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An İ, Doni NY. Many faces of cutaneous leishmaniasis. Postgrad Med J 2024:qgae075. [PMID: 38899808 DOI: 10.1093/postmj/qgae075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 05/23/2024] [Accepted: 06/10/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Our objective in this study is to determine the atypical clinical presentations of cutaneous leishmaniasis (CL) patients diagnosed in Şanlıurfa province. METHODS This retrospective study included 213 patients with atypical clinical presentations among 1751 patients diagnosed with CL between October 2019 and August 2022 in Şanlıurfa Oriental Boil Diagnosis and Treatment Center located in an endemic region for CL. RESULTS We found the prevalence of atypical CL to be 12.1%. The most common atypical lesions were lupoid 21 (9.8%), erysipeloid 16 (7.5%), impetiginous 16 (7.5%), recidivan 15 (7%), eczematous 15 (7%), ecthyma-like 13 (6.1%), pyoderma gangrenous-like 12 (5.6%), and sporotrichoid 12 (5.6%). Other lesions with atypical clinical presentations: chalazion-like, verrucous, dental sinus-like, psoriasiform, zosteriform, lymphoma-like, juvenile xanthogranuloma-like, volcano-like, paronychial, basal cell carcinoma-like, squamous cell carcinoma-like, herpes labialis-like, keratoacanthoma-like, chancriform, annular, lichenoid, mastocitoma-like, keloidal, epidermoid cyst-like, kaposi sarcoma-like, scar leishmaniasis, granulomatous cheilitis-like, mycetoma-like, molluscum contagiosum-like, discoid lupus erythematosus-like, and dermatofibroma-like. CONCLUSIONS In addition to the atypical clinical presentations previously reported, we also defined dermatofibroma-like, Kaposi sarcoma-like, dental sinus-like, juvenile xanthogranuloma-like, mastocytoma-like, and epidermoid cyst-like. It should be kept in mind that CL can clinically mimic many infectious, inflammatory, and neoplastic diseases, which should be considered in the differential diagnosis of long-term non-healing lesions, especially in endemic areas. Key message What is already known on this subject: CL is known as the great imitator disease in dermatology. What this study adds: In addition to the atypical clinical presentations previously reported, we also defined dermatofibroma-like, Kaposi sarcoma-like, dental sinus-like, juvenile xanthogranuloma-like, mastocytoma-like, and epidermoid cyst-like. How this study might affect research, practice, or policy: CL can clinically mimic many infectious, inflammatory and neoplastic diseases, which should be considered in the differential diagnosis of long-term non-healing lesions, especially in endemic areas.
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Affiliation(s)
- İsa An
- Department of Dermatology, Şanlıurfa Training and Research Hospital, Yenice Road, Yenice, Şanlıurfa 63000, Turkey
| | - Nebiye Yentur Doni
- Department of Medical Microbiology, Harran University Medical Faculty, Şanlıurfa 63000, Turkey
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Layouni S, Remadi L, Kidar A, Chaâbane-Banaoues R, Haouas N, Babba H. Clinical polymorphism of zoonotic cutaneous leishmaniasis: combination of the clinical and the parasitological diagnosis. Parasitol Res 2024; 123:238. [PMID: 38856772 DOI: 10.1007/s00436-024-08263-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 06/02/2024] [Indexed: 06/11/2024]
Abstract
Zoonotic cutaneous leishmaniasis (ZCL) is a neglected tropical disease caused by Leishmania (L.) major. This zoonosis is characterized by a broad-spectrum clinical polymorphism and may be underestimated and poorly treated since it is a simulator of various dermatoses. The aim of our study was to analyze the clinical polymorphism of patients with ZCL. A total of 142 patients with confirmed CL based on the microscopic examination of skin lesion biopsies were included in this study. Molecular typing of Leishmania species revealed that all patients were infected with L. major. In total, 14 clinical forms were observed. Six were typical and eight were atypical. The typical ZCL forms are grouped as follows: papular (26.76%), ulcero-crusted (26.05%), ulcerated (13.38%), impetiginous (9.86%), nodular (9.15%), and papulo-nodular (5.63%) lesions. In atypical ZCL forms, we described erythematous (2.81%), erysipeloid (1.4%), sporotrichoid, (1.4%), keratotic (0.7%) lupoid (0.7%), lichenoid (0.7%), psoriasiform (0.7%), and zosteriform (0.7%) lesions. Here, the lichenoid and the keratotic forms caused by L. major were reported for the first time in Tunisia. These findings will help physicians to be aware of the unusual lesions of ZCL that could be confused with other dermatological diseases. For this reason, it will be necessary to improve the diagnosis of CL especially in endemic areas. Such large clinical polymorphism caused by L. major may be the result of a complex association between the vector microbiota, the parasite, and the host immune state, and further studies should be carried out in order to reveal the mechanisms involved in clinical polymorphism of ZCL.
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Affiliation(s)
- Samia Layouni
- Laboratory of Medical and Molecular Parasitology-Mycology LP3M (Code LR12ES08), Department of Clinical Biology B, Faculty of Pharmacy, University of Monastir, Monastir, Tunisia.
- Department of Nutrition and Environmental Sciences, Higher Institute of Applied Sciences and Technology of Mahdia, University of Monastir, Monastir, Tunisia.
| | - Latifa Remadi
- Laboratory of Medical and Molecular Parasitology-Mycology LP3M (Code LR12ES08), Department of Clinical Biology B, Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
- Laboratory of Molecular Entomology, Institute of Molecular Biology & Biotechnology, Foundation for Research & Technology Hellas, Heraklion, Greece
| | | | - Raja Chaâbane-Banaoues
- Laboratory of Medical and Molecular Parasitology-Mycology LP3M (Code LR12ES08), Department of Clinical Biology B, Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
| | - Najoua Haouas
- Laboratory of Medical and Molecular Parasitology-Mycology LP3M (Code LR12ES08), Department of Clinical Biology B, Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
| | - Hamouda Babba
- Laboratory of Medical and Molecular Parasitology-Mycology LP3M (Code LR12ES08), Department of Clinical Biology B, Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
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Solomon M, Fuchs I, Glazer Y, Schwartz E. Gender and Cutaneous Leishmaniasis in Israel. Trop Med Infect Dis 2022; 7:tropicalmed7080179. [PMID: 36006271 PMCID: PMC9416259 DOI: 10.3390/tropicalmed7080179] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/01/2022] [Accepted: 08/06/2022] [Indexed: 11/17/2022] Open
Abstract
Leishmaniasis is estimated to be more common in males than in females. Our purpose was to evaluate differences in preponderance in relation to sex and gender across cutaneous and mucocutaneous leishmaniasis in Israel. An observational study was performed, including cases of endemic CL (cutaneous leishmaniasis) in Israel, and imported MCL (mucocutaneous leishmaniasis). CL is a notifiable disease and is supposed to be reported to the Ministry of Health (MOH). The MOH database shows that males as more likely to be infected by leishmania, with an incidence of 5/100,000 in males vs. 3.5/100,000 in females. However, while conducting a demographic house-to-house survey in several locations in Israel where CL is highly endemic, among 608 people who were screened only 49% were males in Leishmania major (L. major) endemic regions and 41% were males in Leishmania tropica (L. tropica) endemic regions, while among 165 cases of imported New-World cutaneous leishmaniasis in Israeli travelers freturning from abroad, 142 (86%) were males. It may be postulated that there is no real gender difference in leishmanial infection, but, perhaps, infections are more commonly seen in men because of referral/reported bias, due to more risk-taking behaviors by men or, perhaps, men are less likely to strictly adhere to recommended preventive measures and thus increase their risk of contracting the disease.
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Affiliation(s)
- Michal Solomon
- Department of Dermatology, Chaim Sheba Medical Center, Tel Hashomer, The Sackler School of Medicine, Tel Aviv University, Tel Aviv 8436322, Israel
- Correspondence: ; Tel.: +972-52-8629799
| | - Inbal Fuchs
- Clalit Health Services-Southern District Department of Family Medicine, Faculty of Health Sciences, Ben Gurion University, Beer Sheva 84105, Israel
| | - Yael Glazer
- Division of Epidemiology, Ministry of Health, Jerusalem 9462401, Israel
| | - Eli Schwartz
- Center for Geographic Medicine and Tropical Diseases, Chaim Sheba Medical Center, Tel Hashomer, The Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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4
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Saïdi N, Galaï Y, Ben-Abid M, Boussoffara T, Ben-Sghaier I, Aoun K, Bouratbine A. Imaging Leishmania major Antigens in Experimentally Infected Macrophages and Dermal Scrapings from Cutaneous Leishmaniasis Lesions in Tunisia. Microorganisms 2022; 10:microorganisms10061157. [PMID: 35744675 PMCID: PMC9227018 DOI: 10.3390/microorganisms10061157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 02/01/2023] Open
Abstract
Leishmania major cutaneous leishmaniasis (CL) lesions are characterized by an intense process of parasite destruction and antigen processing that could limit microscopic amastigote detection. The aim of our study was to develop a direct immunofluorescence (DIF) assay for in situ visualization of L. major antigens and access its reliability in the routine diagnosis of CL. The developed DIF assay used IgG polyclonal antibodies produced in rabbits by intravenous injections of live L. major metacyclic promastigotes chemically coupled to fluorescein isothiocyanate. Applied to L. major infected RAW macrophages, corresponding macrophage-derived amastigotes and dermal scrapings from CL lesions, the immunofluorescence assay stained specifically Leishmania amastigotes and showed a diffuse Leishmania antigen deposit into cytoplasm of phagocytic cells. Reliability of DIF in CL diagnosis was assessed on 101 methanol-fixed dermal smears from 59 positive and 42 negative CL lesions diagnosed by direct microscopy and/or kDNA real-time PCR. Sensitivity and specificity of DIF was 98.3% and 100%, respectively, being more sensitive than microscopy (p < 0.001) and as sensitive as ITS1-PCR. ITS1-PCR-RFLP allowed Leishmania species identification in 56 out of the 58 DIF-positive smears, identifying 52 L. major, two L. infantum and two L. tropica cases, which indicates antigenic cross-reactivity between Leishmania species.
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Affiliation(s)
- Nasreddine Saïdi
- Laboratoire de Recherche, Parasitoses Médicales, Biotechnologies et Biomolécules, LR 20-IPT-06, Institut Pasteur de Tunis, Université Tunis El-Manar, Tunis 1002, Tunisia; (N.S.); (Y.G.); (M.B.-A.); (I.B.-S.); (K.A.)
| | - Yousr Galaï
- Laboratoire de Recherche, Parasitoses Médicales, Biotechnologies et Biomolécules, LR 20-IPT-06, Institut Pasteur de Tunis, Université Tunis El-Manar, Tunis 1002, Tunisia; (N.S.); (Y.G.); (M.B.-A.); (I.B.-S.); (K.A.)
| | - Meriem Ben-Abid
- Laboratoire de Recherche, Parasitoses Médicales, Biotechnologies et Biomolécules, LR 20-IPT-06, Institut Pasteur de Tunis, Université Tunis El-Manar, Tunis 1002, Tunisia; (N.S.); (Y.G.); (M.B.-A.); (I.B.-S.); (K.A.)
| | - Thouraya Boussoffara
- Laboratoire de Recherche, Transmission, Contrôle et Immunobiologie des Infections, LR 20-IPT-02, Institut Pasteur de Tunis, Université Tunis El-Manar, Tunis 1002, Tunisia;
| | - Ines Ben-Sghaier
- Laboratoire de Recherche, Parasitoses Médicales, Biotechnologies et Biomolécules, LR 20-IPT-06, Institut Pasteur de Tunis, Université Tunis El-Manar, Tunis 1002, Tunisia; (N.S.); (Y.G.); (M.B.-A.); (I.B.-S.); (K.A.)
- Service de Parasitologie-Mycologie, Institut Pasteur de Tunis, Tunis 1002, Tunisia
| | - Karim Aoun
- Laboratoire de Recherche, Parasitoses Médicales, Biotechnologies et Biomolécules, LR 20-IPT-06, Institut Pasteur de Tunis, Université Tunis El-Manar, Tunis 1002, Tunisia; (N.S.); (Y.G.); (M.B.-A.); (I.B.-S.); (K.A.)
- Service de Parasitologie-Mycologie, Institut Pasteur de Tunis, Tunis 1002, Tunisia
| | - Aïda Bouratbine
- Laboratoire de Recherche, Parasitoses Médicales, Biotechnologies et Biomolécules, LR 20-IPT-06, Institut Pasteur de Tunis, Université Tunis El-Manar, Tunis 1002, Tunisia; (N.S.); (Y.G.); (M.B.-A.); (I.B.-S.); (K.A.)
- Service de Parasitologie-Mycologie, Institut Pasteur de Tunis, Tunis 1002, Tunisia
- Correspondence:
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5
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Ziaee M, Ghatee MA, Taylor WR, Karamian M. A family cluster of cutaneous Leishmania major infection unresponsive to intralesional meglumine antimonial: Case reports. Indian J Med Microbiol 2022; 40:451-454. [DOI: 10.1016/j.ijmmb.2022.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/28/2022] [Accepted: 05/17/2022] [Indexed: 12/11/2022]
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Dalal A, Barzilai A, Baum S, Schwartz E. Disseminated cutaneous leishmaniasis in a Thai foreign worker in Israel. J Travel Med 2021; 28:6040772. [PMID: 33345269 DOI: 10.1093/jtm/taaa233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/05/2020] [Accepted: 12/10/2020] [Indexed: 11/14/2022]
Abstract
We report a case of disseminated cutaneous leishmaniasis (CL) acquired in Israel. This very unusual presentation of CL was caused by Leishmania major in an immunocompetent foreign worker from Thailand. CL is an emerging skin infection in travellers and immigrants with a varied, and possibly misleading, clinical presentation.
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Affiliation(s)
- Adam Dalal
- Department of Dermatology, Sheba Medical Center, Tel-HaShomer, Ramat-Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Aviv Barzilai
- Department of Dermatology, Sheba Medical Center, Tel-HaShomer, Ramat-Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Institute of Pathology, Sheba Medical Center, Tel-HaShomer, Ramat-Gan, Israel
| | - Sharon Baum
- Department of Dermatology, Sheba Medical Center, Tel-HaShomer, Ramat-Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eli Schwartz
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- The Center for Geographic Medicine and Tropical Diseases, Sheba Medical Center, Tel-HaShomer, Ramat-Gan, Israel
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Salloum T, Moussa R, Rahy R, Al Deek J, Khalifeh I, El Hajj R, Hall N, Hirt RP, Tokajian S. Expanded genome-wide comparisons give novel insights into population structure and genetic heterogeneity of Leishmania tropica complex. PLoS Negl Trop Dis 2020; 14:e0008684. [PMID: 32946436 PMCID: PMC7526921 DOI: 10.1371/journal.pntd.0008684] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 09/30/2020] [Accepted: 08/06/2020] [Indexed: 12/18/2022] Open
Abstract
Leishmania tropica is one of the main causative agents of cutaneous leishmaniasis (CL). Population structures of L. tropica appear to be genetically highly diverse. However, the relationship between L. tropica strains genomic diversity, protein coding gene evolution and biogeography are still poorly understood. In this study, we sequenced the genomes of three new clinical L. tropica isolates, two derived from a recent outbreak of CL in camps hosting Syrian refugees in Lebanon and one historical isolate from Azerbaijan to further refine comparative genome analyses. In silico multilocus microsatellite typing (MLMT) was performed to integrate the current diversity of genome sequence data in the wider available MLMT genetic population framework. Single nucleotide polymorphism (SNPs), gene copy number variations (CNVs) and chromosome ploidy were investigated across the available 18 L. tropica genomes with a main focus on protein coding genes. MLMT divided the strains in three populations that broadly correlated with their geographical distribution but not populations defined by SNPs. Unique SNPs profiles divided the 18 strains into five populations based on principal component analysis. Gene ontology enrichment analysis of the protein coding genes with population specific SNPs profiles revealed various biological processes, including iron acquisition, sterols synthesis and drug resistance. This study further highlights the complex links between L. tropica important genomic heterogeneity and the parasite broad geographic distribution. Unique sequence features in protein coding genes identified in distinct populations reveal potential novel markers that could be exploited for the development of more accurate typing schemes to further improve our knowledge of the evolution and epidemiology of the parasite as well as highlighting protein variants of potential functional importance underlying L. tropica specific biology.
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Affiliation(s)
- Tamara Salloum
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Byblos, Lebanon
| | - Rim Moussa
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Byblos, Lebanon
| | - Ryan Rahy
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Byblos, Lebanon
| | - Jospin Al Deek
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Byblos, Lebanon
| | - Ibrahim Khalifeh
- Department of Pathology and Laboratory Medicine, American University of Beirut, Beirut, Lebanon
| | - Rana El Hajj
- Department of Pathology and Laboratory Medicine, American University of Beirut, Beirut, Lebanon
| | - Neil Hall
- Earlham Institute, Norwich research Park, University of East Anglia, Norwich, United Kingdom
| | - Robert P. Hirt
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
- * E-mail: (RPH); (ST)
| | - Sima Tokajian
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Byblos, Lebanon
- * E-mail: (RPH); (ST)
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Firooz A, Mortazavi H, Khamesipour A, Ghiasi M, Abedini R, Balighi K, Esmaili N, Nassiri-Kashani M, Eskandari SE, Mohebali M, Mir Amin Mohammadi A, Dowlati Y. Old world cutaneous leishmaniasis in Iran: clinical variants and treatments. J DERMATOL TREAT 2020; 32:673-683. [DOI: 10.1080/09546634.2019.1704214] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Alireza Firooz
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Mortazavi
- Department of Dermatology, Tehran University of Medical Sciences, Razi Hospital, Tehran, Iran
| | - Ali Khamesipour
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Ghiasi
- Department of Dermatology, Tehran University of Medical Sciences, Razi Hospital, Tehran, Iran
| | - Robabeh Abedini
- Department of Dermatology, Tehran University of Medical Sciences, Razi Hospital, Tehran, Iran
| | - Kamran Balighi
- Department of Dermatology, Tehran University of Medical Sciences, Razi Hospital, Tehran, Iran
| | - Nafiseh Esmaili
- Department of Dermatology, Tehran University of Medical Sciences, Razi Hospital, Tehran, Iran
| | - Mansour Nassiri-Kashani
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - S. Ebrahim Eskandari
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Mohebali
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Akram Mir Amin Mohammadi
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Yahya Dowlati
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
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Abstract
Cutaneous leishmaniasis (CL) is called "the great imitator," because it can mimic almost all types of dermatoses. This similarity may sometimes lead to misdiagnosis, resulting in inappropriate treatment and morbidities. Atypical forms occur due to the interaction between parasitic factors and the host immune response. Secondary infection or mistreatment of CL can also alter the natural course, resulting in bizarre and misdiagnosed cases. Atypical leishmaniasis should be considered in longstanding and painless lesions that may simulate erysipelas, dermatitis, verruca, herpes zoster, paronychia, and sporotrichosis. Less commonly, sarcoidosis, deep mycosis, basal and squamous cell carcinoma, cutaneous lymphoma, or pseudolymphomalike lesions may need to be considered in the differential diagnosis. A high index of suspicion is required to consider a diagnosis of CL, especially in nonendemic or newly endemic regions. Smear, histopathologic examination, culture, and polymerase chain reaction serve as important tools to differentiate CL from its clinical and histologic look-alikes. CL is discussed from various perspectives, with emphasis on CL and its broad differential diagnosis.
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Siriwardana Y, Deepachandi B, Gunasekara C, Warnasooriya W, Karunaweera ND. Leishmania donovani Induced Cutaneous Leishmaniasis: An Insight into Atypical Clinical Variants in Sri Lanka. J Trop Med 2019; 2019:4538597. [PMID: 31263501 PMCID: PMC6556790 DOI: 10.1155/2019/4538597] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/28/2019] [Accepted: 05/12/2019] [Indexed: 02/07/2023] Open
Abstract
Sri Lanka is a recent focus having Leishmania donovani induced cutaneous leishmaniasis (CL) as the main clinical entity. A separate clinical entity within profile of CL was described in this study. Laboratory confirmed cases of CL (n= 950, 2002-2014) were analysed. Most lesions showed known classical developmental stages of CL (CCL) observed in other CL endemic settings while few cases (13%, 122/950) showed atypical skin manifestations (ACL). Clinical, geographical, and treatment response patterns of ACL were different from those of CCL. ACL was mainly found among males (68.0%), in 21-40 year age group (51.6%), and reported delayed treatment seeking (23.5% vs 16.3% in CCL), more nonclassical onset (lesions other than acne form <1cm sized papules), (12.1 vs 2.7%, P<0.05.), more head and neck lesions (41.5%. vs 27.2%), more large lesions (>4cm), (18.6 vs 9.9%), and poor laboratory positivity rates (65.6% vs 88.2%) when compared to CCL. When compared to lesions reporting a typical onset, lesions reporting nonclassical onset were more likely to develop ACL later on (50.1% vs 10.7%). As compared to lesions on limbs, those on head and neck and trunk were more likely to be ACL (7.0%, 16.3%, and 22.8%, respectively, P<0.05). ACL features were not age or gender dependent. Highest proportion within ACL category (32.8%) and small proportion of CCL (10.1%) originated from less leishmaniasis prevalent areas (other regions) (P<0.05). North reported more ACL than South (15.9% vs 7.4%). A total of 95 CL cases with a significant travel history were further analyzed. Residents of other regions when acquired infection from North or South developed more ACL than residents in North or South (60.9% vs 15.9% and 42.9% vs 7.4% respectively). Patients in other regions when travelled to North developed more ACL than when they travelled to South (60.9%, 42.9%). ACL and CCL required an average of 18 doses over 16.7 months and 10 doses over 12 weeks, respectively, to achieve a complete clinical cure. Underlying host immunological factors, parasite strain variations and regional variations of both could be underlying etiologies. Established independent transmission within less leishmaniasis prevalent regions combined with an unusual clinical picture leading to poor clinical suspicion and low laboratory confirmation rate will pose potential difficulties in early case detection in these highly populated and commercialized areas. This in turn will further facilitate silent and high disease transmission.
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Affiliation(s)
- Yamuna Siriwardana
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo 00800, Sri Lanka
| | - Bhagya Deepachandi
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo 00800, Sri Lanka
| | | | | | - Nadira D. Karunaweera
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo 00800, Sri Lanka
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11
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Rojas Mora E, Garrido Ríos A, Echeverría García B, Borbujo J. An Unusual Presentation of Cutaneous Leishmaniasis: The Role of Skin Ultrasound. ACTAS DERMO-SIFILIOGRAFICAS 2019. [DOI: 10.1016/j.adengl.2018.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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12
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An Unusual Presentation of Cutaneous Leishmaniasis: The Role of Skin Ultrasound. ACTAS DERMO-SIFILIOGRAFICAS 2018; 110:171-174. [PMID: 30545475 DOI: 10.1016/j.ad.2018.02.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 01/09/2018] [Accepted: 02/07/2018] [Indexed: 11/23/2022] Open
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13
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The Role of Histopathology and Immunohistochemistry in the Diagnosis of Cutaneous Leishmaniasis Without "Discernible" Leishman-Donovan Bodies. Am J Dermatopathol 2018; 39:890-895. [PMID: 29190217 DOI: 10.1097/dad.0000000000000861] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Histopathology plays an important role in the diagnosis of cutaneous leishmaniasis (CL) but Leishman-Donovan (LD) bodies may not always be discernible. Recently, anti-CD1a antibody (Ab), clone MTB1, was found to decorate LD bodies immunohistochemically. OBJECTIVE Can histopathology without discernible LD bodies be used to diagnose CL, and can immunohistochemistry using anti-CD1a Ab, clone MTB1, detect LD bodies in these cases. METHODS Suspected CL lesions were studied histopathologically and immunohistochemically, and the patients' clinical files were reviewed. RESULTS Of the 196 patients with suspected CL, direct smear demonstrated LD bodies in 50 (25.5%). Of the remaining 146 patients, 118 underwent biopsy. In 56 (47.5%) patients, the hematoxylin-eosin-stained sections revealed LD bodies. In 47 (39.8%) patients, LD bodies were not discerned but the histopathology demonstrated histiocytic infiltrates with varying numbers of plasma cells along with other inflammatory cells, and negative Ziehl-Neelsen and periodic acid-Schiff stains. This pattern was termed "histopathology consistent with leishmaniasis." The history, clinical findings, and response to anti-leishmania therapy supported the diagnosis of CL in all of them, and immunostains for CD1a, clone MTB1, detected LD bodies in 11 (23.4%) of these 47 patients. CONCLUSIONS "Histopathology consistent with CL" along with appropriate clinical findings supports the diagnosis of CL in an endemic area, and immunostains with CD1a Ab, clone MTB1, may help in the minority of the cases.
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Kuilder JS, Wismans PJ, Baerveldt EM, van Hellemond JJ, Melo MDM, van Genderen PJJ. Leishmania major Cutaneous Leishmaniasis in 3 Travelers Returning from Israel to the Netherlands. Emerg Infect Dis 2018; 22:2022-2024. [PMID: 27767930 PMCID: PMC5088023 DOI: 10.3201/eid2211.161154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Moafi M, Rezvan H, Sherkat R, Taleban R, Asilian A, Zarkesh Esfahani SH, Nilforoushzadeh MA, Jaffary F, Feizi A. Evaluation of IL-12RB1, IL-12B, CXCR-3 and IL-17a expression in cases affected by a non-healing form of cutaneous leishmaniasis: an observational study design. BMJ Open 2017; 7:e013006. [PMID: 28132002 PMCID: PMC5278291 DOI: 10.1136/bmjopen-2016-013006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Seldom cutaneous leishmaniasis (CL) may present as a lasting and active lesion(s), known as a non-healing form of CL (NHCL). Non-functional type 1 T helper (Th1) cells are assumed the most important factor in the outcome of the disease. The present study aims to assess some molecular defects that potentially contribute to Th1 impairment in NHCL. METHODS AND ANALYSIS This prospective observational study will be implemented among five groups. The first and second groups comprise patients afflicted with non-healing and healing forms of CL, respectively. The third group consists of those recovered participants who have scars as a result of CL. Those participants who have never lived or travelled to endemic areas of leishmaniasis will comprise the fourth group. The fifth group comprises participants living in hyperendemic areas for leishmaniasis, although none of them have been afflicted by CL. The aim is to recruit 10 NHCL cases and 30 participants in each of the other groups. A leishmanin skin test (LST) will be performed to assess in vivo immunity against the Leishmania infection. The cytokine profile (interleukin (IL)-12p70, interferon (IFN)-γ, C-X-C motif chemokine ligand (CXCL)-11 and IL-17a) of the isolated peripheral blood mononuclear cells (PBMCs) will be evaluated through ELISA. Real-time PCR will determine the C-X-C motif chemokine receptor (CXCR)-3 and IL-17a gene expression and expression of IL-12Rβ1 will be assessed by flow cytometry. Furthermore, IL-12B and IL-12RB1 mutation analysis will be performed. DISCUSSION It is anticipated that the outcome of the current study will identify IL-12B and IL-12RB1 mutations, which lead to persistent lesions of CL. Furthermore, our expected results will reveal an association between NHCL and pro-inflammatory cytokines (IL-12p70, IFN-γ IL-17a and CXCL-11), as well as CXCR-3 expression. ETHICS AND DISSEMINATION This study has been approved by a local ethical committee. The final results will be disseminated through peer-reviewed journals and scientific conferences.
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Affiliation(s)
- Mohammad Moafi
- Faculty of Veterinary Science, Department of Pathobiology, Bu-Ali Sina University, Hamedan, Iran
| | - Hossein Rezvan
- Faculty of Veterinary Science, Department of Pathobiology, Bu-Ali Sina University, Hamedan, Iran
| | - Roya Sherkat
- Acquired Immunodeficiency Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Roya Taleban
- Acquired Immunodeficiency Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Asilian
- Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | | | - Fariba Jaffary
- Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Awat Feizi
- Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
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