Cutaneous leishmaniasis: an evolving disease with ancient roots

Abstract

Background Cutaneous leishmaniasis (CL) remains a prioritized neglected tropical disease. CL novel presentations call for updating its features. Methods A multiregional cohort of 396 patients with confirmed CL was reviewed. Lesion's clinical stage and eruption type were assigned. Disease was considered as extensive if numerous (≥5), large (>3 cm), disfiguring, threatening vital sensory organs, and/or older than 12 months. Microscopically, Ackerman's inflammatory pattern, Ridley's pattern (RP), and parasitic index (PI) were recorded. Microscopic variables pertaining to the organisms, epidermis, and host's inflammatory response were also assessed. All cases were confirmed and speciated molecularly. Results In our region, 71.8% of cases showed extensive disease with 15.7% exceeding 12 months duration. Leishmania tropica accounted for 91.3% of cases while Leishmania major constituted 8.7% and presented solely as dry lesions. The dominant inflammatory composite consisted of plasma cells, lymphocytes, and histiocytes. Granulomatous inflammation was present in 55.5%. Most cases showed interface changes (72.7%), spongiosis (75.3%), and marked epidermal hyperplasia (63.9%). Transepidermal elimination of organisms was present in 29.2% of cases. None of traditional classification patterns (clinical stage, microscopic pattern, and RP) showed the predicted linear correlation with lesion age. High and low PI levels correlated with early and healing microscopic patterns, respectively, but did not correlate with the corresponding RPs. PI was bimodal with peaks at 3–6 and 9–12 months. Conclusion Cutaneous leishmaniasis is an evolving disease defying the traditional prediction classifications. Our study sets the ground for adopting updated clinical courses, microscopic presentation, and species mapping.

Evaluation of the Pharmacophoric Role of the O–O Bond in Synthetic Antileishmanial Compounds: Comparison between 1,2-Dioxanes and Tetrahydropyrans

“…Leishmania protozoa are endemic in most tropical and subtropical areas worldwide and in the Mediterranean Europe. − Due to global warming and climate change, these parasites and their sand fly vectors are at risk to spread into countries previously considered nonendemic, including central and western Europe. − The protozoa of the genus Leishmania are responsible for various forms of human leishmaniasis. While cutaneous leishmaniasis can be self-limiting, mucocutaneous infection can lead to profoundly disfiguring lesions, and visceral leishmaniasis is fatal if left untreated . Collectively, the parasites belonging to the genus Leishmania cause one of the most burdensome neglected tropical diseases, affecting predominantly poor populations, providing annually 1.5–2 million new cases and roughly 70,000 deaths .…”

Nonhealing Violaceous Plaque of the Hand Following a Splinter Injury

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