Case Report: Atypical Presentation of Visceral Leishmaniasis: Two Cases from Northwest Ethiopia

Mohammed, Rezika; Fikre, Helina; Mekonnen, Tigist; Abebe, Bewketu; Yeshanew, Arega; Diro, Ermias; Griensven, Johan van

doi:10.4269/ajtmh.20-0666

Cited by 2 publications

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“…The four L. donovani-CL cases in this study manifested in all three clinical forms (LCL, DCL and MCL). While atypical presentations of VL have been reported in northern Ethiopia, that can also involve the skin [27,28], it is unlikely that patients in our study had VL as basic clinical investigations did not raise any VL suspicion. Future studies should conduct a full clinical examination and VL diagnostic tests.…”

Section: Discussionmentioning

confidence: 63%

First report of cutaneous leishmaniasis caused by Leishmania donovani in Ethiopia

Amare,

Mekonnen,

Kassa

et al. 2023

Preprint

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Background Leishmaniasis is a common neglected tropical disease in Ethiopia. Visceral leishmaniasis (VL) caused by Leishmania donovani presents in the lowlands, while cutaneous leishmaniasis (CL) affects people living in the highlands. Although CL is described to be caused by L. aethiopica, there is also evidence of L. tropica and L. major isolated from a patient, sand flies and potential reservoirs. Information on species causing CL in Ethiopia is patchy and no nation-wide study has ever been done. Understanding which species are causing CL in Ethiopia can have important implications for patient management and disease prevention. Methods We analyzed stored routine samples and biobanked DNA isolates from previously conducted studies of CL patients from different centers in the north, center and south of Ethiopia. Species typing was performed using ITS-1 PCR with high-resolution melt (HRM) analysis, followed by HSP70 amplicon sequencing on a selection of the samples. Additionally, socio-demographic, clinical and laboratory data of patients were analyzed. Results Of the 226 CL samples collected, the Leishmania species could be determined for 105 (45.5%). Leishmania aethiopica was identified in 101 (96.2%) samples from across the country. In four samples originating from Amhara region, northwestern Ethiopia, L. donovani was identified by ITS-1 HRM PCR, of which two were confirmed with HSP70 sequences. While none of these four patients had symptoms of VL, two originated from known VL endemic areas. Conclusions The majority of CL was caused by L. aethiopica, but CL due to L. tropica and L. major cannot be ruled out. Our study is the first to demonstrate CL patients caused by L. donovani in Ethiopia. This should spark future research to investigate where, how and to which extent such transmission takes place, how it differs genetically from L. donovani causing VL and whether such patients can be diagnosed and treated successfully with the currently available tools and drugs.

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Section: Discussionmentioning

confidence: 63%

First report of cutaneous leishmaniasis caused by Leishmania donovani in Ethiopia

Amare,

Mekonnen,

Kassa

et al. 2023

Preprint

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“…The four L. donovani CL cases in this study manifested in all three clinical forms (LCL, DCL and MCL). While atypical presentations of VL have been reported in northern Ethiopia, which can also involve the skin [ 27 , 28 ], it is unlikely that patients in our study had VL as basic clinical investigations did not raise any VL suspicion. Future studies should conduct a full clinical examination and VL diagnostic tests.…”

Section: Discussionmentioning

confidence: 64%

First report of cutaneous leishmaniasis caused by Leishmania donovani in Ethiopia

Amare,

Mekonnen,

Kassa

et al. 2023

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Background Leishmaniasis is a common neglected tropical disease in Ethiopia. Visceral leishmaniasis (VL) caused by Leishmania donovani presents in the lowlands, while cutaneous leishmaniasis (CL) affects people living in the highlands. Although CL is described as being caused by Leishmania aethiopica, there is also evidence of L. tropica and L. major isolated from a patient, sand flies and potential reservoirs. Information on species causing CL in Ethiopia is patchy, and no nation-wide study has ever been done. Understanding which species are causing CL in Ethiopia can have important implications for patient management and disease prevention. Methods We analyzed stored routine samples and biobanked DNA isolates from previously conducted studies of CL patients from different centers in the north, center and south of Ethiopia. Species typing was performed using ITS-1 PCR with high-resolution melt (HRM) analysis, followed by HSP70 amplicon sequencing on a selection of the samples. Additionally, sociodemographic, clinical and laboratory data of patients were analyzed. Results Of the 226 CL samples collected, the Leishmania species could be determined for 105 (45.5%). Leishmania aethiopica was identified in 101 (96.2%) samples from across the country. In four samples originating from Amhara region, northwestern Ethiopia, L. donovani was identified by ITS-1 HRM PCR, of which two were confirmed with HSP70 sequences. While none of these four patients had symptoms of VL, two originated from known VL endemic areas. Conclusions The majority of CL was caused by L. aethiopica, but CL due to L. tropica and L. major cannot be ruled out. Our study is the first to our knowledge to demonstrate CL patients caused by L. donovani in Ethiopia. This should spark future research to investigate where, how and to which extent such transmission takes place, how it differs genetically from L. donovani causing VL and whether such patients can be diagnosed and treated successfully with the currently available tools and drugs. Graphical Abstract

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Case Report: Atypical Presentation of Visceral Leishmaniasis: Two Cases from Northwest Ethiopia

Cited by 2 publications

References 14 publications

First report of cutaneous leishmaniasis caused by Leishmania donovani in Ethiopia

First report of cutaneous leishmaniasis caused by Leishmania donovani in Ethiopia

First report of cutaneous leishmaniasis caused by Leishmania donovani in Ethiopia

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