Self-Reporting Cutaneous Leishmaniasis Patients and Nutritional Status: A Study of the Host Factor in Remote Areas of Ethiopia
,
Abstract
Background: Leishmania aethiopica is the leading cause of cutaneous leishmaniasis (CL) in Ethiopia. Different clinical manifestations might be related to host immunity, which itself can be influenced by the host's nutritional status. However, there is limited evidence that associates nutritional status with CL in Ethiopia. We investigated the relationship between clinical variables of CL and malnutrition.
Methods: A retrospective study was conducted in June 2024. Patient data was analyzed from those treated for CL and screened for nutrition from January 2022 to May 2024 at Tefera Hailu and Addis Zemen Primary Hospitals. Nutritional status was assessed through Anthropometric measurements.
Results: A total of 470 CL patients were treated, with a prevalence of 14.65/100, 000 population affected. Out of the total CL patients, 217 were assessed for nutrition, 22% were malnourished. Malnutrition was most prevalent in mucosal (30%) and recurrent cases (38.5%), compared to localized (20%) and new cases (21%) respectively.
Conclusions: Malnutrition might have the potential to shape the clinical manifestation and treatment outcome in CL patients. In CL endemic areas nutritional supplement with the treatment of CL could require for better patient outcome.
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3. Sierra Franco A, Talamante Madrid MJ, Espejo Nuño RM, et al. Cutaneous leishmaniasis: an underdiagnosed entity in the first contact. Int J Res Dermatol. 2023; 9(3):145-149.
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11. Reithinger R, Dujardin J-C, Louzir H, et al. Cutaneous leishmaniasis. Lancet Infect Dis. 2007;7(9):581-596.
12. Revillard J, Cozon G. Experimental models, and mechanisms of immune deficiencies of nutritional origin. Food Addit Contam. 1990;7 Suppl 1:S82-6.
13. Zavitsanou A, Koutis C, Babatsikou F. Leishmaniasis: An overlooked public health concern. HSJ - Health Science Journal. 2008;2(4).
14. Chandra RK. Nutrition and the immune system: an introduction. Am J Clin Nutr. 1997; 66:460S-463S.
15. Feldman M, Friedman L, Brandt L. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 9th ed. Philadelphia: Saunders; 2010.
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17. Oliveira AGL, Brito PD, Schubach AO, et al. Influence of the nutritional status in the clinical and therapeutical evolution in adults and elderly with American Tegumentary Leishmaniasis. Acta Trop. 2013;128(1):36-40.
18. Blackburn GL, Bistrian BR, Maini BS, et al. Nutritional and metabolic assessment of the hospitalized patients. JPEN J Parenter Enteral Nutr. 1977;1(1):11-22.
19. Lockard RD, Wilson ME, Rodríguez NE. Sex-Related Differences in Immune Response and Symptomatic Manifestations to Infection with Leishmania Species. J Immunol Res. 2019; 2019:4103819.
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21. Ethiopian nutrition profile: USAID, updated on May 2023. https://2017-2020.usaid.gov/sites/default/files/documents/1864/Ethiopia-Nutrition-Profile-Mar2018-508.pdf
22. Federal Democratic Republic of Ethiopia. (2016). Seqota Declaration Implementation Plan (2016-2030): Summary program approach document. Vancouver.
23. Yohannes M, Abebe Z, Boelee E. Prevalence and environmental determinants of cutaneous leishmaniasis in rural communities in Tigray, northern Ethiopia. PLoS Negl Trop Dis. 2019; 13: e0007722.
24. Neway S, Yeshitila B, Mebrat B, et al. Prevalence of cutaneous leishmaniasis in Alert Center, retrospective analysis, Addis Ababa. J Health Syst Policies. 2021; 3:110-121.
25. Yizengaw E, Nibret E, Yismaw G, et al. Cutaneous leishmaniasis in a newly established treatment center in the Lay Gayint district, Northwest Ethiopia. Skin Health Dis. 2023; 3:e229.
26. Wondiye K, Asseffa NA, Gemebo TD, Astawesegn FH. Predictors of undernutrition among the elderly in Sodo zuriya district Wolaita zone, Ethiopia. BMC Nutr. 2019; 5:50.
27. Legesse M, Abebe Z, Woldie H. Chronic energy deficiency and associated factors among the older population in Ethiopia: A community-based study. PLoS One. 2019;14(4):e0214861.
28. Abdu AO, Yimamu ID, Kahsay AA. Predictors of malnutrition among older adults aged above 65 years in eastern Ethiopia: neglected public health concern. BMC Geriatr. 2020; 20:497.
29. Yisak, H, Tadege M, Ambaw B, Ewunetei A. Prevalence and Determinants of Stunting, Wasting, and Underweight Among School-Age Children Aged 6–12 Years in South Gondar Zone, Ethiopia. Pediatric Health Med Ther. 2021; 12:23–33.
30. Nweze JA, Nweze EI, Onoja US. Nutrition, malnutrition, and leishmaniasis. Nutrition. 2020; 73:110712.
31. Udaya Kumar V, Favas KT M, Sharma A, et al. The Possible Role of Selected Vitamins and Minerals in the Therapeutic Outcomes of Leishmaniasis. Biol Trace Elem Res. 2023. 201(4):1672-1688.
32. Moya-Salazar J, Pasco IA, Cañari B, Contreras-Pulache H. Cutaneous Lei-shmaniasis Associated With the Level of Poverty of the Andean Rural Population: A Five-Year Single-Center Study. Electron J Gen Med. 2021; 18(6):em335.
33. Boelaert M, Meheus F, Sanchez A, et al. The poorest of the poor: a poverty appraisal of households affected by visceral leishmaniasis in Bihar, India. Trop Med Int Health. 2009; 14:639-44.
34. Wintergerst ES, Maggini S, Hornig DH. Contribution of selected vitamins and trace elements to immune function. Ann Nutr Metab. 2007;51(4):301-23.
35. Tegegne B, Yimer M, Ejigu K, et al. Eight-Year Trend Analysis of Cutaneous Leishmaniasis Cases in West Amhara Region Referred to Amhara Public Health Institute Northwest, Ethiopia: A Retrospective Study. Biomed Res Int. 2022; 2022:6562092.
36. Tegegne B, Yimer M, G/Eyesus T, Ayal A, Yimer M. Short reports on cutaneous leishmaniasis outbreak investigation in Ankesha-Guagsa district, Amhara region, Northwest Ethiopia. Trop Doct. 2022;52(1):131-133.
37. Shita EY, Semegn EN, Wubetu GY, et al. Prevalence of Leishmania RNA virus in Leishmania parasites in patients with tegumentary leishmaniasis: A systematic review and meta-analysis. PLoS Negl Trop Dis. 2022;16(6):e0010427.
38. Machado-Coelho GL, Caiaffa WT, Genaro O, et al. Risk factors for mucosal manifestation of American cutaneous leishmaniasis. Trans R Soc Trop Med Hyg. 2005; 99 (1):55-61.
39. Bruna L. Lima Maciel, Hênio G. et al. Association of Nutritional Status with the Response to Infection with Leishmania chagasi. Am J Trop Med Hyg. 2008; 79(4): 591–598.
40. Carrillo E, Jimenez M, Sanchez C, et al. Protein Malnutrition Impairs the Immune Response and Influences the Severity of Infection in a Hamster Model of Chronic Visceral Leishmaniasis. PLoS One. 2014; 9(2):e89412.
41. Guzman-Rivero M, Rojas E, Verduguez-Orellana A, et al. Nutritional status in patients with cutaneous leishmaniasis and a study of the effects of zinc supplementation together with antimony treatment. Food Nutr Res. 2014; 58:23353.
42. Collins CE, Kershaw J, Brockington S. Effect of nutritional supplements on wound healing in home-nursed elderly: A randomized trial. Nutrition. 2005;21(2):147-155.
43. Merdekios B, Pareyn M, Tadesse D, et al. Detection of Cutaneous Leishmaniasis Foci in South Ethiopia. Am J Trop Med Hyg. 2021; 105(1):156-158.
2. Scorza BM, Carvalho EM, Wilson ME. Cutaneous manifestations of human and murine Leishmaniasis. Int J Mol Sci. 2017; 18 (6):1296.
3. Sierra Franco A, Talamante Madrid MJ, Espejo Nuño RM, et al. Cutaneous leishmaniasis: an underdiagnosed entity in the first contact. Int J Res Dermatol. 2023; 9(3):145-149.
4. Desjeux P. The increase in risk factors for leishmaniasis worldwide. Trans R Soc Trop Med Hyg. 2001; 95:239-43.
5. Aronson N. Cutaneous leishmaniasis: Clinical manifestations and diagnosis. Up-to-date evidence-based Clinical Decision Support; [cited 2023 Jan 21].
6. Burnett M W. Cutaneous leishmaniasis. J Spec Oper Med. 2015; 15(1):128-129.
7. Markle WH, Makhoul K. Cutaneous Leishmaniasis: Recognition and Treatment. Am Fam Physician. 2004;69(6):1455-60.
8. Kamb M, Roy S, Cantey P. Leishmaniasis, Cutaneous. In: CDC Yellow Book 2024 Travel-Associated Infections & Diseases. Vancouver; 2024.
9. Berman JD, Davies CR, Saravia NG. Advances in Leishmaniasis. Lancet. 2005; 366(9496):1561-77.
10. Louzir H, Melby PC, Salah AB, et al. Immunologic determinants of disease evolution in localized cutaneous leishmaniasis due to Leishmania major. J Infect Dis. 1998;177(6):1687-1695.
11. Reithinger R, Dujardin J-C, Louzir H, et al. Cutaneous leishmaniasis. Lancet Infect Dis. 2007;7(9):581-596.
12. Revillard J, Cozon G. Experimental models, and mechanisms of immune deficiencies of nutritional origin. Food Addit Contam. 1990;7 Suppl 1:S82-6.
13. Zavitsanou A, Koutis C, Babatsikou F. Leishmaniasis: An overlooked public health concern. HSJ - Health Science Journal. 2008;2(4).
14. Chandra RK. Nutrition and the immune system: an introduction. Am J Clin Nutr. 1997; 66:460S-463S.
15. Feldman M, Friedman L, Brandt L. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 9th ed. Philadelphia: Saunders; 2010.
16. Nutrition Assessment, Counseling, and Support (NACS): A User’s Guide—Module 2: Nutrition Assessment and Classification, Version 2. Washington, DC: FHI 360/FANTA. 2016.
17. Oliveira AGL, Brito PD, Schubach AO, et al. Influence of the nutritional status in the clinical and therapeutical evolution in adults and elderly with American Tegumentary Leishmaniasis. Acta Trop. 2013;128(1):36-40.
18. Blackburn GL, Bistrian BR, Maini BS, et al. Nutritional and metabolic assessment of the hospitalized patients. JPEN J Parenter Enteral Nutr. 1977;1(1):11-22.
19. Lockard RD, Wilson ME, Rodríguez NE. Sex-Related Differences in Immune Response and Symptomatic Manifestations to Infection with Leishmania Species. J Immunol Res. 2019; 2019:4103819.
20. Anstead GM, Chandrasekar B, Zhao W, et al. Alters the Innate Immune Response and Increases Early Visceralization following Leishmania donovani Infection. Infect Immun. 2001;69(8):4709-4718.
21. Ethiopian nutrition profile: USAID, updated on May 2023. https://2017-2020.usaid.gov/sites/default/files/documents/1864/Ethiopia-Nutrition-Profile-Mar2018-508.pdf
22. Federal Democratic Republic of Ethiopia. (2016). Seqota Declaration Implementation Plan (2016-2030): Summary program approach document. Vancouver.
23. Yohannes M, Abebe Z, Boelee E. Prevalence and environmental determinants of cutaneous leishmaniasis in rural communities in Tigray, northern Ethiopia. PLoS Negl Trop Dis. 2019; 13: e0007722.
24. Neway S, Yeshitila B, Mebrat B, et al. Prevalence of cutaneous leishmaniasis in Alert Center, retrospective analysis, Addis Ababa. J Health Syst Policies. 2021; 3:110-121.
25. Yizengaw E, Nibret E, Yismaw G, et al. Cutaneous leishmaniasis in a newly established treatment center in the Lay Gayint district, Northwest Ethiopia. Skin Health Dis. 2023; 3:e229.
26. Wondiye K, Asseffa NA, Gemebo TD, Astawesegn FH. Predictors of undernutrition among the elderly in Sodo zuriya district Wolaita zone, Ethiopia. BMC Nutr. 2019; 5:50.
27. Legesse M, Abebe Z, Woldie H. Chronic energy deficiency and associated factors among the older population in Ethiopia: A community-based study. PLoS One. 2019;14(4):e0214861.
28. Abdu AO, Yimamu ID, Kahsay AA. Predictors of malnutrition among older adults aged above 65 years in eastern Ethiopia: neglected public health concern. BMC Geriatr. 2020; 20:497.
29. Yisak, H, Tadege M, Ambaw B, Ewunetei A. Prevalence and Determinants of Stunting, Wasting, and Underweight Among School-Age Children Aged 6–12 Years in South Gondar Zone, Ethiopia. Pediatric Health Med Ther. 2021; 12:23–33.
30. Nweze JA, Nweze EI, Onoja US. Nutrition, malnutrition, and leishmaniasis. Nutrition. 2020; 73:110712.
31. Udaya Kumar V, Favas KT M, Sharma A, et al. The Possible Role of Selected Vitamins and Minerals in the Therapeutic Outcomes of Leishmaniasis. Biol Trace Elem Res. 2023. 201(4):1672-1688.
32. Moya-Salazar J, Pasco IA, Cañari B, Contreras-Pulache H. Cutaneous Lei-shmaniasis Associated With the Level of Poverty of the Andean Rural Population: A Five-Year Single-Center Study. Electron J Gen Med. 2021; 18(6):em335.
33. Boelaert M, Meheus F, Sanchez A, et al. The poorest of the poor: a poverty appraisal of households affected by visceral leishmaniasis in Bihar, India. Trop Med Int Health. 2009; 14:639-44.
34. Wintergerst ES, Maggini S, Hornig DH. Contribution of selected vitamins and trace elements to immune function. Ann Nutr Metab. 2007;51(4):301-23.
35. Tegegne B, Yimer M, Ejigu K, et al. Eight-Year Trend Analysis of Cutaneous Leishmaniasis Cases in West Amhara Region Referred to Amhara Public Health Institute Northwest, Ethiopia: A Retrospective Study. Biomed Res Int. 2022; 2022:6562092.
36. Tegegne B, Yimer M, G/Eyesus T, Ayal A, Yimer M. Short reports on cutaneous leishmaniasis outbreak investigation in Ankesha-Guagsa district, Amhara region, Northwest Ethiopia. Trop Doct. 2022;52(1):131-133.
37. Shita EY, Semegn EN, Wubetu GY, et al. Prevalence of Leishmania RNA virus in Leishmania parasites in patients with tegumentary leishmaniasis: A systematic review and meta-analysis. PLoS Negl Trop Dis. 2022;16(6):e0010427.
38. Machado-Coelho GL, Caiaffa WT, Genaro O, et al. Risk factors for mucosal manifestation of American cutaneous leishmaniasis. Trans R Soc Trop Med Hyg. 2005; 99 (1):55-61.
39. Bruna L. Lima Maciel, Hênio G. et al. Association of Nutritional Status with the Response to Infection with Leishmania chagasi. Am J Trop Med Hyg. 2008; 79(4): 591–598.
40. Carrillo E, Jimenez M, Sanchez C, et al. Protein Malnutrition Impairs the Immune Response and Influences the Severity of Infection in a Hamster Model of Chronic Visceral Leishmaniasis. PLoS One. 2014; 9(2):e89412.
41. Guzman-Rivero M, Rojas E, Verduguez-Orellana A, et al. Nutritional status in patients with cutaneous leishmaniasis and a study of the effects of zinc supplementation together with antimony treatment. Food Nutr Res. 2014; 58:23353.
42. Collins CE, Kershaw J, Brockington S. Effect of nutritional supplements on wound healing in home-nursed elderly: A randomized trial. Nutrition. 2005;21(2):147-155.
43. Merdekios B, Pareyn M, Tadesse D, et al. Detection of Cutaneous Leishmaniasis Foci in South Ethiopia. Am J Trop Med Hyg. 2021; 105(1):156-158.
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| Issue | Vol 20 No 1 (2025) | |
| Section | Original Article(s) | |
| Keywords | ||
| Cutaneous-leishmaniasis Malnutrition Ethiopia | ||
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How to Cite
1.
Gashaw B, Yizengaw E, Nigatie F, Nibret E. Self-Reporting Cutaneous Leishmaniasis Patients and Nutritional Status: A Study of the Host Factor in Remote Areas of Ethiopia. Iran J Parasitol. 2025;20(1):65-74.
