Cutaneous leishmaniasis in Iraq

To determine the incidence ofcutaneous leishmaniasis (CL) in Alhaweja District and to clarify the secondary bacterial infection inCL.

A prospective survey was performed in the outpatient clinic of Alhaweja General Hospital. All the patients who presented at the dermatology clinic during the period from 1 October 2004 to the end of April 2005 were included in the study. The provisional diagnosis was dependent on clinical examination; however, biopsies and confirmatory tests were performed for questionable cases. Venous blood was drawn from patients with cutaneous leishmaniasis for determination of IgM. Swabs from the ulcer were taken for culture to determine secondary bacterial infections.

A total of 107 cutaneous leishmaniasis cases were diagnosed during the study period with males representing 57% of the cases. The study participants ranged from 1-60 years. The incidence rate was 45 cases per 10,000. Clinically, 58% of patients had multiple lesions, while 42% had a single lesion. It was found that 36.5% of patients had dry type while 63.5% had wet type lesions. Most lesions were found on upper limbs (57%), while the fewest were found in the ear 1%. The highest number of cases was recorded during February (32.1%), while the lowest rate of cases was recorded in April (3.37%). According to cultures and smears, 73% of the cases were positive to giemsa stain and 43% were positive in cultures. Secondary bacterial infection occurred in 42% of lesions and Staphylococcus epidermidis was the most common bacteria (55%) isolated from lesions, followed by Staphylococcus aureus (33%). The mean of total IgM levels was significantly decreased in patients with CL in comparison with the control group.

CL is endemic in Alhaweja district. CL is an important health problem since secondary bacterial infection was reported in 42% of cases and this infection my influence the natural course of the disease causing more destruction for skin. Giemsa stain was the most sensitive parasitic diagnostic test.