First report of cutaneous leishmaniasis caused by Leishmania donovani in Ethiopia

Abstract

Background Leishmaniasis is a common neglected tropical disease in Ethiopia. Visceral leishmaniasis (VL) caused by Leishmania donovani presents in the lowlands, while cutaneous leishmaniasis (CL) affects people living in the highlands. Although CL is described as being caused by Leishmania aethiopica, there is also evidence of L. tropica and L. major isolated from a patient, sand flies and potential reservoirs. Information on species causing CL in Ethiopia is patchy, and no nation-wide study has ever been done. Understanding which species are causing CL in Ethiopia can have important implications for patient management and disease prevention. Methods We analyzed stored routine samples and biobanked DNA isolates from previously conducted studies of CL patients from different centers in the north, center and south of Ethiopia. Species typing was performed using ITS-1 PCR with high-resolution melt (HRM) analysis, followed by HSP70 amplicon sequencing on a selection of the samples. Additionally, sociodemographic, clinical and laboratory data of patients were analyzed. Results Of the 226 CL samples collected, the Leishmania species could be determined for 105 (45.5%). Leishmania aethiopica was identified in 101 (96.2%) samples from across the country. In four samples originating from Amhara region, northwestern Ethiopia, L. donovani was identified by ITS-1 HRM PCR, of which two were confirmed with HSP70 sequences. While none of these four patients had symptoms of VL, two originated from known VL endemic areas. Conclusions The majority of CL was caused by L. aethiopica, but CL due to L. tropica and L. major cannot be ruled out. Our study is the first to our knowledge to demonstrate CL patients caused by L. donovani in Ethiopia. This should spark future research to investigate where, how and to which extent such transmission takes place, how it differs genetically from L. donovani causing VL and whether such patients can be diagnosed and treated successfully with the currently available tools and drugs. Graphical Abstract

Ecology and Infection Status of Sand Flies in Rural and Urban Cutaneous Leishmaniasis Endemic Areas in Northwest Ethiopia

“…This is currently being further investigated. Moreover, recent evidence indicates that CL caused by L. donovani occurs in Ethiopia as well [ 9 ], although no whole genome sequencing was performed to assess whether this could have been a hybrid between L. donovani and L. aethiopica. This hybridization could have occurred in the midgut of P. orientalis [ 34 , 35 ].…”

“…Cutaneous leishmaniasis in Ethiopia, and some parts of Kenya, is mainly caused by Leishmania aethiopica, although a recent study in northern Ethiopia showed a few CL causes caused by L. donovani [ 9 ]. CL caused by L. aethiopica is generally severe and manifests in three forms: localized CL (LCL), mucocutaneous leishmaniasis (MCL) and diffuse cutaneous leishmaniasis (DCL).…”

Bioassay-Guided Isolation of Dehydrocostus Lactone from <em>Echinops kebericho</em> as a Leishmanicidal Drug

“…Worldwide, 50,000 to 90,000 and 600,000 to 1 million cases have been reported annually for visceral and cutaneous forms of leishmaniasis, respectively [1]. Cutaneous leishmaniasis is the most common form in Ethiopia, with an estimated 20,000 to 50,000 cases annually and Leishmania aethiopica, Leishmania tropica, and Leishmania major are the causative agents [2].…”