Cutaneous Leishmaniasis in Saudi Arabia: A Comprehensive Overview

Abstract

Despite the great efforts by health authorities in Kingdom of Saudi Arabia (KSA), Cutaneous leishmaniasis (CL) continues to be a major public health problem in the country. Many risk factors make KSA prone to outbreaks and epidemics; among these, rapid urbanization and the huge population movement are the most important. The disease is endemic in many parts of KSA, with the majority of cases concentrated in six regions, including Al-Qaseem, Riyadh, Al-Hassa, Aseer, Ha'il, and Al-Madinah. Leishmania major (L. major) and Leishmania tropica (L. tropica) are the main dermotropic species, and Phlebotomus papatasi (vector of L. major) and Phlebotomus sergenti (vector of L. tropica) are the proved vectors of the disease. Psammomys obesus and Meriones libycus have been defined as the principal reservoir hosts of zoonotic CL in Al-Hassa oasis, Al-Madinah, and Al-Qaseem provinces. Clinically, males are affected more than females, and there is no variation between the Saudis and expatriates in terms of number of reported cases, but the disease tends to run a more severe course among non-Saudis. Face is the most commonly affected site, and ulcerative pattern accounts for 90% of lesions. Despite local and international recommendations of using laboratory diagnostics to confirm CL cases, most cases in KSA are diagnosed and treated on clinical grounds and local epidemiology. However, systemic parenteral sodium stibogluconate (SSG) is the first line of therapy and used to treat all CL patients irrespective of their clinical presentation or the incriminated species. In brief, more efforts are needed to combat this disease. Several aspects of the disease require more evaluation through encouragement of national and regional studies. Development of evidence based national diagnostic and management guidelines, as well as algorithms, is urgently needed to improve the practice of diagnosing and treating CL in KSA.

TNF-α − 308 G/A and IFN-γ + 874 A/T gene polymorphisms in Saudi patients with cutaneous leishmaniasis

“…This study determined the association of the two important gene polymorphisms in Saudi patients with cutaneous leishmaniasis. In one of our previous studies, we reported the prevalence of L. species among CL patients in Qassim area of Saudi Arabia [5]. Our reported data 6`represent TT genotype for sample 6.…”

“…Our reported data 6`represent TT genotype for sample 6. All IFN-γ +874 A/T genotypes detected at the same size (263 bp) by the amplification refractory mutation system clearly pointed out that CL patients in this region were mainly infected by L. major and L. tropica [5]. It is now well established that the parasite of leishmaniasis is endemic in all over the globe and now it becomes the major public health problem [5].…”

“…It is now well documented that the leishmania has more than 22 different species but their prevalence varies from region to region [3]. These L. species have a wide geographic distribution from South/North America to all over Middle East with a significant increase of number of patients in last few years in the countries such as Bolivia, Brazil, Peru, Colombia, Afghanistan, Iran, Syria, Algeria and also in Saudi Arabia [2][3][4][5]. Furthermore, the distribution of L. species or CL also reported to have an association with the number of environmental factors including temperature and humidity.…”

“…In Saudi Arabia, despite of the several important efforts taken by the government, but CL remains to be a major heath issue of the country. Several studies have shown that the L. major and L. tropica are the principal reservoirs of this infection, as these species are distributed in almost all region of the country [5]. Reports have also shown that the phlebotomine sandflies are commonly found in the desert regions around the farms, which assumed to be one of the responsible factors for the exposure of this parasitic infection among Saudi population [5].…”

Molecular characterization of Leishmania tropica and Leishmania major from stray dogs and patients in Saudi Arabia

“…These diseases are worldwide associated to the occurrence of phlebotomine sand flies of the genus Phlebotomus in the Old World and Lutzomyia in the New World. Leishmaniases include cutaneous (CL), visceral (VL) and mucocutaneous (ML) forms all of which have been reported in Saudi Arabia [2][3][4]. Moreover, in that Country CL by Leishmania major has the highest prevalence mainly in Riyadh, Qassim, Al-Madinah, Al-Hassa, Hail and Asir [5][6][7] with an estimated number of more than 26,300 cases [2] over the past 10 years (2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016).…”