Cutaneous Leishmaniasis Due to Leishmania aethiopica

Abstract

Leishmania aethiopica is the main causative species for cutaneous leishmaniasis (CL) in Ethiopia. Despite its considerable burden, L. aethiopica has been one of the most neglected Leishmania species. In this review, published evidence on L. aethiopica history, geography, vector, reservoir, epidemiology, parasitology, and immunology is discussed and knowledge gaps are outlined. L. aethiopica endemic regions are limited to the highland areas, although nationwide studies on CL prevalence are lacking. Phlebotomus pedifer and P. longipes are the sandfly vectors and hyraxes are considered to be the main reservoir, but the role of other sandfly species and other potential reservoirs requires further investigation. Where and how transmission occurs exactly are also still unknown. Most CL patients in Ethiopia are children and young adults. Lesions are most commonly on the face, in contrast to CL caused by other Leishmania species which may more frequently affect other body parts. CL lesions caused by L. aethiopica seem atypical and more severe in their presentation as compared to other Leishmania species. Mucocutaneous leishmaniasis and diffuse cutaneous leishmaniasis are relatively common, and healing of lesions caused by L. aethiopica seems to take longer than that of other species. A thorough documentation of the natural evolution of L. aethiopica as well as in depth studies into the immunological and parasitological characteristics that underpin the atypical and severe clinical presentation are needed. Better understanding of CL caused by this parasite species will contribute to interventions related to transmission, prevention, and treatment.

Keywords: Cutaneous leishmaniasis; Ethiopia; Leishmania aethiopica.

Fig. 1

Map of published clinical cutaneous Leishmaniasis studies due to L. aethiopica. Orange indicates community-based studies, while blue dots indicate hospital-based studies. The size of the dot indicates the number of cases concerned. Studies reporting less than five patients are not reported here. For community-based studies the dots are on the (estimated) location of the site studied, while for hospital-based studies the origin of the case was reported where possible. For patients from hospital-based studies where the origin of patients was not described, the location of the hospital is indicated. An interactive version of the map can be accessed on: http://e.itg.be/saskia/. By clicking on the dots representing the studies, the first author, reference number, year of publication, name of location, type of study, case load, and name of the health facility (if applicable) can be viewed. Studies are described in detail in Table 1.

Fig. 2

Common presentations of CL due to L. aethiopica are crusty lesions with a patchy distribution, local oedema and color changes with frequent mucosal involvement.