Cutaneous Leishmaniasis in Saudi Arabia: A Comprehensive Overview

Abstract

Despite the great efforts by health authorities in Kingdom of Saudi Arabia (KSA), Cutaneous leishmaniasis (CL) continues to be a major public health problem in the country. Many risk factors make KSA prone to outbreaks and epidemics; among these, rapid urbanization and the huge population movement are the most important. The disease is endemic in many parts of KSA, with the majority of cases concentrated in six regions, including Al-Qaseem, Riyadh, Al-Hassa, Aseer, Ha'il, and Al-Madinah. Leishmania major (L. major) and Leishmania tropica (L. tropica) are the main dermotropic species, and Phlebotomus papatasi (vector of L. major) and Phlebotomus sergenti (vector of L. tropica) are the proved vectors of the disease. Psammomys obesus and Meriones libycus have been defined as the principal reservoir hosts of zoonotic CL in Al-Hassa oasis, Al-Madinah, and Al-Qaseem provinces. Clinically, males are affected more than females, and there is no variation between the Saudis and expatriates in terms of number of reported cases, but the disease tends to run a more severe course among non-Saudis. Face is the most commonly affected site, and ulcerative pattern accounts for 90% of lesions. Despite local and international recommendations of using laboratory diagnostics to confirm CL cases, most cases in KSA are diagnosed and treated on clinical grounds and local epidemiology. However, systemic parenteral sodium stibogluconate (SSG) is the first line of therapy and used to treat all CL patients irrespective of their clinical presentation or the incriminated species. In brief, more efforts are needed to combat this disease. Several aspects of the disease require more evaluation through encouragement of national and regional studies. Development of evidence based national diagnostic and management guidelines, as well as algorithms, is urgently needed to improve the practice of diagnosing and treating CL in KSA.

Keywords: Cutaneous leishmaniasis; Saudi Arabia; clinical picture; diagnosis; epidemiology; treatment.

FIG. 1.

Graph showing the great drop in number of reported CL cases in Saudi Arabia over the last 30 years. CL, Cutaneous leishmaniasis.

FIG. 2.

Map of the Kingdom of Saudi Arabia showing the distribution of reported cases of CL in 2015 by region.

FIG. 3.

Categorization of regional endemicity according to the incidence rate/100,000 population. High (>10 cases/100,000 population), Average (5–10/100,000), Low (<5/100,000), and Free (no cases).

FIG. 4.

Geographical distribution of Zoonotic (ZCL) and Anthroponotic (ACL) cutaneous leishmaniasis based on the defined parasite species.

FIG. 5.

Geographical distribution of Phlebotomus papatasi.

FIG. 6.

Geographical distribution of Phlebotomus Sergenti.

FIG. 7.

Satellite papules of CL.

FIG. 8.

(a, b) Two expatriates work in the same farm presenting with multiple lesions.