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. 2010 Nov;83(5):1034-9.
doi: 10.4269/ajtmh.2010.10-0234.

Epidemiologic and clinical features of cutaneous leishmaniasis in southeastern Tunisia

Nadia Bousslimi  1 , Karim Aoun, Imène Ben-Abda, Nissaf Ben-Alaya-Bouafif, Mohamed Raouane, Aïda Bouratbine
Affiliations

Epidemiologic and clinical features of cutaneous leishmaniasis in southeastern Tunisia

Nadia Bousslimi et al. Am J Trop Med Hyg. 2010 Nov.

Abstract

Species-specific diagnosis was performed in 66 patients with cutaneous leishmaniasis (CL) living in Tataouine focus in southeastern Tunisia. Leishmania DNA was extracted directly from dermal scrapings (n = 66) and from parasites obtained in culture (n = 12). Species were identified by using polymerase chain reaction-restriction fragment length polymorphism analysis for internal transcribed spacer region 1 and isoenzyme analysis. Leishmania tropica and L. major were identified in 31 (47%) and 35 (53%) cases respectively. Leishmania tropica CL cases were geographically scattered, and L. major CL cases were clustered. Lesions caused by L. tropica were mostly single (83.8%) and face-localized (55.8%), and lesions caused by L. major were multiple (57.1%; P < 0.001) and situated on limbs (83.7%; P < 0.001). For both species, most lesion onsets were reported during June-January. However, lesions that emerged during February-May were mainly caused by L. tropica (83.3%; P < 0.01). Moreover, the delay before seeking medical advice was higher for L. tropica infections than for L. major infections (P < 0.05).

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Figures

Figure 1.
Figure 1.
Leishmania tropica focus in southeastern Tunisia. The map on the right shows the governorate of Tataouine (shaded black). The study area is situated in the northeastern part of the governorate. The photographs on the left show the regional landscape. The photograph on the top left shows the town of Ghomrassen. This figure appears in color at www.ajtmh.org.
Figure 2.
Figure 2.
Distribution of cutaneous leishmaniasis in Tunisia according to Leishmania species. A, geographic distribution of cutaneous leishmaniasis cases caused by L. tropica in the study area (gray circles). B, geographic distribution of L. tropica (gray circles) and L. major (white circles) in the town of Ghomrassen.
Figure 3.
Figure 3.
Number of cutaneous leishmaniasis cases according to the onset date of lesions (June 2008–May 2009) and species-specific diagnosis, Tunisia.
Figure 4.
Figure 4.
Diagnosis lag according to species for case of cutaneous leishmaniais, Tunisia. The box plots show medians and interquartile ranges.
See this image and copyright information in PMC

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