Cutaneous Leishmaniasis in Lebanon, Syria and Saudi Arabia: Clinical, Histologic and Molecular Comparative Study of 122 Patients.
Ibrahim Khalifeh, Lamis Yahya, Mohammad Houreih, Wasim Raslan, Ruba Khattab, Ghazi Zaatari. American University of Beirut, Lebanon; Tishreen University, Lattakia, Syrian Arab Republic; Aramco, Dhahran, Saudi Arabia
Background: Cutaneous leishmaniasis (CL) is a growing problem in Lebanon (LB), Syria (SY) & Saudi Arabia (SA). The spectrum of manifestations of CL is broad both clinically & histologically.
Design: Skin biopsies from 122 patients with untreated CL from LB, SY & SA were analyzed. The clinical/histological features & molecular subspecies (MS) were compared. The clinical data collected included: age, sex, eruption type (papule: P; nodule: N & verrucous: V), duration, anatomic location (face: F; upper: U & lower: L extremity) & biopsy type. Histologically, multiple aspects were recorded including: Ridley's histological pattern & parasitic index system (PI), epidermal hyperplasia (EH) and elimination (EE), neurotropism (NT), granuloma type, interface/spongiotic changes, quantifying inflammatory cell composition & necrosis. To perform MS, PCR was performed using primers specific for the Leishmania ribosomal internal transcribed spacer 1 (ITS1-PCR) followed by restriction fragment length polymorphism (RFLP) analysis. The statistical analysis were performed using Chi square [1, 2] & ANOVA test.
Results: The species tropica was dominant in all regions (97-100%). The patients were of significantly younger age with shorter duration of the lesions in SY & SA compared to LB. SA cases showed more verrucous growth & EH. The mean PI was lower in cases from SA with less EE and NT. The PI showed statistically significant increase in facial lesions, nodular growth, EE and increase in plasma cells. The other clinical & histological variables were statistical insignificant.
|# of cases||40||51||31|
|Mean age (years)||42||29.6||29.2||0.01|
|Duration of lesion (months)||13.9||8.3||4.5||0.04|
|Anatomic location F/U/L||58/28/14||69/20/11||48/20/32||0.01|
|Eruption type P/N/V||8/68/22||0/100/0||3/54/43||0.1|