title: Molecular prevalence and estimated risk of cutaneous leishmaniasis in Libya.
abstract: OBJECTIVE
  Cutanoeus leishmaniasis (CL) is an endemic disease in the Mediterranean area including Libya. The aim of the present study is to detect the prevalent Leishmania species obtained from smeared cutaneous lesions in addition to studying the diverse sociodemographic risk factors of the reported cases from different provinces of Libya.
  
  
  METHODS
  A total of 250 archived microscopic slides from clinically suspected cases of CL attending the leishmaniasis clinic in the Dermatology Department, Tripoli Central Hospital, Tripoli, Libya, were microscopically examined. Leishmania-DNA was amplified using combined polymerase chain reaction (PCR) targeting kinetoplast-DNA (kDNA) and ribosomal internal transcribed spacer 1 (ITS1)-DNA with restriction fragment length polymorphism analysis for direct Leishmania species identification.
  
  
  RESULTS
  Using kDNA and ITS1-PCR, 22.5% and 20% of cases were positive, respectively. Only 14.4% of cases were positive using microscopy. Nominating ITS1-PCR as the reference standard, kDNA-PCR assay was highly sensitive while microscopy was 100% specific but of limited sensitivity (72%) with a substantial agreement and an overall accuracy of 94.4%. Leishmania major and Leishmania tropica were the predominant species reported from the north-western provinces including Tripoli, Zintan, and Gharyan with their related subprovinces; Asabaa, Mizdan, Alkawasem, and Alorban. CL prevailed more among men and residents of rural areas. House wives and students were the most affected professions. Children were the least affected, while the middle-aged were the most affected age group.
  
  
  CONCLUSIONS
  L. major and L. tropica are the predominant species in the north-western regions of Libya. ITS1-PCR-restriction fragment length polymorphism assay offered a sensitive, specific, and faster diagnostic method especially with negative parasitologic examination.
authors: Parasitology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
authors: Ayman A
authors: AA
authors: El-Badry
authors: Dermatology Department, Faculty of Medicine, Tripoli University, Tripoli, Libya.
authors: Hamida
authors: H
authors: El-Dwibe
authors: Parasitology Department, Faculty of Medicine, Cairo University, Cairo, Egypt. Electronic address: drmahaabu@gmail.com.
authors: Maha M A
authors: MMA
authors: Basyoni
authors: Parasitology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
authors: Abeer S A
authors: ASA
authors: Al-Antably
authors: Parasitology Department, Faculty of Medicine, Cairo University, Cairo, Egypt; Department of Parasitology, Faculty of Medicine, Al-Zawia (7th April) University, Libya.
authors: Wafaa A
authors: WA
authors: Al-Bashier
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D018105:DNA, Kinetoplast / Q000235:genetics; D016054:DNA, Protozoan / Q000235:genetics*; D021903:DNA, Ribosomal Spacer / Q000235:genetics; D005260:Female; D006801:Humans; D007223:Infant; D018320:Leishmania major / Q000145:classification / Q000235:genetics* / Q000302:isolation & purification; D007895:Leishmania tropica / Q000145:classification / Q000235:genetics* / Q000302:isolation & purification; D016773:Leishmaniasis, Cutaneous / Q000175:diagnosis / Q000453:epidemiology* / Q000469:parasitology; D008002:Libya / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D012150:Polymorphism, Restriction Fragment Length / Q000235:genetics; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D018105:DNA, Kinetoplast; D016054:DNA, Protozoan; D021903:DNA, Ribosomal Spacer
keywords: Archived microscopic slides; Cutaneous leishmaniasis; ITS1-PCR; kDNA-PCR