Detection and identification of cutaneous leishmaniasis isolates by culture, Polymerase chain reaction and sequence analyses in Syrian and Central Anatolia patients

The Geographical Distribution of Cutaneous Leishmaniasis Causative Agents in Iran and Its Neighboring Countries, A Review

Leishmania tropica and Leishmania major are both the main cause of anthroponotic (ACL) and zoonotic cutaneous leishmaniasis (ZCL), respectively, in the Old World. Leishmania infantum and Leishmania donovani, which are important causes of visceral leishmaniasis, have also occasionally been reported in CL patients. The present study investigates the current distribution of causative species of CL in Iran and neighboring countries in the Middle East. There has been expansion of L. tropica into new urban and rural foci in Iran, with well-documented cases of visceralization, a substantial increase of CL in Syria, and the emergence of new foci and outbreaks in Turkey and Iraq, especially due to L. major. Civil war in Syria and Iraq, population movement, poverty, and climatic change play important roles in the changing CL distribution in this region. Control programs should adopt a multidisciplinary approach based on active surveillance and case finding, especially in vulnerable refugee populations, determination of hazard maps for CL hot points using GIS and other advanced technology, the free distribution of drugs, rodent control, and greater community engagement in poor and marginalized populations. Comprehensive molecular studies that could show the species and strains of Leishmania in different areas of each country can give a better view from the distribution of CL in this region.

The impact of refugees on leishmaniasis in Turkey: a new Syrian/Turkish Leishmania tropica population structure described by multilocus microsatellite typing (MLMT)

Turkey is one of the leishmaniasis endemic countries, and according to the recent reports, more than 45% of the cases were reported from the Southeastern part of Turkey. The disease is endemic in Syria with annually 25,000 cases, and it is emphasized by WHO that the actual number was estimated to be 2-5-fold higher than the reported numbers. Due to the civil war in Syria, more than seven million people were displaced and migrate to neighboring countries. The population structure of Leishmania tropica was investigated in the present study using clinical samples, which were obtained from Syrian patients residing in Turkey. Previously reported database was used to compare the results obtained in the present study. According to the multilocus microsatellite typing profiles, three populations (Şanlıurfa, Mediterranean, and Syrian/Turkish) were identified. Syrian/Turkish population, which is a new structure and identified for the first time in the present study, was comprised of clinical samples obtained from Syrian patients. The newly described population structure was homogeneous and solid comparing to previously identified population structures in Turkey. Further analyses revealed two sub-populations under the main Syrian/Turkish population structure. The findings of the present study revealed that the epidemiological status of leishmaniasis is more complicated than it is estimated. We believe that the data presented here will provide valuable information on the leishmaniasis epidemiology.

Leishmaniasis in Istanbul; A new epidemiological data about refugee leishmaniasis

Leishmania is an intracellular parasite, which is transmitted by the bite of infected female Phlebotominae sand flies. Turkey is a crossroad between Europe and Asia that makes it important in terms of epidemiology. In the present study, we aimed to evaluate Leishmania infection among non-autochthonous patients admitted to Health Sciences University, Dr. Sadi Konuk Research and Training hospital between 2014-2018. Slides were prepared by sampling the edge of the lesions for each patient. Microscopical examination was performed after staining procedures. After microscopical examination slides were washed and DNA extraction was performed. ITS-1 real-time PCR was performed to identify the species of the causative agents. Demographic data were recorded for each patient. Also number, type and location of the lesions were recorded. Totally 13 patients were included in this. Majority (12/13) of them were found to be infected with L. tropica, while one patient was infected with L. infantum. Two of the lesions were wet type and 11 of them were dry type lesions. Several papers were published recently about leishmaniasis in Turkey but to best of our knowledge, this is the first study reporting refugee leishmaniasis in İstanbul.

The increase in neglected cutaneous leishmaniasis in Gaziantep province of Turkey after mass human migration

Outbreaks of Cutaneous Leishmaniasis (CL) due to war-related factors have been reported in different areas in Turkey and Syria. CL has become the most serious of the infectious diseases which have been reported in Gaziantep in southeast Turkey, during the last three years due to the influx of Syrian refugees. The present research involves an analytical cross-sectional epidemiological study of CL cases diagnosed in the Gaziantep Leishmaniasis Diagnosis and Treatment Center. The patient demographic data, the location of the lesions, the number of the lesions, the duration of the lesions, and the treatment of the lesions are included. The diagnosis of CL was made by microscopic examination of smears in all cases, and 81.1% (900/1110) of which were found to be positive. Out of 900 CL patients, 93.8% (845/900) were Syrian citizens and 6.2% (55/900) were Turkish citizens. The disease was more frequent in females with 53.5% (482/900) and in the age group between 0-20 years with 68.3% (615/900). Distribution of lesions in the body showed that the face was the most affected location with 37% (333/900), and the generation time of lesions was 0-6 months with 71.2% (641/900). 94.7% (852/900) of the CL patients healed without relapse, and 5.3% (48/900) of the CL patients relapsed. CL patients have re-emerged in Gaziantep, located in the southeast of Turkey, as a result of Syrian refugees. The increase in CL frequency is alarming and requires control and prevention measures in highly infected areas including this region.