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Cutaneous leishmaniasis due to Leishmania infantum. Case reports and literature review
P del Giudice1, P Marty, J P Lacour
1Department of Infectious Diseases, Center Hospitalier Universitaire de Nice, France.
Background:
Leishmania infantum recently has been identified as a possible agent of cutaneous leishmaniasis (CL). This species has been isolated from cutaneous lesions of patients from the Mediterranean Basin. However, little is known about the clinical, biological, or therapeutic features of this newly recognized CL.
Observations:
Six patients aged 9 months to 85 years in southeastern France were found to have autochthonous leishmaniasis. Parasitological identification showed that the agent was L infantum, zymodemes Montpellier-1 for 2 patients and Montpellier-24 for 1 patient. Five patients who underwent testing with a Western blot assay were found to have antibodies against 4 antigens with molecular masses of 18, 21, 23, and 31 kd. Five patients were successfully treated with local injections of N-methylglucamine, and 1 patient was successfully treated with topical paromomycin sulfate. No patient had visceral disease at diagnosis or after follow-up.
Conclusions:
Recent data provide increasing evidence that L infantum is an important agent of CL. In southwestern Europe, this species is the only agent that has long been identified from autochthonous CL. Leishmania infantum should be considered an agent of CL in areas in which visceral leishmaniasis is endemic. Western blot assay could be a useful test for the diagnosis, but precise parasitological identification is important to having a better knowledge of the disease. The relationships between CL and the visceral disease have to be explored.
Insights
Leishmania infantum is increasingly recognized as a cause of cutaneous leishmaniasis (CL) in southwestern Europe. This study highlights its clinical features and successful treatments, emphasizing its role alongside visceral leishmaniasis.
Area of Science:
- Medical Parasitology
- Infectious Diseases
- Dermatology
Background:
- Leishmania infantum is emerging as a cause of cutaneous leishmaniasis (CL), particularly in the Mediterranean Basin.
- Limited information exists regarding the clinical, biological, and therapeutic aspects of L. infantum-induced CL.
Purpose of the Study:
- To investigate the clinical presentation, diagnosis, and treatment of autochthonous cutaneous leishmaniasis caused by Leishmania infantum.
Main Methods:
- Parasitological identification of Leishmania infantum in six patients with autochthonous leishmaniasis.
- Western blot assay to detect antibodies against specific L. infantum antigens.
- Evaluation of treatment outcomes with N-methylglucamine and paromomycin sulfate.
Main Results:
- Leishmania infantum was identified as the causative agent in six patients presenting with CL.
- Antibodies against four specific antigens (18, 21, 23, and 31 kd) were detected via Western blot.
- Successful treatment was achieved in all patients using local N-methylglucamine injections or topical paromomycin sulfate, with no cases of visceral disease.
Conclusions:
- Leishmania infantum is a significant agent of CL in southwestern Europe and should be considered in endemic areas.
- Western blot may aid diagnosis, but precise parasitological identification is crucial for understanding the disease.
- Further research is needed to explore the relationship between CL and visceral leishmaniasis caused by L. infantum.