Main Article Content
Cutaneous leishmaniasis, Gender, Molecular, Human, Iraq
Background: Cutaneous leishmaniasis (CL) remains a serious public health concern in some parts of Iraq. The aims of this study to report of CL in some parts of Iraq, by different parasitological, cultural, and molecular methods and evaluate sex differences among infected patients. This is the first study conducted to characterize Leishmania species causing CL among Iraqi patients using the sequence analysis of Internal Transcribed Spacer1 (ITS1).
Methods: A total of 700 cases of suspected CL who were referred to the Iraqi's clinics and health centers and they checked for Leishmania amastigote using Giemsa-stained , however the NovyMacneal Nicolle (NNN) culture led to the growth of promastigotes in all samples, then the samples were examined using PCR and RFLP-PCR methods.
Results: The present study indicated that the prevalence of CL in eight Iraqi provinces as follow: Diwaniya 88(15.1%) , Wasit 85(14.5%),Najaf 79(13.6%), Thi-Qar 76(13.1%), Basrah 67(11.5%), Baghdad 65(11.2%), Diyala 63(10.8%) and Salah-Adin province which recorded the lower infection 60(10.3%), and it appeared 83.3% by using Giemsa-smeared in eight Iraqi provinces. The highest infection (100 %) appeared using PCR while the lowest infection (68%) appeared by culture on NNN media. The present study was revealed that the highest infection (60 %) caused by L.major than L.tropica (40 %) . Our results showed that 368 (52.6 %) of CL patients were had single lesion and 215 (30.7 %) had multiple lesions, and the ulcerative wet type lesions were present in 49.6% , while the nodule dry type lesions were present in 33.7 %. The overall prevalence of cutaneous leishmaniasis in the study area was very high (83.3%) having a statistical significant association with sex; males are more prone (56.4%) to Cutaneous Leishmaniasis (CL) as compared to females(43.6%).
A clear and reliable bias toward males exists in some tropical diseases, such as leishmaniasis. Cutaneous leishmaniasis is a major health problem in Iraq and CL caused by many countries including Iraq. Health authorities should be aware of the fact that war and terrorist activities induce expansion of the disease and increase incidence rate in the situation that access to medical treatment is not easy especially in poor conditions of leishmaniasis endemic areas.
2. WHO. Communicable Disease Profile Iraq. Working Group on Emergencies, HQ Division of Communicable Disease Control, EMRO, WHO OFFICE, Baghdad. WHO Office, Baghdad. Communicable Disease Toolkit, IRAQ CRISIS. WHO 2003; 39–44.
3. Klein SL. Hormonal and immunological mechanisms mediating sex differences in parasite infection. Parasite Immunol 2004:26:247–64.
4. Marriott I, Huet-Hudson Y. M. Sexual dimorphism in innate immune responses to infectious organisms. Immunol Res 2006:34:177–92.
5. Travison TG, Araujo AB, O’Donnell AB, Kupelian V, McKinlay JB. A population-level decline in serum testosterone levels in American men. J Clin Endocrinol Metab 2007:92:196–202.
6. Murback ND, Hans Filho G, Nascimento RA, Nakazato KR, Dorval ME. American cutaneous leishmaniasis: clinical, epidemiological and laboratory studies conducted at a university teaching hospital in Campo Grande, Mato Grosso do Sul, Brazil. An Bras Dermatol 2011:86:55–63.
7. Postigo JA. Leishmaniasis in the World Health Organization Eastern Mediterranean Region. In J Antimicrob Agents 2010;36:62–65.
8. Gillis D, Klaus S, Schnur LF, et al. Diffusely disseminated cutaneous Leishmania major infection in a child with acquired immunodeficiency syndrome. Pediatr Infect Dis J 1995;14:247–9.
9. Alvar J, Vélez ID, Bern C, et al. Leishmaniasis worldwide and global estimates of its incidence. PLoS One. 2012;7:35671.
10. Aronson N. Leishmaniasis in American Soldiers: Parasites from the front. In: Scheld W, Hooper D, (ed), Emerging Infections 7. ASM Press, Washington, DC; 2007.
11. Martina S, Valeriya V, Marie C, et al. Gene-specific sex effects on eosinophil infiltration in leishmaniasis. Biology Sex Diff 2016;7(1):59.
12. Guerra-Silveira F, Abad-Franch F. Sex bias in infectious disease epidemiology: patterns and processes. PLoS One 2013;8:e62390.
13. Alexander J, Bryson K. T helper (h)1/Th2 and Leishmania: paradox rather than paradigm. Immunol Lett 2005;99:17–23.
14. Snider H, Lezama-Davila C, Alexander J, Satoskar AR. Sex hormones and modulation of immunity against leishmaniasis. Neuroimmunomodulation 2009;16:106–13.
15. Pan AA, Duboise SM, Eperon S, et al. Developmental life cycle of Leishmania– cultivation and characterization of cultured extracellular amastigotes. J Eu Microbiol1993;40:213–23.
16. Laskay T, Miko TL, NegesseY, et al. Detection of cutaneous Leishmania infection in parafin-embedded skin biopsies using the polymerase chain reaction. Trans R Soc Trop Med Hyg1995;89:273–75.
17. Al-Samarai, AM, AlObaidi HS. Cutaneous leishmaniasis in Iraq. J Infect. Developing Countries 2009;3(2):123–29.
18. Talari SA, Shajari G, Talaei R. Clinical finding of cutaneous leishmaniasis as a new focus of Iran. J Infec Dis 2006;5(2).
19. Ramirez JR, Agudelo S, Muskus C, Alzate JF, Berberish C, et al. Diagnosis of cutaneous leishmaniasis in Colombia: the sampling site within lesions influences the sensitivity of parasitologic diagnosis . J Clin Microbiol 2000;38(10):3768–73.
20. ul Bari A and ber Rahman S. Correlation of clinical, histopathological, and microbiological finding in 60 cases of cutaneous leishmaniasis. Indian J Dermatol Venereol Leprol 2006;72(1):28–32.
21. Faulde M, Schrader J, Heyl G, Amirih M. Differences in transmission seasons as an epidemiological tool for characterization of anthroponotic and zoonotic cutaneous leishmaniasis in northern Afghanistan. Acta Trop 2008;105(2):131–38.
22. Schönian G, Nasereddin A, Dinse N, et al. PCR diagnosis and characterization of Leishmania in local and imported clinical samples. Diagn Microbiol Infect Dis 2003:47:349–58.
23. Sharifi I, Poursmaelian S, Aflatoonian MR, et al. Emergence of a new focus of anthroponotic cutaneous leishmaniasis due to L.tropica in rural communities of Bam district after the earthquake, Iran Trop Med Inter Health 2011;4:510–13.
24. Fata A, Khamesipour A, Mohajery M, et al. Whatman paper (FTA cards) for storing and transferring Leishmania DNA for PCR examination. Iranian J Parasitol 2009;(4):37–42.
25. Rogers MB, Hilley JD, Dickens NJ, et al. Chromosome and gene copy number variation allow major structural change between species and strains of Leishmania. Genome Res 2011;21(12):2129–42.