; therefore diagnosis is difficult for Japanese physicians. There are 21 different pathogenic Leishmania species, and identification is obtained by polymerase chain reaction (PCR). Here we report an imported case of leishmaniasis by Leishmania (Leishmania) donovani infection from Sri Lanka. L. (L.)donovani usually causes visceral leishmaniasis, but in this case, the patient manifested cutaneous leishmaniasis. The identification of Leishmania species by PCR and investigation of the patient's background such as nationality and disease endemicity are important for diagnosis and treatment. This is the first report of cutaneous leishmaniasis by L. (L.)donovani in Japan.

First Case Report of Cutaneous Leishmaniasis Caused by Leishmania (Leishmania) infantum in a Brazilian Patient Treated with Adalimumab

Leishmania (Leishmania) infantum is the main etiologic agent of visceral leishmaniasis in American continent. We report a rare case of cutaneous leishmaniasis caused by viscerotropic specie in a patient with ankylosing spondylitis on treatment with adalimumabe and methotrexate. The patient presented no signs of visceral involvement. PCRRFLP and genetic sequencing demonstrated Leishmania (Leishmania) infantum. The patient was treated with Nmethyl- glucamine (20 mgSbV/kg/day) for 20 days. Despite of interruption of treatment due to elevation of transaminases (TGO 48 U/L and TGP 62 U/L) for a week, the lesions healed completely. Leishmania infection in patients who are on anti-TNF alpha treatment has to be remembered as an opportunistic disease associated with immunosuppression caused by biological therapies, especially in endemic countries. We consider that the use of immunosuppressive drugs may lead to atypical cases of cutaneous leishmaniasis even by viscerotropic agents.

First survey of cutaneous leishmaniasis in Borujerd county, western Islamic Republic of Iran

Lorestan province in the Islamic Republic of Iran has not previously been known as a focus for cutaneous leishmaniasis (CL). Clinical and epidemiological studies were carried out on patients diagnosed with active CL at the central laboratory in Borujerd city during 1998-2010. A total of 137 patients with corroborated CL were studied (mean estimated annual incidence 4.36 per 100 000 inhabitants). The male:female ratio was > 11:1. Patients ranged in age from 8-63 years but > 70% were aged 21-40 years and only 1 was < or = 10 years. The rate of CL was highest in rural residents (56.9%) and among those working as labourers (38.0%) and drivers (32.8%). The rate of active lesions on the upper limbs (69.3%) was significantly higher than other locations, and more cases were dry sores (57.7%) than wet sores (42.3%). The majority of patients (61.3%) had a single active lesion (mean 1.8 ulcers per patient). This is the first report of CL in the area.

Cutaneous and post kala-azar dermal leishmaniasis caused by Leishmania infantum in endemic areas of visceral leishmaniasis, northwestern Iran 2002–2011: a case series

Visceral leishmaniasis (VL) is endemic in Northwest and southern Iran. Reports of cutaneous leishmaniasis (CL) in Northwest areas are rare, and its etiological agents are unknown. In the current study, we report six CL and two post kala-azar dermal leishmaniasis (PKDL) cases caused by Leishmania infantum from endemic areas of VL in the Northwest. Smears were made from skin lesions of 30 suspected patients in 2002–2011, and CL was determined by microscopy or culture. Leishmania spp. were identified by nested-PCR assay. The disease was confirmed in 20 out of 30 (66%) suspected patients by parasitological examinations. L. infantum was identified in eight and Leishmania major in 12 CL cases by nested-PCR. Cutaneous leishmaniasis patients infected with L. major had the history of travel to CL endemic areas. L. infantum antibodies were detected by direct agglutination test (DAT) at titers of 1:3200 in two cases with history of VL. Results of this study indicated that L. infantum is a causative agent of CL as well as PKDL in the VL endemic areas.

Épidémiologie clinique et parasitologique de la leishmaniose cutanée dans cinq villages du Pays Dogon, Mali

The epidemiology of the cutaneous leishmaniasis (CL) with Leishmania major is poorly documented in Mali. Following reports of CL in the tourist areas of the Dogon country (Bandiagara Escarpment), a joint French and Malian bio-clinical team conducted a field study from 16 to 27 January, 2010. The population of 5 villages has been examined by a dermato-infectiologist and cases were selected by visual inspection of skin lesions. Smears and biopsies (from the lesions) and venous blood were obtained from suspected cases of CL. Diagnosis was performed by light microscopy, in vitro cultures, serology and molecular biology. Fifty patients with skin lesions have been examined. Twenty-one have been suspected as CL. At least one sample was obtained from 18 patients. The lesions were predominantly old, more or less scarring and secondary infected. A skin smear was performed for 15 patients, a skin biopsy for 14 patients: smears and cultures were all negative. The PCR (Leishmania spp.) made on 14 biopsies was positive for 12 patients (86%). The low amount of amplified DNA obtained did not allow the sequencing and identification of the species of Leishmania. Western blot (WB) serology was positive in 11 cases out of 12 (92%). This investigation showed the presence of cutaneous leishmaniasis in Bandiagara. A further investigation is required during transmission period (September-October) to confirm the presence of Leishmania major epidemic in Dogon country.

An outbreak of suspected cutaneous leishmaniasis in Ghana: lessons learnt and preparation for future outbreaks

Human cutaneous leishmaniasis (CL) has previously been reported in West Africa, but more recently, sporadic reports of CL have increased. Leishmania major has been identified from Mauritania, Senegal, Mali, and Burkina Faso. Three zymodemes (MON-26, MON-117, and MON-74, the most frequent) have been found. The geographic range of leishmaniasis is limited by the sand fly vector, its feeding preferences, and its capacity to support internal development of specific species of Leishmania. The risk of acquiring CL has been reported to increase considerably with human activity and epidemics of CL have been associated with deforestation, road construction, wars, or other activities where humans intrude the habitat of the vector. In the Ho Municipality in the Volta Region of Ghana, a localised outbreak of skin ulcers, possibly CL, was noted in 2003 without any such documented activity. This outbreak was consistent with CL as evidenced using various methods including parasite identification, albeit, in a small number of patients with ulcers.This paper reports the outbreak in Ghana. The report does not address a single planned study but rather a compilation of data from a number of ad-hoc investigations in response to the outbreak plus observations and findings made by the authors. It acknowledges that a number of the observations need to be further clarified. What is the detailed epidemiology of the disease? What sparked the epidemic? Can it happen again? What was the causative agent of the disease, L. major or some other Leishmania spp.? What were the main vectors and animal reservoirs? What are the consequences for surveillance of the disease and the prevention of its reoccurrence when the communities see a self-healing disease and may not think it is important?

Cutaneous leishmaniasis in red kangaroos: isolation and characterisation of the causative organisms

This is the first report of cutaneous leishmaniasis in kangaroos where infection was acquired within Australia. The diagnosis is based on the clinical criteria used for humans, the lesion histopathology, the detection and isolation of parasites from the lesions, and the analysis of the small subunit ribosomal RNA genes using the polymerase chain reaction. Despite a clear indication that the parasites belong to the genus Leishmania, no assignation to a known Leishmania species could be made using these or other less conserved genetic loci such as the non-transcribed spacer of the mini-exon repeat. As is the case in humans, some but not all animals harbouring lesions had antibodies to the isolated parasites or to several other Leishmania species. The isolated parasites displayed two well characterised Leishmania glycoconjugates, the lipophosphoglycan and proteophosphoglycan. They were infectious for mouse macrophages in vitro and established long-term infection at 33 °C but not at 37 °C. Our findings raise the possibility of transmission to humans, which may be unrecognised and suggest the possibility that imported species of Leishmania could become endemic in Australia.

Lutzomyia longiflocosa (Diptera: Psychodidae) posible vector en el foco de leishmaniasis cutánea del municipio de Planadas, zona cafetera del Tolima

Dueto an increase in the reports of cutaneous leishmaniasis (CL) cases in Planadas (Tolima), in a central Colombian coffee-growing region, a pilot-study was carried out to determine the sand flies of the genus Lutzomyia in La Aldea, La Floresta and Gaitania indigenous area. Sand flies were sampled at night using Shannon traps, CDC light traps and protected human bait. A total of 2,849 sand flies, grouped in five species were found, three of them belonging to the verrucarum group. L. longiflocosa (98.5%) was found mainly in coffee crops, peri and intradomiciliary areas. L. longiflocosa is known to be anthrophophilic and a suspected vector of CL in Huila Department, Colombia. L. nuñez tovari(0.7%), whose L. n. anglesivariety is considered possible Leishmania sp. vector in Bolivia, found in intra and peridomicialiary areas, and L. columbiana (0.1%), was registered in intra and peridomiciliary areas. L. shannoni(0.3%), was mainly present in coffee crops. Some of the collected sand flies were species of the subgenus Helcocyrtomyia (0.5%). From 379 phlebotomine dissected, none was found harbouring flagellate forms in their guts.The results pointed to L. longiflocosa as the most probable vector in this focus. However, it is necessary to carry out further studies to define the role that this species plays in the transmission of CL in the area.

Cutaneous leishmaniasis in Niger

This is the first report of cutaneous leishmaniasis in Niger subsequent to the initial finding in 1911 and the report of a second case in 1943. The clinical, histopathological, and epidemiological features of 64 parasitologically confirmed cases are described. Lesions were mostly multiple, situated on exposed areas of skin, but rarely on the face. Two clinical forms were predominant: ulcero-crusted and humid-ulcerous. Nodular lymphangitis was not uncommon. Patients were mostly from rural areas, but urban transmission did occur. The majority of lesions appeared during the June-October rainy season. All features appeared to be similar to those of this disease in other countries in the sahelian endemic zone.