Identification of Leishmania major and Other Causative Species in Syrian Patients Infected with Cutaneous Leishmaniasis

Abstract

Leishmaniasis is divided into three main clinical forms: Cutaneous Leishmaniasis (CL), Visceral Leishmaniasis (VL) and Mucocutaneous Leishmaniasis (MCL). In Hatay, the causative agents of CL are generally Leishmania (L.) infantum, L.tropica and less frequently L. major. The mass migration wave in Syria in 2011 first started in Hatay. In this study, we aimed to determine the responsible causative species, especially L. major, in Syrian patients diagnosed as CL positive living in households and tent cities in Hatay after the migration.

In this study, smear preparations of 250 Syrian patients diagnosed with CL in Hatay Mustafa Kemal University Faculty of Medicine Parasitology Laboratory since 2011 were retrospectively analyzed. DNA was isolated from smear preparations and molecular typing was performed by Real Time-Polymerase Chain Reaction (RT-PCR) using primers and probes specific to the ITS1 gene region. As a result of molecular analysis, 182 (72.8%) of 250 Syrian patients were infected with L.tropica, 59 (23.6%) with L.infantum/donovani and 9 (3.6%) with L.major.

In Syria, the causative species are L.tropica and L.major. The detection of cases of CL caused by L.infantum in the study suggests the possibility that they were infected by sand flies, the vector of L.infantum in our region, during their stay in tent cities in Hatay. Patients’ uncertainty about lesion onset and infection site supports possible exposure in Hatay. In line with these findings, treating patients in endemic areas with Leishmania species-specific treatment and maintaining effective notification and control activities will play an important role in preventing the spread of CL.