ABSTRACT
Lupoid cutaneous leishmaniasis [LCL] is an uncommon form of chronic cutaneous leishmaniasis, which is mostly caused by Leishmania tropica in the Old World and has a high incidence throughout early life. Between 2012 and 2013, patients with active lesions suspected to be cutaneous leishmaniasis [CL] were examined. Diagnosis was performed through a combination of methods, i.e., clinical examination, direct smears and kDNA polymerase chain reaction [PCR]. Overall, 162[4.2%] subjects, through clinical examination and PCR confirmation alone, were diagnosed as having LCL, with the duration of the lesions varying from 2 to 5 years. Most [85.8%] of the subjects with LCL were <20 years of age. No amastigote was found in direct smears. Moreover, direct PCR on the negative smears for identifying Leishmania provided a specificity of 100%, and the species was identified as Leishmania tropica using specific kDNA PCR. Performing PCR on skin smears appears to offer a valuable method for the diagnosis of LCL because it is highly specific and sensitive, especially for clinical correlative studies
ABSTRACT
Cutaneous leishmaniasis is one of the prevalent health problems in tropical and subtropical areas including Iran. Therefore, it is essential to identify the prevalence and new foci of this disease in different regions of Iran. This study aimed to determine the epidemiology of cutaneous leishmaniasis by active case finding in elementary schools in Pakdasht city, Southeast of Tehran, Iran 2013-2014. This cross sectional study was carried out on 4800 students from 60 elementary schools in Pakdasht during October 2013 to March 2014. After examining the students, some epidemiological data such as age, gender, date, anatomic location of the lesion[s] in the body, number and size of lesion[s], lesion type, and travel history to endemic areas was recorded in a checklist. Students with active lesions were examined using parasitological and molecular methods [PCR]. Totally, 31 students [0.64%] had leishmaniasis, of which 15 [0.31%, 95% CI, 0.15%, 0.47%] had active lesions and 16 [0.33%, 95% CI, 0.17%, 0.49%] had leishmaniasis scars. Molecular testing showed that Leishmania major was the causative agent of leishmaniasis in all patients with active lesion. The highest frequency of cutaneous leishmaniasis was found in the age group 10-12 years [P=0.03]. There was a significant difference between the frequency of the disease in different months [P=0.04] and the anatomic location of the lesion/scar [P=0.04]. Moreover, t-test revealed that there was a significant relationship between number of lesions/scars and the age group [P<0.001]. The leishmanial type diagnosed in all patients was L. major. This finding suggests that Pakdasht might be a new focus for zoonotic cutaneous leishmaniasis