Epidemiological and Evaluative Study of the Prevalence of Cutaneous Leishmaniasis in Najaf Governorate, Iraq
,
Abstract
Background: The developing world encounter rising Leishmaniasis. Therefore, it remains a substantial public health burden in Iraq. A revised dataset on its prevalence and distribution are essential. We aimed to evaluate the epidemiological status of cutaneous leishmaniasis in Najaf Governorate and evaluate the therapeutic effectiveness of included drugs.
Methods: The investigation was conducted in several hospitals in Najaf City, Iraq from March 2023 to May 2025. Samples were collected from 275 suspected patients. Of these, 157 were confirmed to be infected with the disease (103 males and 54 females). Their ages ranged from 3 to 48 years.
Results: Males constituted most of the total infections, accounting for 65.6% of cases, whereas females represented only 34.4%. Regarding distribution, Rural areas recorded the highest proportion of cases (71.34%), while urban areas comprised the remaining percentage (28.66%). Regarding monthly variation, January, February, March, and November represented the peak period, comprising 50.3% of the confirmed cases. Concerning lesion localization, facial lesions were the most common, representing 38.22% of the total cases.
Conclusion: Cutaneous leishmaniasis is found among individuals in the surveyed hospitals, suggesting a significant health issue. Further research is necessary to determine the diseases spread across Iraq and to guide control measures.
1. World Health Organization. Leishmaniasis. World Health Organization. Geneva: World Health Organization; 2023.
2. World Health Organization. The World health report 2004: changing history. Geneva: World Health Organization; 2004.
3. Faulde M, Schrader J, Heyl G, Amirih M. Differences in transmission seasons as an epidemiological tool for characterization of anthroponotic and zoonotic cutaneous leishmaniasis in northern Afghanistan. Acta Trop. 2008; 105(3):131-8.
4. World Health Organization. Leishmaniasis: magnitude of the problem. Geneva: World Health Organization; 2009.
5. Carvalho LM, Pimentel, MI, Conceição-Silva F, et al. Sporotrichoid leishmaniasis: a cross-sectional clinical, epidemiological and laboratory study in Rio de Janeiro State. Brazil. Revista do Instituto de Medicina Tropical de São Paulo. 2017; 1(59):e33.
6. Meireles CB, Maia LC, Soares GC, Teodoro IPP, Gadelha MSV, da Silva CGL, de Lima MAP. Atypical presentations of cutaneous leishmaniasis: A systematic review. Acta Tropica. 2017; 172:240-54.
7. Ferreira BA, Coser EM, de la Roca S, et al. Amphotericin B resistance in Leishmania amazonensis: In vitro and in vivo characterization of a Brazilian clinical isolate. PLOS Negl Trop Dis. 2024; 18(5): e0012175.
8. Mariz Bala, Sánchez-Romero C, Alvarado NAP, Campos EMM, Almeida OPD, Martínez-Pedraza R. Diffuse cutaneous leishmaniasis with oral involvement in a patient of Northern Mexico. Trop Doct. 2019; 49(4):303-6.
9. Belkaid Y, Piccirillo CA, Mendez S, Shevach EM, Sacks DL. CD4+CD25+ regulatory T cells control Leishmania major persistence and immunity. Nature. 2002; 420(6915):502-7.
10. Salotra P, Singh R. Challenges in the diagnosis of post kala-azar dermal leishmaniasis. Indian J Med Res. 2006; 123(3):295-310.
11. Rafati S, Zahedifard F, Nazgouee F. Prime–boost vaccination using cysteine proteinases type I and II of Leishmania infantum confers protective immunity in murine visceral leishmaniasis. Vaccine. 2006; 24(12):2169-75.
12. Haldar AK, Sen P, Roy S. Use of antimony in the treatment of leishmaniasis: Current status and future directions. Mol Biol Int. 2011; 2011:571242.
13. Burza S, Sinha PK, Mahajan R, et al. Five-year field results and long-term effectiveness of 20 mg/kg liposomal amphotericin B (Ambisome) for visceral leishmaniasis in Bihar, India. PLoS Negl Trop Dis. 2014; 8(1): e2603.
14. Vanaerschot M, Decuypere S, Berg M, et al. Drug-resistant microorganisms with a higher fitness– can medicines boost pathogens? Crit Rev Microbiol. 2013; 39(4):384-94.
15. Rijal S, Yardley V, Chappuis F, et al. Antimonial treatment of visceral leishmaniasis: are current in vitro susceptibility assays adequate for prognosis of in vivo therapy outcome? Microbes Infect. 2007; 9(4):529-35.
16. Yardley V, Ortuno N, Llanos-Cuentas A, et al. American tegumentary leishmaniasis: Is antimonial treatment outcome related to parasite drug susceptibility? J Infect Dis. 2006; 194(8):1168-75.
17. Aronson NE, Joya CA. Cutaneous leishmaniasis: Updates in diagnosis and management. Infect Dis Clin North Am. 2019; 33(1):101-17.
18. Pagheh A, Fakhar M, Mesgarian F, Gholami S, Ahmadpour E. An improved microculture method for diagnosis of cutaneous leishmaniasis. J Parasit Dis. 2014; 38(4):347-51.
19. Handler MZ, Patel PA, Kapila R, Al-Qubati Y, Schwartz RA. Cutaneous and mucocutaneous leishmaniasis: Differential diagnosis, diagnosis, histopathology, and management. J Am Acad Dermatol. 2015; 73(6):911-26.
20. AL-Hucheimi S. Acomportive study of some methods used for cutaneous Leishmaniasis [MSc thesis]. Al-Kufa University; 2005. DOI: 10.33545/27080013.2024.v5.i1a.126
21. Noyes H, Reyburn H, Bailey W, Smith D. A nested PCR based schizodeme method for identifying Leishmania kinetoplast minicircle classes directly from clinical samples and its application to the study of the epidemiology of Leishmania tropica in Pakistan. J Clin Microbiol. 1998;36(10):2877-81.
22. Manson-Bahr P, Bell DR. Manson's Tropical Diseases. 19th ed. London: Bailliere Tindall; 1987. 1557 p. ISBN: 0702011878.
23. Adini I, Jacobson RL, Kasap M, Schlein Y, Jaffe CL. Species-specific detection of Leishmania in sand flies using an enzyme-linked immunosorbent assay. Trans R Soc Trop Med Hyg. 1998; 92(1):35-7.
24. Aronson N, Herwaldt BL, Libman M, et al. Diagnosis and treatment of leishmaniasis: clinical practice guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH). Clin Infect Dis. 2016; 63(12):e202-64.
25. Balasegaram M, Ritmeijer K, Lima MA, et al. Liposomal amphotericin B as a treatment for human leishmaniasis. Expert Opin Emerg Drugs. 2012 Dec; 17(4):493-510.
26. Sharifi I, Fekri AR, Aflatonian MR, Nadim A, Nikian Y, Khamesipour A. Cutaneous leishmaniasis in primary school children in the south-eastern Iranian city of Bam, 1994-1995. Bull World Health Organ. 1998; 76(3):289-93.
27. Akcali C, Culha G, Inaloz HS. Cutaneous leishmaniasis in Hatay. J Turk Acad Dermatol. 2007; 1(1):07111a1.
28. Abolghazi A, Ebrahimzadeh F, Sharafi F, Hatami N, Vafai Z. A declining trend of leishmaniasis based on previous data in Larstan, South of Iran 2007–2017. Ann Glob Health. 2019 Mar 15; 85(1):27.
29. Abou-Elaaz FZ, Outourakht A, Bouhout S, Himmi O, Guernaoui S. Thirty years of cutaneous leishmaniasis in Tadla-Azilal focus, Morocco. Parasite Epidemiol Control. 2019 May; 4:e00091.
30. Kahime K, Boussaa S, Laamrani-El Idrissi A, Nhammi H, Boumezzough A. Epidemiological study on acute cutaneous leishmaniasis in Morocco. J Acute Dis. 2016; 5(1):41-5.
31. UL-Bari A, Azam SH, Ejaz A. Mahmood T. Comparion of various cytodiagnostic tests in the rapid diagnosis of cutaneous leishmaniasis. Pak J Pak Assoc Dermatol. 2010; 20: 63-69.
32. El Omari H, Chahlaoui A, Talbi F, Ouarrak K, El Ouali Lalami A. Impact of urbanization and socioeconomic factors on the distribution of cutaneous leishmaniasis in the center of Morocco. Interdiscip Perspect Infect Dis. 2020; 2020:2196418.
33. Ait Kbaich M, Mhaidi I, Ezzahidi A, et al. New epidemiological pattern of cutaneous leishmaniasis in two pre-Saharan arid provinces, southern Morocco. Acta Trop. 2017; 173:11-6.
34. Haut Commissariat au Plan. Monographie de la province de Ouarzazate. Rabat: Direction Régionale de Drâa-Tafilalet; 2019. 120 p.
35. World Health Organization. Leishmaniasis [Internet]. Geneva: World Health Organization; 2023.
36. Daoui O, Bennaid H, Kbaich MA, et al. Environmental, climatic, and parasite molecular factors impacting the incidence of cutaneous leishmaniasis due to Leishmania tropica in three Moroccan foci. Microorganisms. 2022; 10(9):1712.
37. Valero NNH, Uriarte M. Environmental and socioeconomic risk factors associated with visceral and cutaneous leishmaniasis: a systematic review. Parasitol Res. 2020; 119(2):365-84.
38. Darriba D, Taboada GL, Doallo R, Posada D. jModelTest 2: more models, new heuristics and parallel computing. Nat Methods. 2012; 9(8):772.
39. Ronquist F, Huelsenbeck JP. MrBayes 3: Bayesian phylogenetic inference under mixed models. Bioinformatics. 2003;19(12):1572-4.
40. Rajesh K, Sanjay K. Change in global climate and prevalence of visceral leishmaniasis. Int J Sci Res Publ. 2013; 3(1):1-5.
41. Ramezankhani R, Sajjadi N, Esmaeilzadeh RN, Jozi SA, Shirzadi MR. Spatial analysis of cutaneous leishmaniasis in an endemic area of Iran based on environmental factors. J Arthropod Borne Dis. 2017; 11(3):416-29.
42. Pérez-Flórez M, Ocampo CB, Valderrama-Ardila C, Alexander N. Spatial modeling of cutaneous leishmaniasis in the Andean region of Colombia. Mem Inst Oswaldo Cruz. 2016; 111(7):433-42.
43. Stobie L, Gurunathan S, Prussin C, et al. The role of antigen and IL-12 in sustaining Th1 memory cells in vivo: IL-12 is required to maintain memory/effector Th1 cells sufficient to mediate protection to an infectious parasite challenge. Proc Natl Acad Sci USA. 2000; 97(15):8427-32.
44. Qader A, Abood M, Bakir T. Identification of Leishmania parasites in clinical samples obtained from cutaneous leishmaniasis patients using PCR technique in Iraq. Iraqi J Sci. 2012; 53(3):457-63.
45. Dube A, Singh N, Sundar S, Singh N. Refractoriness to the treatment of sodium stibogluconate in Indian kala-azar field isolates persist in in vitro and in vivo experimental models. Parasitol Res. 2005; 96(4):216-23.
46. Coser EM, Ferreira BA, Yamashiro-Kanashiro EH, Lindoso JA, Coelho AC. Susceptibility to paromomycin in clinical isolates and reference strains of Leishmania species responsible for tegumentary leishmaniasis in Brazil. Acta Trop. 2021; 215:105806.
47. Sundar S, Chakravarty J. Liposomal amphotericin B and leishmaniasis: dose and response. J Glob Infect Dis. 2010; 2(2):159-66.
2. World Health Organization. The World health report 2004: changing history. Geneva: World Health Organization; 2004.
3. Faulde M, Schrader J, Heyl G, Amirih M. Differences in transmission seasons as an epidemiological tool for characterization of anthroponotic and zoonotic cutaneous leishmaniasis in northern Afghanistan. Acta Trop. 2008; 105(3):131-8.
4. World Health Organization. Leishmaniasis: magnitude of the problem. Geneva: World Health Organization; 2009.
5. Carvalho LM, Pimentel, MI, Conceição-Silva F, et al. Sporotrichoid leishmaniasis: a cross-sectional clinical, epidemiological and laboratory study in Rio de Janeiro State. Brazil. Revista do Instituto de Medicina Tropical de São Paulo. 2017; 1(59):e33.
6. Meireles CB, Maia LC, Soares GC, Teodoro IPP, Gadelha MSV, da Silva CGL, de Lima MAP. Atypical presentations of cutaneous leishmaniasis: A systematic review. Acta Tropica. 2017; 172:240-54.
7. Ferreira BA, Coser EM, de la Roca S, et al. Amphotericin B resistance in Leishmania amazonensis: In vitro and in vivo characterization of a Brazilian clinical isolate. PLOS Negl Trop Dis. 2024; 18(5): e0012175.
8. Mariz Bala, Sánchez-Romero C, Alvarado NAP, Campos EMM, Almeida OPD, Martínez-Pedraza R. Diffuse cutaneous leishmaniasis with oral involvement in a patient of Northern Mexico. Trop Doct. 2019; 49(4):303-6.
9. Belkaid Y, Piccirillo CA, Mendez S, Shevach EM, Sacks DL. CD4+CD25+ regulatory T cells control Leishmania major persistence and immunity. Nature. 2002; 420(6915):502-7.
10. Salotra P, Singh R. Challenges in the diagnosis of post kala-azar dermal leishmaniasis. Indian J Med Res. 2006; 123(3):295-310.
11. Rafati S, Zahedifard F, Nazgouee F. Prime–boost vaccination using cysteine proteinases type I and II of Leishmania infantum confers protective immunity in murine visceral leishmaniasis. Vaccine. 2006; 24(12):2169-75.
12. Haldar AK, Sen P, Roy S. Use of antimony in the treatment of leishmaniasis: Current status and future directions. Mol Biol Int. 2011; 2011:571242.
13. Burza S, Sinha PK, Mahajan R, et al. Five-year field results and long-term effectiveness of 20 mg/kg liposomal amphotericin B (Ambisome) for visceral leishmaniasis in Bihar, India. PLoS Negl Trop Dis. 2014; 8(1): e2603.
14. Vanaerschot M, Decuypere S, Berg M, et al. Drug-resistant microorganisms with a higher fitness– can medicines boost pathogens? Crit Rev Microbiol. 2013; 39(4):384-94.
15. Rijal S, Yardley V, Chappuis F, et al. Antimonial treatment of visceral leishmaniasis: are current in vitro susceptibility assays adequate for prognosis of in vivo therapy outcome? Microbes Infect. 2007; 9(4):529-35.
16. Yardley V, Ortuno N, Llanos-Cuentas A, et al. American tegumentary leishmaniasis: Is antimonial treatment outcome related to parasite drug susceptibility? J Infect Dis. 2006; 194(8):1168-75.
17. Aronson NE, Joya CA. Cutaneous leishmaniasis: Updates in diagnosis and management. Infect Dis Clin North Am. 2019; 33(1):101-17.
18. Pagheh A, Fakhar M, Mesgarian F, Gholami S, Ahmadpour E. An improved microculture method for diagnosis of cutaneous leishmaniasis. J Parasit Dis. 2014; 38(4):347-51.
19. Handler MZ, Patel PA, Kapila R, Al-Qubati Y, Schwartz RA. Cutaneous and mucocutaneous leishmaniasis: Differential diagnosis, diagnosis, histopathology, and management. J Am Acad Dermatol. 2015; 73(6):911-26.
20. AL-Hucheimi S. Acomportive study of some methods used for cutaneous Leishmaniasis [MSc thesis]. Al-Kufa University; 2005. DOI: 10.33545/27080013.2024.v5.i1a.126
21. Noyes H, Reyburn H, Bailey W, Smith D. A nested PCR based schizodeme method for identifying Leishmania kinetoplast minicircle classes directly from clinical samples and its application to the study of the epidemiology of Leishmania tropica in Pakistan. J Clin Microbiol. 1998;36(10):2877-81.
22. Manson-Bahr P, Bell DR. Manson's Tropical Diseases. 19th ed. London: Bailliere Tindall; 1987. 1557 p. ISBN: 0702011878.
23. Adini I, Jacobson RL, Kasap M, Schlein Y, Jaffe CL. Species-specific detection of Leishmania in sand flies using an enzyme-linked immunosorbent assay. Trans R Soc Trop Med Hyg. 1998; 92(1):35-7.
24. Aronson N, Herwaldt BL, Libman M, et al. Diagnosis and treatment of leishmaniasis: clinical practice guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH). Clin Infect Dis. 2016; 63(12):e202-64.
25. Balasegaram M, Ritmeijer K, Lima MA, et al. Liposomal amphotericin B as a treatment for human leishmaniasis. Expert Opin Emerg Drugs. 2012 Dec; 17(4):493-510.
26. Sharifi I, Fekri AR, Aflatonian MR, Nadim A, Nikian Y, Khamesipour A. Cutaneous leishmaniasis in primary school children in the south-eastern Iranian city of Bam, 1994-1995. Bull World Health Organ. 1998; 76(3):289-93.
27. Akcali C, Culha G, Inaloz HS. Cutaneous leishmaniasis in Hatay. J Turk Acad Dermatol. 2007; 1(1):07111a1.
28. Abolghazi A, Ebrahimzadeh F, Sharafi F, Hatami N, Vafai Z. A declining trend of leishmaniasis based on previous data in Larstan, South of Iran 2007–2017. Ann Glob Health. 2019 Mar 15; 85(1):27.
29. Abou-Elaaz FZ, Outourakht A, Bouhout S, Himmi O, Guernaoui S. Thirty years of cutaneous leishmaniasis in Tadla-Azilal focus, Morocco. Parasite Epidemiol Control. 2019 May; 4:e00091.
30. Kahime K, Boussaa S, Laamrani-El Idrissi A, Nhammi H, Boumezzough A. Epidemiological study on acute cutaneous leishmaniasis in Morocco. J Acute Dis. 2016; 5(1):41-5.
31. UL-Bari A, Azam SH, Ejaz A. Mahmood T. Comparion of various cytodiagnostic tests in the rapid diagnosis of cutaneous leishmaniasis. Pak J Pak Assoc Dermatol. 2010; 20: 63-69.
32. El Omari H, Chahlaoui A, Talbi F, Ouarrak K, El Ouali Lalami A. Impact of urbanization and socioeconomic factors on the distribution of cutaneous leishmaniasis in the center of Morocco. Interdiscip Perspect Infect Dis. 2020; 2020:2196418.
33. Ait Kbaich M, Mhaidi I, Ezzahidi A, et al. New epidemiological pattern of cutaneous leishmaniasis in two pre-Saharan arid provinces, southern Morocco. Acta Trop. 2017; 173:11-6.
34. Haut Commissariat au Plan. Monographie de la province de Ouarzazate. Rabat: Direction Régionale de Drâa-Tafilalet; 2019. 120 p.
35. World Health Organization. Leishmaniasis [Internet]. Geneva: World Health Organization; 2023.
36. Daoui O, Bennaid H, Kbaich MA, et al. Environmental, climatic, and parasite molecular factors impacting the incidence of cutaneous leishmaniasis due to Leishmania tropica in three Moroccan foci. Microorganisms. 2022; 10(9):1712.
37. Valero NNH, Uriarte M. Environmental and socioeconomic risk factors associated with visceral and cutaneous leishmaniasis: a systematic review. Parasitol Res. 2020; 119(2):365-84.
38. Darriba D, Taboada GL, Doallo R, Posada D. jModelTest 2: more models, new heuristics and parallel computing. Nat Methods. 2012; 9(8):772.
39. Ronquist F, Huelsenbeck JP. MrBayes 3: Bayesian phylogenetic inference under mixed models. Bioinformatics. 2003;19(12):1572-4.
40. Rajesh K, Sanjay K. Change in global climate and prevalence of visceral leishmaniasis. Int J Sci Res Publ. 2013; 3(1):1-5.
41. Ramezankhani R, Sajjadi N, Esmaeilzadeh RN, Jozi SA, Shirzadi MR. Spatial analysis of cutaneous leishmaniasis in an endemic area of Iran based on environmental factors. J Arthropod Borne Dis. 2017; 11(3):416-29.
42. Pérez-Flórez M, Ocampo CB, Valderrama-Ardila C, Alexander N. Spatial modeling of cutaneous leishmaniasis in the Andean region of Colombia. Mem Inst Oswaldo Cruz. 2016; 111(7):433-42.
43. Stobie L, Gurunathan S, Prussin C, et al. The role of antigen and IL-12 in sustaining Th1 memory cells in vivo: IL-12 is required to maintain memory/effector Th1 cells sufficient to mediate protection to an infectious parasite challenge. Proc Natl Acad Sci USA. 2000; 97(15):8427-32.
44. Qader A, Abood M, Bakir T. Identification of Leishmania parasites in clinical samples obtained from cutaneous leishmaniasis patients using PCR technique in Iraq. Iraqi J Sci. 2012; 53(3):457-63.
45. Dube A, Singh N, Sundar S, Singh N. Refractoriness to the treatment of sodium stibogluconate in Indian kala-azar field isolates persist in in vitro and in vivo experimental models. Parasitol Res. 2005; 96(4):216-23.
46. Coser EM, Ferreira BA, Yamashiro-Kanashiro EH, Lindoso JA, Coelho AC. Susceptibility to paromomycin in clinical isolates and reference strains of Leishmania species responsible for tegumentary leishmaniasis in Brazil. Acta Trop. 2021; 215:105806.
47. Sundar S, Chakravarty J. Liposomal amphotericin B and leishmaniasis: dose and response. J Glob Infect Dis. 2010; 2(2):159-66.
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| Issue | Vol 21 No 1 (2026) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijpa.v21i1.21635 | |
| Keywords | ||
| Prevalence Cutaneous leishmaniasis Iraq | ||
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How to Cite
1.
Neamah BA, Merza F, Saeed HM. Epidemiological and Evaluative Study of the Prevalence of Cutaneous Leishmaniasis in Najaf Governorate, Iraq. Iran J Parasitol. 2026;21(1):67-75.
