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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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Fakhar M, Rasooli SA, Banimostafavi ES, Soleymani M. Atypical manifestations of cutaneous leishmaniasis in a boy from Afghanistan. Clin Case Rep 2022; 10:e05738. [PMID: 35441027 PMCID: PMC9012161 DOI: 10.1002/ccr3.5738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 11/29/2022] Open
Abstract
Cutaneous leishmaniasis is one of the most common forms of leishmaniasis in Afghanistan, which is caused by different Leishmania species that are transmitted to humans by sandflies. Its clinical manifestations are very diverse and depend on a variety of parasite and host factors.
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Affiliation(s)
- Mahdi Fakhar
- Toxoplasmosis Research Center Communicable Diseases Institute Iranian National Registry Center for Lophomoniasis (INRCL) Mazandaran University of Medical Sciences Sari Iran
| | - Seyed Abobaker Rasooli
- National Health Coordinator (NHC) and Head of Herat WHO Sub‐office Herat Province Afghanistan
| | - Elham Sadat Banimostafavi
- Toxoplasmosis Research Center Communicable Diseases Institute Iranian National Registry Center for Lophomoniasis (INRCL) Mazandaran University of Medical Sciences Sari Iran
| | - Mostafa Soleymani
- Toxoplasmosis Research Center Communicable Diseases Institute Iranian National Registry Center for Lophomoniasis (INRCL) Mazandaran University of Medical Sciences Sari Iran
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Mohammadpour I, Hatam GR, Handjani F, Bozorg-Ghalati F, PourKamal D, Motazedian MH. Leishmania cytochrome b gene sequence polymorphisms in southern Iran: relationships with different cutaneous clinical manifestations. BMC Infect Dis 2019; 19:98. [PMID: 30696426 PMCID: PMC6352432 DOI: 10.1186/s12879-018-3667-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 12/28/2018] [Indexed: 01/04/2023] Open
Abstract
Background Cutaneous leishmaniasis (CL) caused by Leishmania species, is a geographically extensive disease that infects humans and animals. CL is endemic in half of the 31 provinces of Iran, with 29,201 incidence cases reported in Fars province from 2010 to 2015. CL is polymorphic and may result in lesions characterized by different clinical features. Parasite genetic diversity is proposed to be one of the factors affecting the clinical outcome and lesion characteristics in CL patients. However, there is still very limited data regarding the genetic variation of Leishmania spp. based on the sequencing of Cytochrome b (Cyt b) gene. Methods All patients originated from endemic regions in Fars province. The amplification of the Cyt b gene from isolates of 100 patients with disparate clinical forms of CL was accomplished using Nested-PCR. Sequence analysis of the amplified Cyt b was used to scrutinize the genetic variations among Leishmania isolates and connect the results with clinical pictures. The clinical demonstrations were basically of two types, typical and atypical lesions. Molecular phylogenetic tree was constructed using the Neighbor-Joining method, with species/strains from this study compared to species/strains from other geographical regions. Results Leishmania major was identified as the predominant infecting Leishmania spp. (86% of cases), with the remainder of cases being infected by Leishmania tropica. Clinical examination of patients revealed 12 different clinical CL forms. Among Leishmania samples analyzed, five distinct haplotypes were recognized: three in L. major and two in L. tropica. We found a correlation between clinical outcomes and Cyt b sequence variation of Leishmania spp. involved. Moreover, we observed a higher presence of polymorphisms in L. major compared with L. tropica. This difference may be due to the different eco-epidemiologies of both species, with L. tropica being an anthroponosis compared to L. major, which is a zoonosis. Conclusions The sequence analysis of Cyt b gene from 25 L. major and L. tropica strains demonstrated genetic variability of L. major and L. tropica causing CL in southern Iran, and a feasible connection amid the genetic heterogeneity of the parasite, geographical source and clinical appearance of the disease in human was detected.
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Affiliation(s)
- Iraj Mohammadpour
- Department of Medical Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Gholam Reza Hatam
- Department of Medical Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farhad Handjani
- Molecular Dermatology Research Center, Department of Dermatology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farzaneh Bozorg-Ghalati
- Department of Molecular Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Daniel PourKamal
- Fajr Health Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hossein Motazedian
- Basic Sciences in Infectious Diseases Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
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[Epidemiology and prevention of leishmaniasis in northern Afghanistan]. DER HAUTARZT 2016; 66:347-54. [PMID: 25821066 DOI: 10.1007/s00105-015-3602-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Leishmaniasis is estimated to cause the ninth largest disease burden among infectious diseases worldwide and it is not preventable by vaccination or chemoprophylaxis, but only by personal protective measures preventing bites of infectious arthropod vectors. OBJECTIVES Which leishmania species are endemic in northern Afghanistan, what are the clinical characteristics of skin lesions produced by cutanizing leishmania species, what are their epidemiological characteristics, and which preventive measures are feasible? METHODS The medical literature was reviewed, knowledge gaps were analyzed and completed by our own data collected locally. RESULTS Four Leishmania species are considered endemic in northern Afghanistan, of which Leishmania tropica, L. major, and L. donovani can produce skin lesions while L. donovani and L. infantum visceralize. Transmission modes and seasons vary markedly among focally epidemic urban anthroponotic L. tropica and rural enzootic L. major. Combined preventive measures may reduce the infection rate by more than 10,000-fold. CONCLUSION Cutaneous as well as visceral leishmaniasis can occur among returnees from Afghanistan. Atypical, poorly healing skin lesions can be caused by L. donovani. Extensive use of personal protective measures against arthropod vectors is strongly recommended for all travelers.
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Mans DRA, Kent AD, Hu RV, Lai A. Fat EJ, Schoone GJ, Adams ER, Rood EJ, Alba S, Sabajo LOA, Lai A Fat RF, de Vries HJC, Schallig HDFH. Monitoring the response of patients with cutaneous leishmaniasis to treatment with pentamidine isethionate by quantitative real-time PCR, and identification ofLeishmaniaparasites not responding to therapy. Clin Exp Dermatol 2015; 41:610-5. [DOI: 10.1111/ced.12786] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2015] [Indexed: 11/29/2022]
Affiliation(s)
- D. R. A. Mans
- Anton de Kom University of Suriname; Paramaribo Suriname
| | - A. D. Kent
- Anton de Kom University of Suriname; Paramaribo Suriname
| | - R. V. Hu
- Dermatological Service; Ministry of Health; Paramaribo Suriname
| | - E. J. Lai A. Fat
- Department of Dermatology; Academic Hospital Paramaribo; Paramaribo Suriname
| | | | - E. R. Adams
- Royal Tropical Institute; Amsterdam The Netherlands
| | - E. J. Rood
- Royal Tropical Institute; Amsterdam The Netherlands
| | - S. Alba
- Royal Tropical Institute; Amsterdam The Netherlands
| | - L. O. A. Sabajo
- Dermatological Service; Ministry of Health; Paramaribo Suriname
| | - R. F. Lai A Fat
- Department of Dermatology; Academic Hospital Paramaribo; Paramaribo Suriname
| | - H. J. C. de Vries
- Department of Dermatology; Academic Medical Center; Amsterdam The Netherlands
- Center for Infection and Immunology Amsterdam (CINIMA); University of Amsterdam; Amsterdam The Netherlands
- STI Outpatient Clinic; Public Health Service of Amsterdam (GGD Amsterdam); Amsterdam The Netherlands
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Yazidi R, Bettaieb J, Ghawar W, Jaouadi K, Châabane S, Zaatour A, Ben Salah A. RAPD-PCR reveals genetic polymorphism among Leishmania major strains from Tunisian patients. BMC Infect Dis 2015; 15:269. [PMID: 26170197 PMCID: PMC4501292 DOI: 10.1186/s12879-015-1010-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 07/06/2015] [Indexed: 11/17/2022] Open
Abstract
Background Zoonotic cutaneous leishmaniasis caused by Leishmania (L.) major is endemoepidemic in the Center and South of Tunisia. The clinical course of the disease varies widely among different patients and geographic regions. Although genetic diversity in L. major parasites has been suggested as a potential factor influencing their pathogenic variability, little information on genetic polymorphism among L. major strains is available in the literature. This work aimed to estimate the genetic variability within different isolates of L. major. Methods Our sample comprised 39 isolates (confirmed as L. major by restriction fragment length polymorphism typing) from patients experiencing the same clinical manifestations but living in different regions of Tunisia where L. major is endemic. Random amplified polymorphic DNA (RAPD) PCR marker polymorphism was estimated by calculating Nei and Li’s genetic distances and by an analysis of molecular variance (AMOVA). Results Analysis of the genetic diversity among the isolates revealed a high level of polymorphism (43 %) among them. AMOVA indicated that the highest variability (99 %) existed within the study regions. Conclusions Our results revealed a heterogeneous genetic profile for L. major with similar clinical manifestations occurring within the different geographical regions. Additional L. major isolates from patients, insect vectors, and reservoir hosts from different endemic foci should be collected for further analysis.
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Affiliation(s)
- Rihab Yazidi
- Department of Medical Epidemiology, Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Pasteur Institute of Tunis, 13 Place Pasteur BP-74, Tunis, Belvedere, 1002, Tunisia.
| | - Jihene Bettaieb
- Department of Medical Epidemiology, Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Pasteur Institute of Tunis, 13 Place Pasteur BP-74, Tunis, Belvedere, 1002, Tunisia.
| | - Wissem Ghawar
- Department of Medical Epidemiology, Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Pasteur Institute of Tunis, 13 Place Pasteur BP-74, Tunis, Belvedere, 1002, Tunisia.
| | - Kaouther Jaouadi
- Department of Medical Epidemiology, Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Pasteur Institute of Tunis, 13 Place Pasteur BP-74, Tunis, Belvedere, 1002, Tunisia.
| | - Sana Châabane
- Department of Medical Epidemiology, Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Pasteur Institute of Tunis, 13 Place Pasteur BP-74, Tunis, Belvedere, 1002, Tunisia.
| | - Amor Zaatour
- Department of Medical Epidemiology, Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Pasteur Institute of Tunis, 13 Place Pasteur BP-74, Tunis, Belvedere, 1002, Tunisia.
| | - Afif Ben Salah
- Department of Medical Epidemiology, Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Pasteur Institute of Tunis, 13 Place Pasteur BP-74, Tunis, Belvedere, 1002, Tunisia.
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Evaluation of four single-locus markers for Leishmania species discrimination by sequencing. J Clin Microbiol 2014; 52:1098-104. [PMID: 24452158 DOI: 10.1128/jcm.02936-13] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Several genetic markers have been described for discriminating Leishmania species. In most reported cases, one or a few polymorphisms are the basis of species identification, and the methods were validated on a limited number of strains from a particular geographical region. Therefore, most techniques may underestimate the global intraspecies variability and are applicable only in certain areas. In addition, interlaboratory standardization is mostly absent, complicating comparisons among different studies. Here, we compared species typing results from all sequence polymorphisms found in four popular markers that can be applied directly on clinical samples: the miniexon or spliced leader, the internal transcribed spacer of the ribosomal DNA array, the 7SL RNA gene, and the heat shock protein 70 gene. Clustering was evaluated among 74 Leishmania strains, selected to represent a wide geographic distribution and genetic variability of the medically relevant species of the genus. Results were compared with a multilocus sequence typing (MLST) approach using 7 single-copy household genes and with multilocus enzyme electrophoresis (MLEE), still considered the gold standard by some. We show that strain groupings are highly congruent across the four different single-locus markers, MLST, and MLEE. Overall, the heat shock protein 70 gene and the miniexon presented the best resolutions for separating medically relevant species. As gene sequence analysis is validated here on a global scale, it is advocated as the method of choice for use in genetic, clinical, and epidemiological studies and for managing patients with unknown origins of infection, especially in Western infectious disease clinics dealing with imported leishmaniasis.
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Bart A, van Thiel PPAM, de Vries HJC, Hodiamont CJ, Van Gool T. Imported leishmaniasis in the Netherlands from 2005 to 2012: epidemiology, diagnostic techniques and sequence-based species typing from 195 patients. Euro Surveill 2013; 18:20544. [DOI: 10.2807/1560-7917.es2013.18.30.20544] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Leishmaniasis is an imported disease in the Netherlands. We report data for the period between 2005 and 2012, on clinical presentation, country where leishmaniasis was acquired, and causative species, for 195 civilian and military patients who had travelled abroad. Most patients were affected by cutaneous leishmaniasis (CL) (n=185 patients), while visceral leishmaniasis (VL) (n=8 patients) and mucocutaneous leishmaniasis (n=2 patients) were less frequently observed. All VL patients had been infected in Europe. CL was mainly acquired in Afghanistan, Surinam, Morocco and Spain. The majority of CL patients consisted of military personnel (55%, 102/185), 78 of whom had been infected during an outbreak in Afghanistan. Parasitological diagnosis was made by a combination of polymerase chain reaction (PCR), microscopy and culture. Compared to a standard of parasitological proof by any method other than the one under consideration, sensitivities of the individual methods ranged from 73% to 98%. Microscopy was least sensitive, but is fast and cheap. Mini-exon repeat PCR combines high sensitivity and specificity, and allows differentiation between species by sequencing of the PCR product. Eight different species or species complexes were identified, allowing species-specific therapy. Four patients proved infected with Leishmania naiffi, a hitherto rarely described cause of leishmaniasis. In comparison to previous decennia, an increase in cutaneous leishmaniasis was observed in our hospital, both in civilian and military patients who had travelled abroad. This calls for increased awareness among clinicians, availability of diagnostic tests and species-specific treatment guidelines in non-endemic countries.
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Affiliation(s)
- A Bart
- Department of Medical Microbiology, section of Parasitology, Academic Medical Center, Amsterdam, the Netherlands
| | - P PAM van Thiel
- Department of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Center, Amsterdam, the Netherlands
| | - H JC de Vries
- Department of Dermatology, Academic Medical Center, Amsterdam, the Netherlands
| | - C J Hodiamont
- Department of Medical Microbiology, section of Parasitology, Academic Medical Center, Amsterdam, the Netherlands
| | - T Van Gool
- Department of Medical Microbiology, section of Parasitology, Academic Medical Center, Amsterdam, the Netherlands
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