title: Old World Leishmaniasis: an ancient disease with nonstandardized microscopic and clinical classifications.
abstract: BACKGROUND
  Microscopic and clinical classifications of cutaneous leishmania have been set in the 1980s. Since then, they have been used invariably. Lebanon, a nonendemic country, is suffering from a leishmaniasis epidemic because of the massive population influx from endemic Syria.
  
  
  METHODS
  Patients diagnosed and speciated with leishmania (n = 169) using molecular and microscopic analysis were studied. General demographic data, microscopic data [Ridley's pattern (RP), microscopic pattern, Parasitic Index (PI)] and clinical stage were documented. Clinical score was scored as: 1: inflammatory; 2: proliferative/reorganization; 3: healed phases. The three patterns were studied in comparison to the lesion age and PI.
  
  
  RESULTS
  At low PI, the clinical score and microscopic pattern showed healing scores (scores 3 and 4, respectively). In contrast, RP showed variable distribution at low PI. The same pattern is noted when correlating the different patterns with high PI. In comparison to lesion age, none of the three patterns showed the predicted linear correlation with lesion progression.
  
  
  CONCLUSIONS
  In the studied population, the previously adopted classifications did not correlate with the disease progression. Such findings may raise the possibility of evolving disease. The proposed clinical and microscopic patterns showed better correlation with the disease progression.
authors.affiliation: Department of Plastic Reconstructive and Aesthetic Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Elias
authors.initials: E
authors.lastname: Zgheib
authors.affiliation: Department of Internal Medicine Outcomes Research Unit, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Robert
authors.initials: R
authors.lastname: Habib
authors.affiliation: Department of Otolaryngology and Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon. rm17@aub.edu.lb.
authors.forename: Roger
authors.initials: R
authors.lastname: Moukarbel
authors.affiliation: Department Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon. ik08@aub.edu.lb.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Khalifeh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D004641:Emigration and Immigration; D005260:Female; D006801:Humans; D007223:Infant; D007861:Lebanon / Q000453:epidemiology; D016774:Leishmaniasis, Diffuse Cutaneous / Q000453:epidemiology* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D013593:Syria / Q000453:epidemiology
keywords: Parasitic Index; Ridley's Pattern; classification; clinical score; cutaneous leishmaniasis