[Comparative characterization of skin lesions observed in the three endemic varieties of cutaneous leishmaniasis in Tunisia].
BACKGROUND
The recent spread in the geographical distribution of the three forms of cutaneous leishmaniasis (CL) endemic in Tunisia has resulted in the coexistence of more than one species of Leishmania (L.) in some foci, rendering characterization on the basis of geographical criteria alone more difficult. The aim of the study was to establish clinical criteria associated with these noso-geographic forms, namely sporadic CL (SCL) due to L. infantum, zoonotic CL (ZCL) due to L. major and chronic CL (CCL) due to L. tropica.


METHODS
One hundred and twelve patients with biologically confirmed CL were involved in the study. Leishmania species was systematically identified by iso-enzyme analysis and/or PCR-RFLP. Details of the number, the location, the morphological aspect and the month of outbreak of the lesions were noted for each patient.


RESULTS
SCL lesions appeared later than ZCL lesions (53.8% of cases appeared from December onwards vs. 23.6%, P<0.001). ZCL lesions were often multiple (75%) and situated on the limbs (84.7%, P<0.001), whereas SCL lesions were single (92.3%, P<0.001) and located on the face (84.6%, P<0.001). CCL lesions were also single (78.6%) and located on the face (71.4%). The classical ulcerous presentation with scabs was mainly observed in ZCL patients (69.4%) and the erythematous presentation was described more frequently in SCL patients (75%; P<0.001).


CONCLUSIONS
The number, site, morphological aspect and month of outbreak of lesions could be considered as useful criteria that help differentiate between the three noso-geographical forms of CL prevailing in Tunisia. Such characterization is useful for the individual management of patients and for optimizing the combat against the disease.
Laboratoire de recherche parasitoses médicales, biotechnologie & biomolécules, LR 11 IPT 06, institut Pasteur de Tunis, 13, place Pasteur, BP 74, 1002 Tunis Belvédère, Tunisie. karim.aoun@pasteur.rns.tn
K
K
Aoun
I
I
Ben Abda
N
N
Bousslimi
J
J
Bettaieb
E
E
Siala
R
R
Ben Abdallah
R
R
Benmously
A
A
Bouratbine
D000328:Adult; D000818:Animals; D003430:Cross-Sectional Studies; D019353:Endemic Diseases; D005260:Female; D006801:Humans; D018314:Leishmania infantum; D018320:Leishmania major; D007895:Leishmania tropica; D016773:Leishmaniasis, Cutaneous / Q000175:diagnosis* / Q000453:epidemiology / Q000469:parasitology / Q000473:pathology; D008297:Male; D016133:Polymerase Chain Reaction; D012150:Polymorphism, Restriction Fragment Length; D011446:Prospective Studies; D012621:Seasons; D012867:Skin / Q000469:parasitology / Q000473:pathology; D014416:Tunisia; D015047:Zoonoses