Clinical Features of Anthroponotic Cutaneous Leishmaniasis in a Major Focus, Southeastern Iran, 1994-2014
AbstractBackground: Cutaneous leishmaniasis (CL) is associated with a broad and complex clinical spectrum of diseases. The objectives of this study were to assess the clinical features and identification of the causative agents of CL in a well-known focus of anthroponotic CL (ACL) caused by Leishmania tropica, southeast Iran.Methods: This study was performed randomly as a descriptive cross-sectional survey to evaluate 2000 CL patients by active and passive case-detection approaches in Kerman Province from 1994 to 2014. The ACL patients were confirmed by direct smear and 600 cases by one or a combination of intrinsic methods.Results: Children aged <10 yr old were the most infected patients (P<0.001). The majority of the CL lesions were located in hands (46.3%), face (34.1%), legs (14.3%), and other parts of the body (5.3%). The mean number of lesions was 1.5 and most of the patients had single lesion (65%).Typical clinical lesions included papule (36.8%), followed by ulcerated nodule (20.7%), plaque (18.4%), and ulcerated plaque (18.5%). While among atypical clinical features, leishmaniasis recidivans (LR) (4.7%) and leishmanid (0.3%) were the dominant forms, followed by diffuse, disseminated, sporotrichoid, and erysipeloid types, 0.1% each, and then lymphedematous, lymphadenic, hyperkeratotic, paronychial, and mutilating types, 0.05% each. Based on various intrinsic methods the parasites isolated from the lesions were characterized as L. tropica.Conclusion: ACL due to L. tropica presents numerous cases of localized form and diverse uncommon clinical presentations, which mimic other disease conditions. Therefore, physicians should be aware of such manifestations for selecting appropriate treatment modality.
Alvar J, Velez ID, Bern C et al. the WHO Leishmaniasis Control Team. Leishmaniasis Worldwide and global estimates of its incidence. PLoS One. 2012;7(5):e35671.
Desjeux P. Leishmaniasis: current situation and new perspectives. Comp Immunol Microbiol Infect Dis. 2004;27(5):305-18.
Postigo JA. Leishmaniasis in the World Health Organization Eastern Mediterranean Region. Int J Antimicrob Agents. 2010;36 Suppl 1:S62-5.
Shirzadi MR, Esfahania SB, Mohebali M et al. Epidemiological status of leishmaniasis in the Islamic Republic of Iran, 1983–2012. East Mediterr Health J. 2015;21(10):736-42.
Reithinger R, Dujardin JC, Louzir H et al. Cutaneous leishmaniasis (Review). Lancet Infect Dis. 2007;7(9):581-96.
Griffiths WAD. Old World cutaneous leishmaniasis. In: Peters W, Killick-Kendrick R, eds. The Leishmaniases in biology and medicine, London, Orlando: Academic Press, 1987; 2: 617–36.
World Health Organization. Control of the Leishmaniases. World Health Organ Tech Rep Ser. 2010;(949):xii-xiii, 1-186.
Dowleti Y. Cutaneous leishmaniasis. Clin Dermatol. 1996; 14: 425-31.
Momeni AZ, Aminjavaheri M. Clinical picture of cutaneous leishmaniasis in Isfahan, Iran. Int J Dermatol. 1994;33(4):260-5.
Murray HW, Berman JD, Davies CR et al. Advances in leishmaniasis. Lancet. 2005;366(9496):1561-77.
Bañuls AL, Hide M, Prugnolle F. Leishmania and the leishmaniases: a parasite genetic update and advances in taxonomy, epidemiology and pathogenicity in humans. Adv Parasitol. 2007;64:1-109.
Schwenkenbecher JM, Wirth T, Schnur LF et al. Microsatellite analysis reveals genetic structure of Leishmania tropica. Int J Parasitol. 2006;36(2):237-46.
Alborzi A, Pouladfar GR, Fakhar M et al. Isolation of Leishmania tropica from a patient with visceral leishmaniasis and disseminated cutaneous leishmaniasis, southern Iran. Am J Trop Med Hyg. 2008;79(3):435-7.
Sharifi I, Fekri AR, Aflatoonian MR, Khamesipour A, Mahboudi F, Dowlati Y, Nadim A, Modabber F. Leishmaniasis recidivans among school children in Bam, South-east Iran, 1994-2006. Int J Dermatol. 2010; 49: 557-561.
Andrade-Narváez FJ, Vargas-González A, Canto-Lara S et al. Clinical picture of cutaneous leishmaniases due to Leishmania (Leishmania) mexicana in the Yucatan Peninsula, Mexico. Mem Inst Oswaldo Cruz, Rio de Janeiro. 2001; 96(2):163-7.
Sharifi I, Aflatoonian MR2, Fekri AR et al. A comprehensive review of cutaneous leishmaniasis in Ker¬man province, southeastern Iran- narrative review article. Iran J Public Health. 2015;44(3):299-307.
Sharifi I, FeKri AR, Aflatonian MR et al. Randomised vaccine trial of single dose of killed Leishmania major plus BCG against anthroponotic cutaneous leishmaniasis in Bam, Iran. Lancet. 1998;351(9115):1540-3.
Aflatoonian MR, Sharifi I, Hakimi Parizi M et al. A prospective cohort study of cutaneous leishmaniasis risk and opium addiction in south eastern Iran. PLoS One. 2014;9(2):e89043.
Fazaeli A, Fouladi B, Hashemi-Shahri SM et al. Clinical features of cutaneous leishmania-sis and direct PCR- based identification of parasite species in a new focus in south-east of Iran. Iran J Publ Health. 2008; 37(3) 44–51.
Aflatoonian MR, Sharifi I, Aflatoonian B et al. A review of impact of Bam earthquake on cutaneous leishmaniasis and status: epidemic of old foci, emergence of new foci and changes in features of the disease. J Arthropod Borne Dis. 2016;10(3):271-80.
Gomes CM, Cesetti MV, de Morais OO et al. The influence of treatment on the development of leishmaniasis recidiva cutis: a 17-yr case-control study in Midwestern Brazil. J Eur Acad Dermatol Venereol. 2015;29(1):109-14.
Berlin C, Brenner S. Leishmanid. Isr J Med Sci. 1982;18(2):285-6.
Carvalho EM, Barral A, Costa JM et al. Clinical and immunopathological aspects of disseminated cutaneous Leishmania. Acta Trop. 1994;56(4):315-25.
Jafari S, Hajiabdolbaghi M, Mohebali M et al. Disseminated leishmaniasis caused by Leishmania tropica in HIV-positive patients in the Islamic Republic of Iran. East Mediterr Health J. 2010;16(3):340-3.
Hajazi H, Mirmohammad Sadeghi H, Dabirzadeh M et al. Aypical clinical forms of zoonotic cutaneous leishmaniasis due to Leishmani major in Isfahan Iran. J Isfahan Med School. 2007:8:43-48.
Salmanpour R, Handjani F, Zerehsaz F et al. Erysipeloid leishmaniasis: an unusual clinical presentation. Eur J Dermatol.1999;9(6):458-9.
Raja KM, Khan AA, Hameed A et al. Unusual clinical variants of cutaneous leishmaniasis in Pakistan. Br J Dermatol. 1998;139(1):111-3.
Masmoudi A, Ayadi N, Boudaya S et al. Clinical polymorphism of cutaneous leishmaniasis in centre and south of Tunisia. Bull Soc Pathol Exot. 2007;100(1):36-40.
Masmoudi A, Ayadi N, Khabir A et al. Sporotrichoid cutaneous leishmaniasis in Tunisia: a clinical and histological study. Ann Dermatol Venereol. 2008;135(1):63-7.
Shirian S, Oryan A, Hatam GR et al. Three Leishmania/L. species - L. infantum, L. major, L. tropica - as causative agents of mucosal leishmaniasis in Iran. Pathog Glob Health. 2013;107(5):267-72.