Leishmania aethiopica: The unusual etiologic agent of cutaneous leishmaniasis in Ho District of the Volta region of Ghana

Background Cutaneous leishmaniasis (CL) in Ethiopia, caused by Leishmania aethiopica, is often severe and hard to treat compared to CL caused by other species elsewhere. Miltefosine is the only oral anti-leishmanial drug, with a favorable side-effect profile compared to routinely available sodium stibogluconate (SSG), but evidence about its use for L. aethiopica is lacking. Methodology and principal findings In an observational cohort study, treatment outcomes, safety and adherence among CL patients who required systemic treatment and received miltefosine for 28 days in Boru Meda Hospital and University of Gondar Hospital were studied. Patient cure was defined as 100% flattening for non-ulcerated lesions and 100% flattening and 100% re-epithelization for ulcerated lesions. Outcomes were documented for day 28, 90 and 180, both per site, and pooled, adjusting for site as a fixed effect with effect coding. Among 94 included patients (32 in Gondar, 62 in Boru Meda), median lesion duration was 12 months, median size six cm, and mucosal involvement (46.8%) and diffuse (30.9%) lesions were common. Adherence to miltefosine was good, and side-effects were tolerable. Initial outcomes at day 28 were promising, with 68.8% and 94.0% of patients having good improvement or cure in Gondar and Boru Meda respectively. In Boru Meda, outcomes were good with 72.7% and 72.9% cure at day 90 and day 180 respectively. In Gondar, results were less promising, with only 12.5% and 26.7% cure at day 90 and day 180, although confidence intervals were wide. In pooled estimates, 48.7% of patients reached cure at day 180, and 32.3% relapsed. Outcomes were better in Boru Meda Hospital, for smaller lesions and for mucosal lesions. Conclusions/Significance Based on miltefosine’s good initial response, tolerable side-effects, tablet-form, we propose to include miltefosine for future clinical trials using extended treatment schedules, combination therapy, or targeting specific subgroups. Trial registration ClinicalTrials.gov NCT04004754.

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Detection of cutaneous leishmaniasis in three communities of Oti Region, Ghana

PLoS Neglected Tropical Diseases ◽

10.1371/journal.pntd.0009416 ◽

2021 ◽

Vol 15 (5) ◽

pp. e0009416

Author(s):

Richard Akuffo ◽

Carmen Sanchez ◽

Carmen Chicharro ◽

Eugenia Carrillo ◽

Naiki Attram ◽

...

Keyword(s):

Cutaneous Leishmaniasis ◽

Treponema Pallidum ◽

Epidemiological Data ◽

Cross Sectional Study ◽

Common Type ◽

Mycobacterium Ulcerans ◽

Sectional Study ◽

Cross Sectional ◽

Skin Ulcers ◽

Volta Region

Background Cutaneous leishmaniasis (CL) is the most common type of leishmaniasis, a neglected tropical disease caused by parasites of the genus Leishmania. In Ghana, some studies in the Volta region have detected Leishmania parasites among persons with skin ulcers. Methodology/Principal findings Using a cross-sectional study design, the prevalence of CL in three communities of the Oti Region of Ghana was investigated. Demographic and epidemiological data were obtained by a structured interviewer administered questionnaire. A total of 426 (12.4%) out of 3,440 participants screened had at least one skin ulcer. Of 595 skin ulcers sampled and tested by PCR for Leishmania infection, 150 (25.2%) ulcers from 136 individuals tested positive, accounting for an overall CL prevalence of 31.9% among persons with skin ulcers. Individual community CL prevalence of 23.2%, 29.8%, and 36.8% was observed in Ashiabre, Keri, and Sibi Hilltop respectively among persons with skin ulcers. Conclusions/Significance Confirmation of CL in the study area suggests an active cycle of transmission of Leishmania infection. The observation of skin ulcers which tested negative to Leishmania infection suggests a need to test for additional causes of skin ulcers such as Treponema pallidum pertenue and Mycobacterium ulcerans in the study area.

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Treatment response of cutaneous leishmaniasis due to Leishmania aethiopica to cryotherapy and generic sodium stibogluconate from patients in Silti, Ethiopia

Transactions of the Royal Society of Tropical Medicine and Hygiene ◽

10.1016/j.trstmh.2012.02.006 ◽

2012 ◽

Vol 106 (8) ◽

pp. 496-503 ◽

Cited By ~ 22

Author(s):

Edessa Negera ◽

Endalamaw Gadisa ◽

Jemal Hussein ◽

Howard Engers ◽

Teklu Kuru ◽

...

Keyword(s):

Cutaneous Leishmaniasis ◽

Treatment Response ◽

Sodium Stibogluconate ◽

Leishmania Aethiopica

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Human immunodeficiency virus and recurrence of cutaneous leishmaniasis long after healed localized cutaneous leishmaniasis due to Leishmania aethiopica

Transactions of the Royal Society of Tropical Medicine and Hygiene ◽

10.1016/0035-9203(95)90027-6 ◽

1995 ◽

Vol 89 (4) ◽

pp. 400-401 ◽

Cited By ~ 13

Author(s):

Nega Berhe ◽

Asrat Hailu ◽

Teferi Gemetchu

Keyword(s):

Human Immunodeficiency Virus ◽

Cutaneous Leishmaniasis ◽

Leishmania Aethiopica ◽

Immunodeficiency Virus

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Treatment of Cutaneous Leishmaniasis Caused by Leishmania aethiopica: A Systematic Review

PLoS Neglected Tropical Diseases ◽

10.1371/journal.pntd.0004495 ◽

2016 ◽

Vol 10 (3) ◽

pp. e0004495 ◽

Cited By ~ 23

Author(s):

Johan van Griensven ◽

Endalamaw Gadisa ◽

Abraham Aseffa ◽

Asrat Hailu ◽

Abate Mulugeta Beshah ◽

...

Keyword(s):

Systematic Review ◽

Cutaneous Leishmaniasis ◽

Leishmania Aethiopica

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Risk Assessment of the Role of the Ecotones in the Transmission of Zoonotic Cutaneous Leishmaniasis in Central Tunisia

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18179274 ◽

2021 ◽

Vol 18 (17) ◽

pp. 9274

Author(s):

Walid Barhoumi ◽

Ifhem Chelbi ◽

Wasfi Fares ◽

Sami Zhioua ◽

Mohamed Abbas ◽

...

Keyword(s):

Cutaneous Leishmaniasis ◽

Leishmania Major ◽

Etiologic Agent ◽

Control Measures ◽

Sand Fly ◽

Main Peak ◽

Sand Flies ◽

Central Tunisia ◽

Zoonotic Cutaneous Leishmaniasis ◽

Significant Difference

Zoonotic cutaneous leishmaniasis (ZCL), endemic in Central and Southern Tunisia, is caused by Leishmania major (Kinetoplastida: Trypanosomatidae), which is transmitted by the sand fly Phlebotomus papatasi. In Tunisia, the fat sand rat Psammomys obesus and the desert jird Meriones shawi are the principal reservoir hosts of L. major. The presence of the P. papatasi vector of the L. major etiologic agent of ZCL was assessed in the vicinity of villages in endemic areas of Central Tunisia. The study was performed from September through October 2019, a period corresponding to the main peak of activity of P. papatasi. Sand flies were collected from rodent burrows located at the ecotone level, which is the transition zone between the natural environment and human settlement. Sand flies were identified to species level and tested for the presence of L. major by PCR. Our entomological survey showed that P. papatasi is the most abundant sand fly species associated with rodent burrows, and this abundance is even higher in ecotones primarily occupied by P. obesus in comparison to ecotones occupied by M. shawi. Infections with Leishmania major were detected only in P. papatasi, with an overall minimum infection rate (MIR) of 2.64%. No significant difference was observed between the MIRs in ecotones of P. obesus and of M. shawi. Incidence of ZCL in the studied areas ranged from 200 to 700 cases per 100,000 inhabitants, with a mean incidence of 385.41 per 100,000. Higher ZCL incidence was identified in ecotones of M. shawi compared to ecotones of P. obesus. ZCL cases are positively correlated with the MIRs. Considering the short flight range of P. papatasi, increases in its densities associated with burrows of P. obesus or M. shawi at the ecotone level expand the overlap of infected vectors with communities and subsequently increase ZCL incidence. Therefore, control measures should target P. papatasi populations at the ecotones.

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