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Cutaneous leishmaniasis: an evolving disease with ancient roots.

Maelle Saliba1, Awss Shalhoub2, Suad Taraif3

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Cutaneous leishmaniasis presents with evolving features, challenging traditional classifications. This study highlights updated clinical and microscopic presentations, crucial for disease management and species identification.

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Area of Science:

  • Dermatology
  • Infectious Diseases
  • Tropical Medicine

Background:

  • Cutaneous leishmaniasis (CL) is a significant neglected tropical disease.
  • Novel clinical presentations necessitate an update in understanding CL features.

Purpose of the Study:

  • To analyze the clinical and microscopic features of cutaneous leishmaniasis in a multiregional cohort.
  • To evaluate the correlation between traditional classification patterns and disease progression.
  • To identify updated characteristics for improved CL diagnosis and management.

Main Methods:

  • Reviewed a cohort of 396 patients with confirmed CL.
  • Assigned clinical stage, eruption type, and defined extensive disease criteria.
  • Recorded microscopic variables including inflammatory patterns (Ackerman, Ridley's Pattern), parasitic index (PI), and epidermal changes.
  • Performed molecular confirmation and speciation of Leishmania parasites.

Main Results:

  • 71.8% of cases exhibited extensive CL, with 15.7% lasting over 12 months.
  • Leishmania tropica was the predominant species (91.3%).
  • Microscopic findings included interface changes (72.7%), spongiosis (75.3%), and epidermal hyperplasia (63.9%).
  • Traditional classification patterns did not correlate linearly with lesion age.
  • Parasitic index correlated with early and healing microscopic patterns but not Ridley's patterns.

Conclusions:

  • Cutaneous leishmaniasis exhibits an evolving nature that challenges traditional predictive classifications.
  • Updated clinical courses, microscopic presentations, and species distribution are essential for managing CL.
  • This study provides a foundation for revised approaches to CL diagnosis and treatment.