Epidemiologic and Clinical Features of Cutaneous Leishmaniasis in Southeastern Tunisia

Abstract

Species-specific diagnosis was performed in 66 patients with cutaneous leishmaniasis (CL) living in Tataouine focus in southeastern Tunisia. Leishmania DNA was extracted directly from dermal scrapings (n = 66) and from parasites obtained in culture (n = 12). Species were identified by using polymerase chain reaction–restriction fragment length polymorphism analysis for internal transcribed spacer region 1 and isoenzyme analysis. Leishmania tropica and L. major were identified in 31 (47%) and 35 (53%) cases respectively. Leishmania tropica CL cases were geographically scattered, and L. major CL cases were clustered. Lesions caused by L. tropica were mostly single (83.8%) and face-localized (55.8%), and lesions caused by L. major were multiple (57.1%; P < 0.001) and situated on limbs (83.7%; P < 0.001). For both species, most lesion onsets were reported during June–January. However, lesions that emerged during February–May were mainly caused by L. tropica (83.3%; P < 0.01). Moreover, the delay before seeking medical advice was higher for L. tropica infections than for L. major infections (P < 0.05).

No Evidence of Interspecific Genetic Exchange by Multi-Locus Microsatellite Typing Between Leishmania Killicki and Leishmania Major in a Mixed Focus of Cutaneous Leishmaniasis in Southeast Tunisia

“…killicki was first detected in the micro-focus of Tataouine in southeast Tunisia in 1980, in an epidemic of CL [4,48]. The first cases of L. major in Tataouine were only recorded in 1991 [49,50], but now chronic and zoonotic CL co-exist in this governorate [3][4][5]. In agreement with previous epidemiological reports, our analysis found that L. major and L. killicki (syn.…”

“…L.tropica) are the only species circulating in the Tataouine governorate. The isolates were collected in different villages of the investigated region, confirming the geographical spread of Leishmania [3,7,9]. Contrary to previous studies, the most abundant species was L. killicki, accounting for 80% of our sampling.…”

“…In Tataouine, southeast Tunisia, Leishmania (L.) major and L. killicki (synonymous L. tropica) [2] are currently the causative agents of cutaneous leishmaniasis (CL) [3]. Leishmania killicki is responsible for the chronic CL observed in villages built on the flank of the Rocky Mountains [3][4][5]. Leishmania major, the causative agent of zoonotic CL, probably emerged as a human pathogen in this area as a result of recent establishment of a high density of susceptible human populations at the margins of villages [3].…”

“…Leishmania killicki is responsible for the chronic CL observed in villages built on the flank of the Rocky Mountains [3][4][5]. Leishmania major, the causative agent of zoonotic CL, probably emerged as a human pathogen in this area as a result of recent establishment of a high density of susceptible human populations at the margins of villages [3].…”

“…In Tataouine, southeast Tunisia, Leishmania (L.) major and L. killicki (synonymous L. tropica) [2] are currently the causative agents of cutaneous leishmaniasis (CL) [3]. Leishmania killicki is responsible for the chronic CL observed in villages built on the flank of the Rocky Mountains [3][4][5].…”