Types Of Cutaneous Leishmaniasis Research Articles

Impact of Some Immunological Parameters (antioxidant – cytokines) in Cutaneous leishmaniasis in a Sample of Patients in the Al-Ramadi City.

Background: Cutaneous leishmaniasis is one of the endemic diseases in Iraq. Both types of cutaneous leishmaniasis that cause different ulcers are present, namely Leishmania major and Leishmania tropica, The disease also represents a major public and global health problem all over the world. Objective: Investigation of the relationship between parasitic infection with cutaneous leishmaniasis and some antioxidants Superoxide, Nitric oxide and immune cytokines tumor necrosis factor-alpha, Interferon-gamma. Materials and Methods: The demographic and epidemiological study included 55 cases suspected of being infected with cutaneous leishmaniasis. They visited Ramadi Teaching Hospital, with 25 volunteers. After obtaining their consent, they were used as control samples, where blood serum samples were obtained from both study groups. After that, work was done in laboratories. Department of Biology - College of Education for Pure Sciences - Anbar University. Results: The patients and healthy people were of different genders, and among the 55 samples from the infected, the number of males was 36 (65.5)% and females 19 (34.5)%, with statistically significant differences p<0.05, and the age groups of the patients were from one year to 60 years. With an average age of (31 years), they were distributed into 6 groups. Also, among the 25 samples from the control group, the number of males was 12 (48%) and females were 13 (52%), Their ages also ranged from one year to 60 years, with an average age of (13) years, the enzyme-linked immunoabsorbent assay (ELISA) technique was used to detect the level of immunological indicators TNF-α, IFN-γ, SOD, NO, where the results showed High levels in the serum of cutaneous leishmaniasis patients (120.00 ± 52.11, 123.00 ± 44.21, 3.10 ± 1.21 and 121.93 ± 33.22), respectively compared to healthy subjects (72.86 ± 14.94, 21.91 ± 45.40, 0.88 ± 0.12, and 81.46 ± 4.50 ) respectively With statistically significant differences at the level of p < 0.05, p < 0.001. Conclusions: The inflammatory cytokines TNF-α, IFN-γ play a vital role in increasing or decreasing the severity in the pathogenesis of the disease and eliminating it.

The stigma associated with cutaneous leishmaniasis (CL) and mucocutaneous leishmaniasis (MCL): A protocol for a systematic review.

Leishmaniasis is a neglected tropical disease with three main clinical types; cutaneous leishmaniasis (CL), mucocutaneous leishmaniasis (MCL), and visceral leishmaniasis (VL). CL and MCL are considered to be highly stigmatizing due to potentially disfiguring skin pathology. CL and MCL-associated stigma are reported across the world in different contexts assimilating different definitions and interpretations. Stigma affects people with CL, particularly in terms of quality of life, accessibility to treatment, and psycho-social well-being. However, evidence on CL- and MCL-associated stigma is dispersed and yet to be synthesized. This systematic review describes the types, measurements, and implications of the stigma associated with CL and MCL and identifies any preventive strategies/interventions adopted to address the condition. This study was developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) statement which is registered in the International Platform of Registered Systematic Review and Meta-analysis Protocols PROSPERO (ID- CRD42021274925). We will perform an electronic search in MEDLINE, Embase, Scopus, PubMed, EBSCO, Web of Science, Global Index Medicus, Trip, and Cochrane Library databases, and in Google Scholar, using a customized search string. Any article that discusses any type of CL- and/or MCL-associated stigma in English, Spanish and Portuguese will be included. Articles targeting veterinary studies, sandfly vector studies, laboratory-based research and trials, articles focusing only on visceral leishmaniasis, and articles on diagnostic or treatment methods for CL and MCL will be excluded. Screening for titles and abstracts and full articles and data extraction will be conducted by two investigators. The risk of bias will be assessed through specific tools for different study types. A narrative synthesis of evidence will then follow. This review will identify the knowledge gap in CL-associated stigma and will help plan future interventions.

Patterns of cutaneous leishmaniasis during the COVID-19 pandemic in four endemic regions of Iran.

Both zoonotic cutaneous leishmaniasis (ZCL) and anthroponotic cutaneous leishmaniasis are endemic in different regions of Iran. It is important to know the type of cutaneous leishmaniasis (CL) for prevention strategies. On the other hand, Iran is one of the countries that was severely affected by the coronavirus 2019 (COVID-19) pandemic. However, little is known about the causative agents of CL during the COVID-19 pandemic in Iran. In this study, a total of 181 samples were isolated from patients with CL lesions in four different endemic cities of Iran (Jahrom, Juyom, Kashan and Shoushtar) during the COVID-19 pandemic (the summer and autumn of 2021). The nested-PCR targeting kinetoplast DNA (kDNA) minicircles was applied for species identification of the parasite and the internal transcribed spacer-1 (ITS-1) gene was applied for sequencing and phylogenetic analysis. Molecular detection of kDNA minicircles revealed that all isolates from the four cities were Leishmania major, indicating the ZCL pattern. Ten isolates were sequenced by the ITS-1 gene and deposited in GenBank [accession numbers: OL627363-72]. Sequencing and phylogenetic analysis displayed a high similarity rate of the isolates with sequences from other parts of Iran and Iraq. Over half of the patients (53.59%) had a single lesion, while 17.12, 14.92, 2.21 and 12.16% of cases had two, three, four and more than four lesions, respectively. About half of the patients (50.27%) had lesions on their hands, while the rest had lesions on multiple locations (19.34%), legs (16.58%), face (9.94%), ears (1.66%) and waist (2.21%). This study revealed the occurrence of ZCL during the COVID-19 pandemic in four endemic regions of Iran. Strategies for prevention and control of the disease should be considered to mitigate the occurrence of ZCL.

Biophysical and ultrasonographic changes of acute Old World cutaneous leishmaniasis skin lesions in comparison with uninvolved skin: A possible tool for non-invasive early detection and treatment outcome assessment.

Cutaneous leishmaniasis (CL) is a skin disease caused by intracellular protozoa, which is endemic in Iran. The goal of this study was to compare biophysical characteristics in CL lesions with uninvolved skin. Stratum corneum hydration, transepidermal water loss, surface friction, pH, sebum, melanin, erythema, temperature, elasticity parameters (R0, R2, and R5), thickness and echo-density of epidermis and dermis were measured on the active erythematous indurated part of a typical CL lesion in 20 patients, and compared with the same location on the other side of the body as control. Paired t-test was used for statistical analyses and a p < 0.05 was considered significant. Melanin content, R2 and echo-density of dermis were significantly lower, whereas transepidermal water loss, friction index, pH, erythema index, temperature, and the thickness of dermis were significantly higher in CL lesions. There was no significant difference in stratum corneum hydration, sebum, R0, R5, thickness of epidermis, and density of epidermis between CL and normal skin. CL lesions are characterized by certain changes in biophysical and ultrasonographic properties, which are mostly correlated with histological features. These changes are likely to be useful in the non-invasive early detection of CL and also as treatment outcome measures for clinical trials of new treatment modalities for CL in the future.

Ecological characterization of a cutaneous leishmaniasis outbreak through remotely sensed land cover changes.

In this work we assessed the environmental factors associated with the spatial distribution of a cutaneous leishmaniasis (CL) outbreak during 2015-2016 in north-eastern Argentina to understand its typical or atypical eco-epidemiological pattern. We combined locations of human CL cases with relevant predictors derived from analysis of remote sensing imagery in the framework of ecological niche modelling and trained MaxEnt models with cross-validation for predictors estimated at different buffer areas relevant to CL vectors (50 and 250 m radii). To account for the timing of biological phenomena, we considered environmental changes occurring in two periods, 2014-2015 and 2015-2016. The remote sensing analysis identified land cover changes in the surroundings of CL cases, mostly related to new urbanization and flooding. The distance to such changes was the most important variable in most models. The weighted average map denoted higher suitability for CL in the outskirts of the city of Corrientes and in areas close to environmental changes. Our results point to a scenario consistent with a typical CL outbreak, i.e. changes in land use or land cover are the main triggering factor and most affected people live or work in border habitats.

Study of Ecological Factors Associated With Leishmaniosis in the Township Fariman 2006-2018 Years

Introduction: ecological factors such as climate change, environmental, social, economic and political factors are effective in increasing the incidence of Leishmaniasis disease in the Middle East. This study aimed to evaluate ecological causes of leishmaniasis in Fariman city during twelve years (2006-2017). Methods: In this descriptive-analytical study, all patients residing in Fariman city who completed the Leishmaniasis Survey Form were included. The data of climatic variables of the city were also extracted and analyzed using MS- Excel and SPSS software. Finally, the above information was plotted in Arc-GIS software. Results: The highest incidence of cutaneous leishmaniasis in Fariman are 38.2% in 2009 and the lowest incidence rate in 2017 was 12.0%. According to the incidence date, the disease was in summer, spring, autumn, and according to the date of diagnosis, the disease had a peak in spring, winter, autumn, and summer. In this study, there was no relationship between the type of cutaneous leishmaniasis and any of the demographic variables. There was no significant relationship between climatic variables (temperature, humidity, precipitation), climatic factor of height, vegetation index and Comprehensive plan in rural areas with leishmaniasis. Conclusion: Considering that most cases of disease were in urban area of Fariman and two rural areas of Ghale No and Kate shamshir, in order to make better use of the GIS, entomological examination in the area and overlap of the relevant layer with other layers such as patients' accommodation and type of cutaneous leishmaniasis are required.

Species Composition of Sand-fly and Occurrence of Cutaneous Leishmaniasis in Owerri North Local Government Area, Imo State

Cutaneous leishmaniasis (CL) is a neglected tropical disease of public health value vectored by sand-fly in tropical and vegetative regions of the world. This study was carried out between March and September, 2019 to determine species composition of Sand fly and occurrence of cutaneous leishmaniasis in Owerri North Local Government Area of Imo State. Light and paper oil trap were used to trap 204 Sandflies from 3 villages and identified with standard entomological technique based on morphological characteristics. Assessment of the skin for cutaneous leishmaniasis manifestation was carried out on available respondents above 15 years. Blood samples were collected from 42 head of households and emptied into EDTA containers. Laboratory analysis of blood samples was carried out using standard method of staining and microscopy. Result was represented in percentages and subjected to chi-square analysis. The result revealed two sand-fly genera; Phlebotomus (135) and Lutzomyia (69) with abundant rates of 66.17% and 33.82% respectively. The different species were present in the villages sampled and female flies accounted for 45.59% of the collection. There was no typical CL skin manifestation observed among villagers, however, laboratory analysis of the household respondents showed 3(7.14) persons had amastigote form of leis hymenia in their blood. The study reveals occurrence of cutaneous leishmaniasis and its possible vectors in the study area. There is need for public health awareness, health education and application of effective control measures for sand-fly in this area

Using Q-methodology to understand the perspectives and practical experiences of dermatologists about treatment difficulties of cutaneous leishmaniasis

BackgroundDuring the outbreak of cutaneous leishmaniasis in the Kurdistan Region of Iraq that started in 2015, the course of the disease and the treatment were not consistent with the available literature. Physicians, particularly dermatologists, faced challenges with treating the cutaneous leishmaniasis lesions with high rates of treatment failure and resistance to treatment. We used Q-methodology to understand the range and diversities of opinions and the practical experiences of dermatologists about the treatment difficulties of cutaneous leishmaniasis.MethodsThis Q-methodology study was carried out in Erbil, Kurdistan Region of Iraq, and involved 37 dermatologists. A set of 40 statements related to different aspects of difficulties and uncertainties of treating cutaneous leishmaniasis was prepared. The dermatologists were requested to distribute the 40 statements into a scaled grid of nine piles from least agree to most agree. We applied by-person factor analysis using PQMethod 2.35 for the data analysis.ResultsThe analysis revealed two different viewpoints about the treatment of cutaneous leishmaniasis and a consensus viewpoint. The first viewpoint emphasized the use of sodium stibogluconate-based combination therapy, concerns with treatment failure, and lack of compliance with the treatment. The second viewpoint emphasized the lack of standard treatment and advances in the treatment of cutaneous leishmaniasis. There was a consensus between both groups of respondents about many aspects of the treatment of cutaneous leishmaniasis, including considering sodium stibogluconate the first drug of choice for cutaneous leishmaniasis treatment.ConclusionsThis study revealed a diversity of viewpoints and uncertainties about the effectiveness of the available treatment modalities and treatment difficulties and failure. Interrupted supply and poor quality of the available drugs and lack of a standard and advanced treatment are the main problems facing the treatment of cutaneous leishmaniasis. More research is required to determine the best treatment modalities for the different types of cutaneous leishmaniasis. There is a need for the development of treatment guidelines specific to the Iraqi context with a particular focus on the treatment of the resistant and atypical cases of cutaneous leishmaniasis.

Intraspecies Polymorphisms in the Lipophosphoglycan of L. braziliensis Differentially Modulate Macrophage Activation via TLR4.

Lipophosphoglycan (LPG) is the major Leishmania surface glycoconjugate having importance during the host-parasite interface. Leishmania (Viannia) braziliensis displays a spectrum of clinical forms including: typical cutaneous leishmaniasis (TL), mucocutaneous (ML), and atypical lesions (AL). Those variations in the immunopathology may be a result of intraspecies polymorphisms in the parasite's virulence factors. In this context, we evaluated the role of LPG of strains originated from patients with different clinical manifestations and the sandfly vector. Six isolates of L. braziliensis were used: M2903, RR051 and RR418 (TL), RR410 (AL), M15991 (ML), and M8401 (vector). LPGs were extracted and purified by hydrophobic interaction. Peritoneal macrophages from C57BL/6 and respective knock-outs (TLR2−/− and TLR-4−/−) were primed with IFN-γ and exposed to different LPGs for nitric oxide (NO) and cytokine production (IL-1β, IL-6, IL-12, and TNF-α). LPGs differentially activated the production of NO and cytokines via TLR4. In order to ascertain if such functional variations were related to intraspecies polymorphisms in the LPG, the purified glycoconjugates were subjected to western blot with specific LPG antibodies (CA7AE and LT22). Based on antibody reactivity preliminary variations in the repeat units were detected. To confirm these findings, LPGs were depolymerized for purification of repeat units. After thin layer chromatography, intraspecies polymorphisms were confirmed especially in the type and/size of sugars branching-off the repeat units motif. In conclusion, different isolates of L. braziliensis from different clinical forms and hosts possess polymorphisms in their LPGs that functionally affected macrophage responses.

Leishmania species in biopsies of patients with different clinical manifestations identified by high resolution melting and nested PCR in an Endemic district in Peru

BackgroundThe parasite of the genus Leishmania causes a neglected disease known as leishmaniasis, which has different clinical aspects depending on the species that infects the person and the immune response of the patient. The objective was to determine, using molecular biology, the current circulating species of Leishmania in biopsies of different types of cutaneous leishmaniasis (CL) from the endemic district in the region of “Madre de Dios”, Peru. MethodsThe study's 19 samples were obtained in the Huepethue district in the “Madre de Dios” region from patients who were diagnosed for suspected leishmaniasis infection with three clinical manifestations. These were analyzed using kDNA-PCR, Nested-PCR and HRM-PCR to identify the genus of an infecting parasite as well as its species. ResultskDNA-PCR detected all tests for the genus of Leishmania to be positive, while the Nested-PCR could not detect 20.9% of species (one L. (V.) braziliensis and three L. (V.) amazonensis), and the HRM-PCR detected all species presented in the samples. The most prevalent species was L. (V.) braziliensis (73.7%), and the clinical manifestations were ulcers (63.2%), superficial scabs (5.3%) and diffuse form (5.3%), followed by L. (V.) amazonensis (15.8%), manifesting ulcers (15.6%), and L. (V.) lainsoni (10.5%), manifesting superficial scabs (5.3%) and ulcers (5.3%). L. (V.) braziliensis, L. (V.) amazonensis and L. (V.) lainsoni were detected effectively using HRM-PCR in the samples with different clinical manifestations. ConclusionsHighlighting the findings of a high diversity of Leishmania species using High Resolution Melting PCR in biopsies with different clinical manifestations of cutaneous leishmaniasis.

Molecular detection of Leishmania species in northeast of Iran

Two known types of cutaneous leishmaniasis (CL) including zoonotic CL due to Leishmania major and anthroponotic CL due to Leishmania tropica are prevalent in 14 of 22 countries located in the Eastern Mediterranean region including Iran. According to existing data, CL is endemic in Sabzevar City (northeast of Iran) and, because of the climatic conditions in this semi-desert region, is suitable for living vector/reservoir hosts of infection. The aim of our study was to identify the recent status of CL causative species in rural areas of Sabzevar County. Suspected patients of CL who were referred to health centers in suburban areas of Sabzevar and confirmed via microscopic observation of amastigotes were included in the study. Molecular identification of Leishmania species was done via nested PCR assay, based on amplification of kinetoplast minicircle fragments of L. major and L. tropica. In total, 153 patients including 89 males and 64 females were enrolled in this study. A high infection rate was reported in the autumn season (with a peak in October). Our findings revealed that L. major is responsible for 100% of infections. In addition, there was no association between CL and risk factors after statistical analysis. It seems that the infection pattern of CL is changing predominantly to L. major in most regions of Iran, which may be due to environmental changes, or ecological amendment and their effects on (vector/reservoir) host distribution in rural parts. Finally, controlling programs as well as promotion in public health systems should be considered in this area.

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.

An Atypical Case of Leishmaniasis with HIV Co-Infection

An article describes an atypical case of rural type of cutaneous leishmaniasis at the HIV-infected patient, clinical stage 4. There is no case, described in literature until this day, (PubMed, Google, Medline, ResearchGate) when the clinical presentation of rural type of cutaneous leishmaniasis extended for year and half. According to authors, the length and severity of disease’s progression is caused with HIV-co-infection and a secondary bacterial infection accompanying the pathological process.

Cutaneous Leishmaniasis Caused byLeishmania killicki,Algeria

Cutaneous Leishmaniasis Caused by<i>Leishmania killicki,</i>Algeria

Comparison of Conventional, Molecular, and Immunohistochemical Methods in Diagnosis of Typical and Atypical Cutaneous Leishmaniasis

Localized cutaneous leishmaniasis (CL) typically presents as papules, crusted nodules, plaques, or noduloulcerative lesions. Atypical CL does not show these features or mimic malignant lesion. In atypical forms, CL may be overlooked because of its similarity to other dermal diseases. To compare conventional, molecular, and immunohistochemical methods in the diagnosis of typical and atypical CL. The kinetoplast DNA, nested, polymerase chain reaction assay and immunohistochemical methods were compared and validated against conventional methods, including cytology and pathology, using 100 specimens of typical and atypical lesions of suspected CL. Compared with other methods, polymerase chain reaction of the kinetoplast DNA showed the highest sensitivity (typical positive, 100%, 67 of 67; atypical positive, 94%, 31 of 33) and specificity (100%), followed by immunohistochemistry (typical positive, 97%, 65 of 67, with 100% specificity; atypical positives, 94%, 31 of 33, with 100% specificity), and cytology (typical positive, 79%, 53 of 67, with 100% specificity; atypical positive, 58%, 19 of 33, with 100% specificity), followed by pathology (typical positive, 70%, 47 of 67, with 100% specificity; atypical positive, 42%, 14 of 33, with 100% specificity). In addition, polymerase chain reaction enabled identification of 98% (98 of 100) of the positive samples that included strains of Leishmania major (99% [99 of 100] cases) and Leishmania tropica (1% [1 of 100] cases). Because cytology is cheap and easy to perform with high sensitivity, it is the preferred, primary approach for typical CL, but cytology and pathology do not have sufficient sensitivity for diagnosis of atypical CL cases. Nested polymerase chain reaction and immunohistochemistry are sensitive tests for diagnosis of both typical and atypical CL and are recommended as complementary tests in suspected CL with negative conventional microscopy results.

Identification and Diagnosis of Cutaneous Leishmaninsis by Polymerase Chain Reaction Assay (Pcr) in Najaf Alashraf Province

Objective: The present study aimed to determine the effectiveness of a polymerase chain reaction (PCR) technique for identification and differentiation of the cutaneous leishmaniasis parasite in clinical sample collected of lesion exudates patients. Methodology: The (115) sample were examined by smear slid preparation culture on RPMI 1640 and NNN then DNA isolation. The DNA of the promastigote were amplified by PCR including primers selected on repetitive KDNA for identification of leishmania species. The data was analyzed by using frequency and percentage. Results: The PCR result showed that two species of leishmania (L. major with 620 bp and L. tropica with 800 bp) exist. Conclusion: It is concluded of the present study that the PCR technique has high specificity and sensitivity during the differentiation between Cutaneous Leishmanial species in comparing with conventional methods. Recommendation: The PCR technique can be use it to diagnosis and differentiation between different type of Cutaneous Leishmaniasis.

Evaluation of leishmanin skin test reaction in different variants of cutaneous leishmaniasis

Introduction:Cutaneous leishmaniasis (CL) is a parasitic disease which has different clinical forms. The aim of this study is to compare the response to leishmanin skin test (LST) in three forms of CL including plaque type, lupoid type, and sporotrichoid type.Materials and Methods:This was a descriptive cross-sectional study. The patients enrolled in this study had three clinical forms of CL confirmed by positive smear of their lesions and then LST was performed for them. Results were categorized as negative (0-5 mm induration), positive (6-14 mm), and strongly positive (≥15 mm). The data were documented in the patients’ files and analyzed with SPSS windows software version 16 (Inc.Chicago, USA).Results:200 patients were enrolled in the study. In the group with plaque type, 86% had a positive LST, 13.3% were negative, and 0.7% were strongly positive. In the lupoid group, these figures were 45.8%, 8.4%, 45.8%, respectively. In the sporotrichoid group, LST was positive in 27.3%, negative in 72.7%, and none of the patients had a strongly positive reaction (P < 0.05). Discussion: The most of the positive LST were belong to plaque and lupoid groups, the most of strongly positive were belong to lupoid, and the most of negative LST were related with sporotrichoid type.Conclusion:It can be suggested that lupoid and sporotrichoid types of CL are parts of a continuous spectrum of the disease with an enhanced cellular immunity in lupoid form and a decreased state in sporotrichoid type.

Auricular enlargement: An atypical presentation of old world cutaneous leishmaniasis

The auricle is an extremely rare site for cutaneous leishmaniasis (CL) in Old World, which tends to be a benign disease with self-healing small nodules such as the “oriental sore”. However, in the New World, there is a type of CL of the ear, named as “chiclero's ulcer” which is caused by Leishmania mexicana. Herein, we describe a case of massive auricular enlargement due to Old World CL.

Development of Cutaneous Leishmaniasis after Leishmania Skin Test

Thirty-year-old female with a previous history of a cutaneous ulcer suspicious of leishmaniasis 20 years ago presented with a new complaint of a depressed papular lesion 8 × 7 mm in the right lower extremity. The lesion was of 10-day duration. Because early cutaneous leishmaniasis (CL) lesions may have a non-ulcerated appearance, a Leishmania skin test (LST) was performed on the forearm with a strong positive result (38 × 32 mm). After 8 days, the lesion in the leg, which was diagnosed as folliculitis, completely healed. However, a typical CL ulcer (26 × 24 mm) developed at the LST site. Histopathology of the new lesion did not identifiy parasites, but the findings were consistent with a diagnosis of CL. Further analysis identified amastigotes by immunohistochemical stain. Mononuclear cells harvested from the patient were stimulated with Leishmania antigen and showed high levels of production of both tumor necrosis factor-alpha (TNF-α) and interferon-gamma (IFN-γ): 2,943 pg/mL and 2,313 pg/mL, respectively. After 40 days of treatment with antimony and pentoxifylline, the ulcer resolved. The development of CL at the LST site suggests a strong Th1 immune response, and it is an in vivo documentation of the role of the host immune response in the pathology of CL. It teaches us that LST should be cautiously, if at all, used in patients with self-healing CL ulcers.

Sand flies of Nicaragua: a checklist and reports of new collections

Sand flies within the genus Lutzomyia serve as the vectors for all species of the protozoan parasite Leishmania in the New World. In this paper, we present a summary of the 29 species of Lutzomyia and one of Brumptomyia previously reported for Nicaragua and report results of our recent collections of 565 sand flies at eight localities in the country from 2001-2006. Lutzomyia longipalpis was the predominant species collected within the Pacific plains region of western Nicaragua, while Lutzomyia cruciata or Lutzomyia barrettoi majuscula were the species most frequently collected in the central highlands and Atlantic plains regions. The collection of Lutzomyia durani (Vargas & Nájera) at San Jacinto in July 2001 is a new record for Nicaragua. Leishmaniasis is endemic to Nicaragua and occurs in three forms: cutaneous, mucocutaneous and visceral leishmaniasis. Cutaneous infections are the most prevalent type of leishmaniasis in Nicaragua and they occur in two different clinical manifestations, typical cutaneous leishmaniasis and atypical cutaneous leishmaniasis, depending on the species of the infecting Leishmania parasite. The distribution of sand flies collected during this study in relation to the geographic distribution of clinical forms of leishmaniasis in the country is also discussed.