Cutaneous leishmaniasis in North-Western Yemen: A clinicoepidemiologic study and Leishmania species identification by polymerase chain reaction–restriction fragment length polymorphism analysis
Accepted 20 April 2009. published online 20 August 2009.
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.
aDepartment of Dermatology, Saudi Hospital at Hajjah, Sana'a, Yemen Republic
bVector-borne Diseases and International Health, Department of Infectious, Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, Rome, Italy
Reprint requests: Mishri Lal Khatri, MD, Saudi Hospital at Hajjah, PO Box: 2757, Sana'a, Yemen Republic.
Funding sources: None.
Conflicts of interest: None declared.
Proceedings of the study were presented, in part, at the 21st World Congress of Dermatology, Buenos Aires, Argentina, Oct 1-5, 2007.
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