Cutaneous leishmaniasis in North-Western Yemen: A clinicoepidemiologic study and Leishmania species identification by polymerase chain reaction–restriction fragment length polymorphism analysis

• Published in: Journal of the American Academy of Dermatology Vol. 61; no. 4; pp. e15 - e21
• Main Authors: Khatri, Mishri Lal, MD, Di Muccio, Trentina, MD, Gramiccia, Marina, MD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.10.2009
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Animals; Child; Child, Preschool; Cutaneous leishmaniasis; Dermatology; Female; Geographic Information Systems; Humans; Infant; L donovani; L infantum; L tropica; Leishmania - genetics; Leishmania - isolation & purification; Leishmania donovani - genetics; Leishmania donovani - isolation & purification; Leishmania infantum - genetics; Leishmania infantum - isolation & purification; Leishmania PCR-RFLP; Leishmania tropica - genetics; Leishmania tropica - isolation & purification; Leishmaniasis, Cutaneous - epidemiology; Leishmaniasis, Cutaneous - microbiology; Leishmaniasis, Cutaneous - pathology; Male; Middle Aged; North-Western Yemen; Polymerase Chain Reaction; Polymorphism, Restriction Fragment Length; Yemen - epidemiology; Young Adult; Yemen; Cutaneous leishmaniasis; restriction fragment length polymorphism; L tropica; Leishmania PCR-RFLP; North-Western Yemen; CL; L donovani; PCR; polymerase chain reaction; RFLP; L infantum
• DOI: 10.1016/j.jaad.2009.04.047
• ISSN: 0190-9622

Background Cutaneous leishmaniasis (CL) is widespread in Yemen, but not fully documented. Objective To study the clinicoepidemiologic profile of CL in the northwestern region of Yemen Republic and to identify the responsible Leishmania species by molecular methods. Methods All 265 CL cases (176 males and 89 females) were subjected to detailed analysis. Diagnosis was based on clinical features, positive slit skin smear, and histopathologic findings in some cases. In 198 cases, positive smears were examined at the Leishmania Reference Centre of Istituto Superiore di Sanità, Rome (Italy), by polymerase chain reaction–restriction fragment length polymorphism (PCR-RFLP) analysis for Leishmania typing. Results All patients were Yemeni nationals, originated from 10 governorates of northwestern Yemen. Most of the patients had a single noduloulcerative lesion on the face suggestive of “dry”-type CL. Slit skin smear was positive in 255 cases (96.23%). Leishmania sp PCR was positive in all 198 cases examined; the RFLP analysis was positive in 155 samples with the following identification results: L tropica in 133 cases (85.80%), L infantum in 17 (10.97%), and L donovani in 5 (3.23%). Limitations This was a prospective study of CL cases at one center only; hence, the full extent of the disease in the entire region cannot be predicted. Conclusion CL appears to be endemic in northwestern region of Yemen, clinically presenting as 'dry' type, caused mainly by L tropica (85.8% of cases) and occasionally by L infantum (10.97%) and L donovani (3.23%). There is a need for a multicenter study to evaluate the extent of the disease and diffusion of each Leishmania responsible species.