Clinical features of Old World cutaneous leishmaniasis in elderly patients

Abstract

DEAR EDITOR, Leishmaniasis encompasses a group of chronic infections caused by over 20 species of the Leishmania genus. It is transmitted by sandflies between animal and human hosts and accounts for a complicated health problem in endemic areas, often of developing countries. 1 The elderly population has specific health characteristics: alterations in the immune system, 2 hormonal changes, 3 altered attention to illness and treatment, irregular and multiple drug consumption, comorbidities and different disease presentations. 4,5 M€ uller et al. 2 have shown that in older rats the severity of leishmaniasis lesions and the number of parasites were less than in younger rats. Davies et al. 6 have reviewed the epidemiology of leishmaniasis in five countries in South America; they reported a lower number of lesions in older people. However, Guessous-Idrissi et al. 7 indicated more severe and larger lesions in older patients in an epidemiological study in north Morocco. A shortage of studies about leishmaniasis in the elderly population and their contradictory results encouraged us to conduct a descriptive prospective study between April 2010 and March 2011 on confirmed cases of cutaneous leishmaniasis in Mashhad, Iran, to evaluate the clinical features of cutaneous leishmaniasis in two age groups: a younger group (age ≤ 20 years) and an older group (age ≥ 60 years). Demographic data, the past medical history of the patients, and the site, number, size and duration of the lesions were recorded. The clinical manifestation and the pattern of lesions were categorized as stated in Table 1. The area of lesions was calculated as a circle, the diameter of which was the mean of the largest and smallest diameter of each lesion.We studied 598 cases of cutaneous leishmaniasis (284 male and 314 female) aged under 20 years (age range 0Á2-20 years, mean AE SD = 9Á7 AE 5Á9 years) and 152 cases (55 male and 97 female) over 60 years old (age range 60-96 years, mean AE SD = 66Á7 AE 8Á4 years). The head and neck was the most common site of involvement in younger patients (67Á1% of lesions), while in the older patients the upper extremities encompassed the most lesions (63Á8% of lesions). In the lower extremities and trunk there were no significant differences between the two age groups.The average number of lesions and the mean size of lesions were larger in the over-60s group (2Á38 AE 2Á21 vs.1Á83 AE 1Á5 lesions, P = 0Á002; and 947Á85 AE 126Á8 vs.

Anti Leishmanial Effect of Plantago psyllium (ovate) and White Vinegar on Leishmania major Lesion in BALB/c Mice

“…This disease has a worldwide distribution and is transmitted by sand-flies between animals and human hosts ( 1 , 2 ). According to the World Health Organization (WHO) reports, leishmaniasis has a high mortality rate and is a health problem in endemic areas, especially in the developing countries ( 3 , 4 ). Cutaneous leishmaniasis (CL) can be observed in the two forms of rural and urban in 97 different countries, and approximately 1.5 million new cases are reported throughout the world annually, with over 80% of the cases occurring in the developing countries ( 5 , 6 ).…”