Epidemiology, pathology and treatment of cutaneous leishmaniasis in taif region of saudi arabia.
AbstractBackground: Cutaneous leishmaniasis is an annoying and disfiguring disease affecting around 1,500,000 individuals globally. There are endemic pockets of this disease in Taif region. In some patients, lesion often weeps and leads to scar formation. The study was conducted to see the efficacy of fluconazole and itraconazole in the patients of cutaneous leishmaniasis and the effect of these drugs on liver enzymes and kidney markers.Methods: Positivity of Leishmania was recorded by microscopic examinations of smears. Specific diagnosis for Leishmania major and L. tropica was made with the help of nested polymerase chain reaction. Fluconazole was given at the rate of 200mg/day while itraconazole was given at 150mg/day for six weeks. AST, ALT, creatinine and urea were estimated during medication.Results: Leishmania major and L. tropica were the species responsible for cutaneous leishmaniasis in Taif region. 81% patients had single lesions, mostly on face followed by hands and legs. 15% of the lesions had bacterial contamination.In terms of efficacy, fluconazole gave slightly better results compared to itraconazole. After 6 weeks of medications, slightly elevated values were recorded for liver enzymes and creatinine.Conclusion: Transmission of leishmaniasis in Taif region is probably because of poor coverage of residual insecticides spraying at hiding places in pile-ups of rocks and abandoned houses from where sand flies visit nearby houses and cattle sheds during night. Fluconazole and itraconazole may be used for the treatment of cutaneous leishmaniasis with good recovery rate and fewer side effects.
Desjeux P. Leishmaniasis: current situation and new perspectives. Comp Immunol Microbiol Infect Dis. 2004; 27: 305–318.
World Health Organization. Report of the consultative meeting on cutaneous leishmaniasis, WHO, Geneva, 2008; 36 pp.
Alvar J, Velez ID, Bern C, Herrero M, Desjeux P, Cano J, Jannin J, den Boer M. Leishmaniasis worldwide and global estimates of its incidence. PloS One. 2012; 7: e35671.
Al-Gindan Y, Abdulaziz O, and Kubba R. Cutaneous leishmaniases in Al-Hassa, Saudi Arabia. Int J Dermatol. 1984; 23: 194-197.
El-Biharis AH, Cheema AH, El-Hassan AM. Leishmania infecting man and animals in Saudi Arabia. Canine cutaneous leishmaniasis in the Eastern Province. Roy Soc Trop Med Hyg.1987; 81:925-927.
Al-Zahrani MA, Peters W, Evans DA, Smith V, Ching Chin I. Leishmania infecting man and wild animals in Saudi Arabia. 6. Cutaneous leishmaniasis of man in the south-west. Trans R Soc Trop Med Hyg. 1989; 83: 621-628.
Kubeyinje EP, Belagavi CS, Jamil YA. Cutaneous leishmaniasis in expatriates in northern Saudi Arabia. East Afr Med J. 1997; 74: 249-251.
Magzoub M, Subaih M. Prevalence of human cutaneous Leishmaniasis in El-Quassim region of Saudi Arabia. Zagazig Vet J. 1998; 26:106-110.
Mustafa MB, Hussein SM, Ibrahim EA et al. Phlebotomus papatasi (Scopoli), vector of zoonotic cutaneous leishmaniasis in Riyadh province, Saudi Arabia. Trans R Soc Trop Med Hyg. 1994; 88: 40.
Morsy TA, Al- Gahtani YM, Faris RM. Two abnormal cases of anthroponotic cutaneous leishmaniasis in Al- Baha, Saudi Arabia. J Egypt Soc Parasitol. 1991; 21: 675-678.
Shalaby I, Gherbawy Y, Jamjoom M, Banaja AE. Genotypic characterization of cutaneous leishmaniasis at Al Baha and Al Qasim Provinces (Saudi Arabia) Vector Borne Zoonotic Dis. 2011; 11: 807-813. 12. Svobodova M, Votypka J, Peckova J et al. Distinct transmission cycles of Leishmania tropica in two adjacent foci, Northern Israel. Emerg Infect Dis. 2006; 12: 1860-1868.
Shehata MG, Samy AM, Doha SA et al. First report of Leishmania tropica from a classical focus of L. major in North-Sinai, Egypt. Am J Trop Med Hyg. 2009; 81: 213-218.
Davami MH, Motazedian MH, Sarkari B. The changing profile of cutaneous leishmaniasis in am focus of the disease in Jahrom district, southern Iran. Ann Trop Med Parasitol. 2010; 104:377-382.
Faiman R, Abbasi I, Jaffe C et al. A newly emerged cutaneous leishmaniasis focus in Northern Israel and two new reservoir hosts of Leishmania major. PLoS Negl Trop Dis. 2013; 7: e2058.
Ibrahim AA, Abdoon AM. Distribution and population dynamics of Phlebotomus sand flies (Diptera: Psychodidae) in an endemic area of cutaneous leishmaniasis in Asir region, Southwestern Saudi Arabia. J Entomol. 2005; 2: 102-108.
El-Badry AA, Al-Juhani AM, Ibrahim EKD, Al- Zubiany SF. Distribution of sand flies in El- Nekheil province, in Al-Madinah Al-Munawwarah region, western of Saudi Arabia. Parasitol Res. 2008; 103: 151-156.
Albanese G, Giorgetti P, Santagostino L, Crippa D, Sala G. Cutaneous leishmaniasis: treatment with itraconazole. Arch Dermatol. 1989; 125: 1540–1542.
Al-Fouzan AS, Al Saleh QA, Najem NM, Rostom AI. Cutaneous leishmaniasis in Kuwait. Clinical experience with itraconazole. Int J Dermatol. 1991; 30: 519-521.
Sahar H, Al-Natour MD. Update in the treatment of cutaneous leishmaniasis. J Family Community Med. 2009; 16: 41–47.
Alrajhi AA, Ibrahim EA, De Vol EB et al. Fluconazole for the treatment of cutaneous leishmaniasis caused by Leishmania major. N Engl J Med. 2002; 346: 891-895.
Emad M, Hayati F, Fallahzadeh MK, Namazi MR. Superior efficacy of oral fluconazole 400 mg daily versus oral fluconazole 200 mg daily in the treatment of cutaneous Leishmania major infection: a randomized clinical trial. J Am Acad Dermatol. 2011; 64: 606-608.
Wilkinson JH, Baron DN, Moss DW, Walker PG. Standardization of clinical enzyme assays: A reference method for aspartate and alanine transaminases. J Clin Pathol. 1972; 25: 940.
Thomas L. Editor. Clinical Laboratory diagnostics. Frankfurt: TH-Books Verlagsgesellschaft; 1998. P. 366-374.
Kalpan A. Editor. Standard Methods of Clinical Chemistry. New York: New York Academic Press; 1965. P. 245-256.
Killick-Kendrick R, Leaney AJ, Peters W, Rioux JA, Bray RS. Zoonotic cutaneous leishmaniasis in Saudi Arabia: the incrimination of Phlebotomus papatasi as the vector in the Al-Hassa Oasis. Trans R Soc Trop Med Hyg. 1985; 79: 252-255.
Janini R, Saliba E, Khoury S, Oumeish O, Adwan S, Kamhawi S. Incrimination of Phlebotomus papatasi as vector of Leishmania major in the southern Jordan Valley. Med Vet Entomol. 1995; 9(4): 420-422.
Rassi Y, Abai MR, Javadian E et al. Molecular data on vectors and reservoir hosts of zoonotic cutaneous leishmaniasis in central Iran. Bull Soc Pathol Exot. 2008; 101: 425-428.
Wajihullah, Alswat M. A preliminary report on epidemiology of cutaneous leishmaniasis in Taif region, Saudi Arabia. J Vet Parasitol. 2009; 23: 101-102.
Ministry of Health Saudi Arabia: Health Statistical Year Book. VI: Leishmaniasis; 2007; P. 67.
Ministry of Health Saudi Arabia: Health Statistical Year Book. VI: Leishmaniasis; 2008; P. 73.
Ministry of Health Saudi Arabia: Health Statistical Year Book. VI: Leishmaniasis; 2009; P. 70.
Faraj C, Ouahabi S, El Bachir-Adlaoui EB et al. Insecticide susceptibility status of Phlebotomus( Paraphlebotomus) sergenti and phlebotomus (Phlebotomus) papatasi in endemic foci of cutaneous leishmaniasis in Morocco. Parasites& Vectors. 2012; 5: 51. doi:10.1186/1756-3305-5-51.
Saeidi Z, Vatandoost H, Akhavan AA et al. Baseline susceptibility of a wild strain of Phlebotomus papatasi(Diptera: Psychodidae) to DDT and pyrethroids in an endemic focus of zoonotic cutaneous leishmaniasis in Iran. Pest Manag Sci. 2012; 68(5): 669-675.
Akhoundi M, Hajjaran H, Baghaei A, Mohebali M. Geographical distribution of Leishmania species of human cutaneous leishmaniasis in Fars Province, Southern Iran. Iran Parasitol. 2013; 8: 85-91.
Akhoundi M, Mohebali M, Asadi M et al. Molecular characterization of Leishmania spp. in reservoir hosts in endemic foci of zoonotic cutaneous leishmaniasis in Iran. Folia Parasitol (Praha). 2013; 60: 218-224.
Abu Khamsin A. Cutaneous leishmaniasis: a 46- year study of the epidemiology and clinical features in Saudi Arabia (1956–2002). Int J Infect Dis. 2004; 8(4): 244-250.
Farahmand M, Nahrevanian H, Shirazi HA. Naeimi S, Farzanehnejad Z. An overview of a diagnostic and epidemiologic reappraisal of cutaneous leishmaniasis in Iran. Braz J Infect Dis. 2011; 15: 17-21.
Buttiker W, Lewis DJ. Ecological studiesatHofuf, Eastern Saudi Arabia, in relation to dermal leishmaniasis Tropenmed Parasitol. 1879; 30: 220-229.
Al-Taqi M, Behbehani K. Cutaneous leishmaniasis in Kuwait. Ann Trop Med Parasitol. 1980; 74: 495-501.Azadeh B, Samad A, Ardehali S. Histological spectrum of cutaneous leishmaniasis due to Leishmania tropica. Trans R Soc Trop Med Hyg. 1985; 79 (5): 631-636.
Azadeh B, SamadA, ArdehaliS. Histological spectrum of cutaneous leishmaniasis due to Leismania tropica. Trans R Soc Trop Med Hyg. 1985; 79(5): 631-636.
Gaafar A, el Kadaro AY, Theander TG et al. The pathology of cutaneous leishmaniasis due to Leishmania major in Sudan. Am J Trop Med Hyg. 1995; 52 (5): 438-442.
Uthman MAE, Satir AA, Tabbara KS. Clinical and histopathological features of zoonotic cutaneous leishmaniasis in Saudi Arabia. J Eur Acad Dermatol Venereol. 2005; 9: 431-436.
Al-Samarai AM, Al-Obaidi HS. Cutaneous leishmaniasis in Iraq. J Infect Dev Ctries. 2009; 3: 123-129.
Bhutto AM, Soomro FR, Baloch JH, Matsumoto J, Uezato H, Hashiguchi Y, Katakura K. Cutaneous leishmaniasis caused by Leishmania (L.) major infection in Sindh province, Pakistan. Acta Trop. 2009; 111: 295-298.
Kazemi-Rad E, Mohebali M, Khadem-Erfan MB et al. Identification of antimony resistance markers in Leishmania tropica field isolates through a cDNA-AFLP approach. Exp Parasitol. 2013; 135: 344-349.
Khanjani N, Gonzalez U, Leonardi-Bee J, Mohebali M, Saffari M, Khamesipour A. Vaccine for preventing cutaneous leishmaniasis (protocol). Copyright C 2009. The Cochrane Collaboration. Published by John Wiley & Sons Ltd.
Sousa AQ, Frutuoso MS, Moraes EA, Pearson RD, Pompeu MM. High-dose oral fluconazole therapy effective for cutaneous leishmaniasis due to Leishmania (Vianna) braziliensis. Clin Infect Dis. 2011; 53(7): 693-695.
Malik A. Origin of drugs in current use: the Diflucan story, 2001. Available at: http://www.world-offungi.org/Mostly_Medical-/Abrar_Malik/Abrar_Malik.htm. Accessed 24 September 2010.
Como JA, Dismukes WE. Oral azole drugs as systemic antifungal therapy. N Engl J Med. 1994; 330: 263-272.
Dogra J, Aneja N, Lal BB, Mishra SN. Cutaneous leishmaniasis in India. Clinical experience with itraconazole). Int J Dermatol. 1990; 29 (9): 661-662.
Momeni AZ, Jalayer T, Emamjomeh M et al. Treatment of cutaneous leishmaniasis with itraconazole.mRandomized double-blind study. Arch Dermatol. 1996; 132 (7): 784-786.
Blum J, Desjeux P, Schwartz E, Beck B, Hatz C. Treatment of cutaneous leishmaniasis among travellers. J Antimicrob Chemother. 2004; 53:158-166.
Amin TT, Kaliyadan F, Al-Ajyan MI et al. Public awareness and attitudes towards cutaneous leishmaniasis in an endemic region in Saudi Arabia. J Eur Acad Dermatol Venereol. 2012; 26: 1544-1551.