title: Clinical Presentation of Cutaneous Leishmaniasis caused by Leishmania major.
abstract: OBJECTIVE
  The diagnosis of cutaneous leishmaniasis (CL) is based on the microscopic detection of amastigote, isolation of the parasite, or the detection of Leishmania DNA. Nevertheless, since these techniques are time consuming and not usually available in many endemic countries, the diagnosis remains clinical. Consequently, such disease may be overlooked because of its similarity to other skin diseases. The aim of this study is to describe the clinical polymorphism of CL caused by Leishmaniamajor.
  
  
  METHODS
  A cross-sectional survey was carried out on 166 patients. Diagnoses were made by both microscopic examination of stained tissue-scraping smears and PCR. The Leishmania species was identified by restriction enzyme analysis of the ribosomal internal transcribed spacer 1 region. The clinical polymorphism was analyzed only for patients with a positive diagnosis for CL and L. major as the identified species.
  
  
  CONCLUSIONS
  Of the 166 patients, 75 patients fit the inclusion criteria. Twelve different types of CL caused by L. major were defined. The most common type was the ulcero-crusted form followed by the papulonodular form and the impetigenous form. The ulcerated, mucocutaneous, lupoid, and sporotricoid forms were less common. The eczematiform, erysipeloid, verrucous, psoriasiform, and pseudotumoral types were represented by a single case. Zoonotic CL caused by L. major can simulate many other skin diseases, which may lead to a significant spread of this disease and increases in morbidity and drug resistance. This large polymorphism may be the result of a complex association between the genetics of the parasite and the immune response of the host.
authors.affiliation: Laboratory of Medical and Molecular Parasitology-Mycology (code LR12ES08), Department of Clinical Biology B, Faculty of Pharmacy, University of Monastir, Monastir, Tunisia.
authors.forename: Latifa
authors.initials: L
authors.lastname: Remadi
authors.forename: Najoua
authors.initials: N
authors.lastname: Haouas
authors.forename: Dhekra
authors.initials: D
authors.lastname: Chaara
authors.forename: Darine
authors.initials: D
authors.lastname: Slama
authors.forename: Najla
authors.initials: N
authors.lastname: Chargui
authors.forename: Radhia
authors.initials: R
authors.lastname: Dabghi
authors.forename: Henda
authors.initials: H
authors.lastname: Jbeniani
authors.forename: Habib
authors.initials: H
authors.lastname: Mezhoud
authors.forename: Hamouda
authors.initials: H
authors.lastname: Babba
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D018320:Leishmania major / Q000302:isolation & purification*; D016773:Leishmaniasis, Cutaneous / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D055815:Young Adult
keywords: Clinical polymorphism; Cutaneous leishmaniasis; Leishmania major