Prevalence of cutaneous leishmaniasis in the largest populated city Karachi, Pakistan

The study was undertaken from September 2018 to April 2019 to determine the prevalence of cutaneous leishmaniasis in human beings living in six districts of Karachi. Suspected persons were screened for the disease and positive cases were identified on the basis of skin lesions and blood samples. Samples were observed by mounting their smear. A total of 207 subjects of different ages and sex groups were investigated, however, only 192 (92%) of the suspected cases were found to have the disease 64% of cases were male which were significantly high (p<0.05), than female 36%. The lesion was more frequently detected among the youth ages of 21-30 years (31%) as compared to other groups. In both sexes, legs were found to be more infected (25% male + 20% female) followed by arms (20% male + 0% female) and face (15% male +11% female). The mixed body parts had shown the lowest infections such as (4% in males + 5%) in females. In conclusion, the highest and lowest leishmaniasis infections were observed in District West (23% male + 9% female) followed by District East (15% male + 7% female), District Malir (11% male+ 4% female), District Central (7% male + 5% female), District Korangi (4% male + 7% female) and District South (4% male + 4% female) respectively.

Knowledge, Attitudes, Practices and its associated risk factors related to Cutaneous Leishmaniasis in Ilam province of Iran

Knowledge, Attitudes and Practices (KAP) surveys precede an awareness or intervention program, it addresses a felt need in a population in which that need exists. In an endemic region of cutaneous leishmaniasis disease occurrence, public enlightenment on its preventive and control measures is highly important. Ilam province of Iran is a provincial border town transited annually by pilgrims was reported to have the most cases of cutaneous leishmaniasis ranking highest since 2010 yet no report on KAP survey has been previously conducted.

Distribution and Diversity of Sand Fly Species (Diptera: Psychodidae, Phlebotominae) in Two Geoclimatic Zones of Chad

Leishmaniasis transmitted by sandflies is an important vector-borne disease. In Chad, information on sandflies is outdated, and so this study was designed to update the sandfly fauna. Sandflies were collected in five health districts representing two geoclimatic zones using sticky traps and pyrethrum sprays in indoor and peridomestic habitats between September 2019 and December 2020. All collected sandfly specimens were identified based on species-level morphological characters. A total of 2,015 specimens belonging to 13 species of sandflies (one Phlebotomus and twelve Sergentomyia) were collected and identified. The vector of human cutaneous leishmaniasis, Phlebotomus duboscqi, represents 0.65% of all collected sandflies and is the only representative of the Phlebotomus genus to be collected predominantly inside human dwellings. Phlebotomus orientalis, the vector of visceral leishmaniasis previously collected in Chad in 1976 was not found in this study. Sergentomyia clydei, Sergentomyia schwetzi, Sergentomyia antennata and Sergentomyia africana were the most abundant species collected with 44.71%; 22.73%; 16.03% and 11.17%, respectively. Sergentomyia schwetzi and Sergentomyia dubia, the two species involved in the transmission of canine leishmaniasis, were found in five and four study sites respectively. According to our results, the sandfly fauna of the two geoclimatic zones of Chad is comprised of 13 species. Our data showed that, unlike P. orientalis which was not found, P. duboscqi is present in four of the five sites surveyed. Therefore, these areas are at risk and remain potential foci of cutaneous leishmaniasis. However, the need for further studies such as vector species detection, their seasonal fluctuations and their vector competence.

Topical and intralesional immunotherapy in cutaneous infections

Immunotherapy has revolutionized the treatment of extensive and resistant warts. Promising results have extended the role of immunotherapy to other infections such as extensive molluscum contagiosum, recurrent herpes simplex infections, and cutaneous leishmaniasis, which are resistant to standard treatment. This review focuses on topical and intralesional immunotherapy in the management of cutaneous infections.

An Insight Into Systemic Immune Response in Leishmania donovani Mediated Atypical Cutaneous Leishmaniasis in the New Endemic State of Himachal Pradesh, India

Leishmaniasis continues to afflict known and newer endemic sites despite global efforts towards its control and elimination. In this regard, the emergence of newer endemic sites with unusual disease formats is recognized wherein Leishmania donovani complex classically known to cause visceral disease is demonstrated to cause cutaneous manifestation. In this context, atypical cutaneous leishmaniasis (CL) cases caused by L. donovani genetic variants from the newer endemic state of Himachal Pradesh (HP) in India are beginning to be understood in terms of parasite determinants. The atypical CL manifestation further needs to be explored to define host immune correlates with a possible role in driving the unusual disease progression. In the given study, we performed comprehensive systemic-immune profiling of the atypical CL patients from the study area in HP, India, in comparison with the classical visceral leishmaniasis (VL) patients from the northeast region of India. The systemic immune response was studied using ELISA-based assessment of Th1, Th2, Th17, Treg, and Th22 specific plasma cytokine expression pattern and parasite-specific total serum IgG/IgG subclasses. The specified immune correlates are known to exhibit heterogeneous association with the different infecting parasite species, infection load, and co-lateral host immunopathology in classical CL and VL. In the atypical CL patient group, altered expression of IL-10 emerged as the key finding that could potentially fine-tune the Th1/Th17/Th22 effector cytokine axis towards a localized cutaneous manifestation. A reduced expression of IL-10 along with a high IFN-γ/IL-10 ratio as a readout of effective parasite killing defined atypical cutaneous outcome. In contrast, high circulatory IL-10 levels and a depressed IFN-γ/IL-10 ratio were seen in classical VL patients in line with an ineffective parasite-killing cytokine response. Overall, the study highlights new knowledge on host immune correlates in terms of cytokine expression pattern and IgG subclasses that underline atypical disease manifestation such that L. donovani, a generally visceralizing parasite species cause skin localized cutaneous lesions.

Antibody Responses to Phlebotomus papatasi Saliva in American Soldiers With Cutaneous Leishmaniasis Versus Controls

Leishmania major, transmitted in Iraq by the bite of a sand fly Phlebotomus papatasi, causes cutaneous leishmaniasis (CL). The sand fly saliva is immunogenic, with both systemic humoral and cellular human immune responses resulting from natural exposure. 248 Americans who developed L. major infection in Iraq were sex, race/ethnicity, year of Iraq deployment-matched to controls without CL. Using a case-control study design, we compared sand fly saliva-specific human IgG levels and recognized antigens between the two groups. Serologic responses to Ph. papatasi salivary gland homogenate were studied with ELISA and Western blot, using serial samples obtained from before travel, during CL treatment (CL) or at time of return to US (controls), as well as (for CL cases) six to 24 months after return to non-endemic US. The mean change in optical density (MCOD), reflecting the change in sand fly saliva-specific IgG before and after exposure in Iraq, was 0.296 (range -0.138 to 2.057) in cases and 0.151 (range -0.454 to1.085) in controls, p&lt;0.001. Low levels of sand fly saliva specific antibody were noted in CL cases by 7-8 months after return to the US. The most frequently recognized Ph. papatasi salivary antigens were MW30 (PpSP32) and MW64, although other salivary proteins recognized were MW12/14, 15, 18, 28, 32, 36, 42, 44, 46, 52. Logistic regression suggested that MW15, 28 and 42 were associated with the largest effect on the MCOD. MW30 was the most frequently recognized antigen suggesting a role as biomarker for sand fly exposure and CL risk. Anti-Ph. papatasi saliva IgG waned within months of return to the US. We also discuss vector antigenic saliva proteins in the context of CL presentation and identify some salivary antigens that may correlate with less lesion area, ulcer versus papule/plaque, race among those with CL.