Old world cutaneous leishmaniasis in Iran: clinical variants and treatments

Firooz, Alireza; Mortazavi, Hossein; Khamesipour, Ali; Ghiasi, Maryam; Abedini, Robabeh; Balighi, Kamran; Esmaili, Nafiseh; Nassiri-Kashani, Mansour; Eskandari, S. Ebrahim; Mohebali, Mehdi; Mohammadi, Akram; Dowlati, Yahya

doi:10.1080/09546634.2019.1704214

Cited by 40 publications

(40 citation statements)

References 69 publications

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“…ZCL and ACL are observed in rural and urban areas, respectively, and cause wet and dry lesions at the wound site, respectively. ( Firooz et al, 2020 ) In Iran, the rural type is prevalent in about 17 provinces of Iran while the urban type is affecting almost all of the country's urban areas ( Shirzadi et al, 2015 ; Norouzinezhad et al, 2016 ). North Khorasan is one of the provinces in which ZCL is endemic.…”

Section: Introductionmentioning

confidence: 99%

Reemergence of zoonotic cutaneous leishmaniasis in an endemic focus, northeastern Iran

Jalali

Enayati

Fakhar

et al. 2021

Parasite Epidemiology and Control

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Zoonotic cutaneous leishmaniasis (ZCL) is a form of disease, which is mostly caused by Leishmania major (L.major ) in the Old World with high incidence through early life. Recently, the high incidence of CL has been reported in Jajarm County, northeastern Iran. The aim of the present study was to investigate the epidemiological aspects of CL and to identify Leishmania spp. in the area. Between 2012 and 2018, patients with active lesions suspected of CL were examined. Diagnosis was performed by methods of clinical examination and direct smears. Conventional kDNA polymerase chain reaction (PCR) was used to identify species of Leishmania . During the seven-year study period, 629 subjects were diagnosed as CL cases by clinical and microscopic examination. Considering the population of the study area, the average incidence rate was 237.8 per 100,000 population. Most (29.4%) of the subjects with ZCL were aged <10 years. Most of the patients (58.7%) were male and the rest were female. Most ulcers were observed on the face (32.2%) and hands (23.7%), respectively. Most patients (90%) had two or more ulcers on their body. The highest incidence was in the autumn in October (32%). Our data revealed that an ongoing reemergence of ZCL focus caused by L.major has arisen in the study area. Moreover, direct PCR on the smears for identifying Leishmania showed 100% specificity, and the species was identified as L. major using species -specific kDNA PCR. The use of conventional PCR on skin smears seems to provide a valuable method for confirming the clinical diagnosis of ZCL, which is very specific and sensitive particularly for clinical correlative studies. Further investigations are needed to improve planning strategies of vectors and reservoirs populations.

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Section: Introductionmentioning

confidence: 99%

Reemergence of zoonotic cutaneous leishmaniasis in an endemic focus, northeastern Iran

Jalali

Enayati

Fakhar

et al. 2021

Parasite Epidemiology and Control

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“…Several differences exist between zoonotic CL (ZCL) due to L major (rural or wet type lesion) and anthroponotic CL (ACL) due to L tropica (urban or dry type lesion) in regard to clinical presentations in humans 3 which seems to be associated with differential immune response triggered by L major vs L tropica parasites. 4 The incubation period is a few weeks in the case of L major and may last up to several months in the case of L tropica.…”

Section: Introductionmentioning

confidence: 99%

“…CL is usually a self‐healing lesion which is caused by L major , L tropica and L aethiopica and rarely by L infantum in the Old World. Several differences exist between zoonotic CL (ZCL) due to L major (rural or wet type lesion) and anthroponotic CL (ACL) due to L tropica (urban or dry type lesion) in regard to clinical presentations in humans 3 which seems to be associated with differential immune response triggered by L major vs L tropica parasites 4 …”

Section: Introductionmentioning

confidence: 99%

Differential inflammatory responses associated with Leishmania major and L tropica in culture

Darzi

Davoudian

Rostami

2021

Parasite Immunology

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Background: Anthroponotic cutaneous leishmaniasis (ACL) due to Leishmania tropica and zoonotic CL (ZCL) due to L major have different clinical and epidemiological features. Objectives: To determine whether pro-inflammatory cytokines are involved in diverse pathogenicity of Leishmania species causing CL. Patients/Methods: The capacity of L major/L tropica to modulate expression of IL-1β, IL-8 (CXCL8), IFNγ, TNFα and MCP-1 (CCL2) in peripheral blood mononuclear cells (PBMCs) and monocyte-derived macrophages (MDMs) was evaluated by real-time RT-PCR technique.Results: PBMCs from both ZCL and ACL cases expressed significantly higher IFNγ (P < .001) and TNFα (P < .05) compared with healthy controls (HC). PBMCs from ACL patients expressed significantly higher IL-1β and IL-8 compared with ZCL patients and HC when stimulated with live L major or L tropica promastigotes (P < .001).After 4 and 10 hours, L major-infected MDMs expressed significantly higher IFNγ (P < .05), and after 10 hours, L tropica-infected MDMs expressed significantly higher IL-1β, IFNγ and IL-8 compared with noninfected cells (P < .05). Conclusions:This study shows differential parasite-mediated stimulations of the inflammatory response with L major vs L tropica ex vivo. Pro-inflammatory cytokines particularly IL-8 (CXCL8) and IL-1β might contribute in diverse clinical features of CL such as longer duration of lesion persistence in ACL patients.

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“…Although the CL condition is self-limiting and the resulting lesions heal within a year, there are cases with diffused infection resulting in chronic ulcers [4]. Because wounds and lesions caused by leishmaniasis are more common in the upper limbs, especially in the face, it can affect a person's beauty and cause psychological and social stress in the patient [5].…”

Section: Introductionmentioning

confidence: 99%

The Role of ATP-binding Cassette Transporter Genes Expression for Treatment Failure in Cutaneous Leishmaniasis

Boozhmehrani

Eslami

Khamesipour

et al. 2021

Preprint

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Background: Leishmaniasis is one of the common diseases transmitted by sand flies in tropical and subtropical regions of the world. Currently, antimonal derivatives are the first line of treatment. Some of the members of the ATP-binding cassette (ABC) family of Leishmania are shown to be associated with resistance to antimonial. In this study, we evaluated ABCI4, ABCG2, ABCC7, and ABCC3 gene expression in Leishmania isolated from patients with non-healing cutaneous leishmaniasis. Results: Five cases were treatment failure that all of them were identified as L. major. All treatment failure clinical isolates were L. major. Gene expression analysis in treatment failure isolates showed that the ABC transported genes had a different pattern in each isolate. ABCC7 had overexpression in all isolates. Among the treatment failure isolates, only one sample had overexpression in all ABC transporter genes under study. Conclusions: Treatment failure has been reported for cutaneous leishmaniasis worldwide. Knowledge of the molecular mechanisms of treatment failure could solve this problem. ABC transporter genes are considered controversy over the mechanisms of treatment failure outcomes. In this study, we showed that ABC transporter genes could be considered one the important mechanisms.

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Old world cutaneous leishmaniasis in Iran: clinical variants and treatments

Cited by 40 publications

References 69 publications

Reemergence of zoonotic cutaneous leishmaniasis in an endemic focus, northeastern Iran

Reemergence of zoonotic cutaneous leishmaniasis in an endemic focus, northeastern Iran

Differential inflammatory responses associated with Leishmania major and L tropica in culture

The Role of ATP-binding Cassette Transporter Genes Expression for Treatment Failure in Cutaneous Leishmaniasis

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