Many faces of cutaneous leishmaniasis.

BACKGROUND: Our objective in this study is to determine the atypical clinical presentations of cutaneous leishmaniasis (CL) patients diagnosed in Sanliurfa province. METHODS: This retrospective study included 213 patients with atypical clinical presentations among 1751 patients diagnosed with CL between October 2019 and August 2022 in Sanliurfa Oriental Boil Diagnosis and Treatment Center located in an endemic region for CL. RESULTS: We found the prevalence of atypical CL to be 12.1%. The most common atypical lesions were lupoid 21 (9.8%), erysipeloid 16 (7.5%), impetiginous 16 (7.5%), recidivan 15 (7%), eczematous 15 (7%), ecthyma-like 13 (6.1%), pyoderma gangrenous-like 12 (5.6%), and sporotrichoid 12 (5.6%). Other lesions with atypical clinical presentations: chalazion-like, verrucous, dental sinus-like, psoriasiform, zosteriform, lymphoma-like, juvenile xanthogranuloma-like, volcano-like, paronychial, basal cell carcinoma-like, squamous cell carcinoma-like, herpes labialis-like, keratoacanthoma-like, chancriform, annular, lichenoid, mastocitoma-like, keloidal, epidermoid cyst-like, kaposi sarcoma-like, scar leishmaniasis, granulomatous cheilitis-like, mycetoma-like, molluscum contagiosum-like, discoid lupus erythematosus-like, and dermatofibroma-like. CONCLUSIONS: In addition to the atypical clinical presentations previously reported, we also defined dermatofibroma-like, Kaposi sarcoma-like, dental sinus-like, juvenile xanthogranuloma-like, mastocytoma-like, and epidermoid cyst-like. It should be kept in mind that CL can clinically mimic many infectious, inflammatory, and neoplastic diseases, which should be considered in the differential diagnosis of long-term non-healing lesions, especially in endemic areas. Key message What is already known on this subject:  CL is known as the great imitator disease in dermatology. What this study adds:  In addition to the atypical clinical presentations previously reported, we also defined dermatofibroma-like, Kaposi sarcoma-like, dental sinus-like, juvenile xanthogranuloma-like, mastocytoma-like, and epidermoid cyst-like. How this study might affect research, practice, or policy:  CL can clinically mimic many infectious, inflammatory and neoplastic diseases, which should be considered in the differential diagnosis of long-term non-healing lesions, especially in endemic areas.

Geriatric cutaneous leishmaniasis: a retrospective analysis of 622 cases.

BACKGROUND: Cutaneous leishmaniasis (CL) is most common in childhood because children are exposed to the parasite early and, unlike adults, do not have immunity to CL. Since CL is less common in geriatric patients, clinical and epidemiological data in this age group are limited. This study aims to compare the clinical and demographic characteristics of geriatric patients diagnosed with CL with young patients. METHODS: In this retrospective study, 622 patients aged 65 and over and 6350 patients aged 19-64, who applied to Sanliurfa Oriental Boil Diagnosis and Treatment Center between January 2013 and February 2024 and were diagnosed with CL by parasitological examination, were included. Clinical and demographic characteristics of patients diagnosed with CL, such as age, gender, location of the lesion, lesion size, duration of the lesion, and treatments applied due to the diagnosis of CL, were recorded. Clinical and demographic characteristics of geriatric and young patients were compared. RESULTS: The mean age of elderly CL cases was 72.95 ± 6.54 years, and 65.2% were female. The most common clinical forms were ulcers (51.9%) and plaques (41%), respectively, in young and elderly patients. The most common locations of the lesions were upper limbs (54.8%) in all patients. The most preferred treatment method was intralesional (IL) meglumine antimoniate (MA) treatment (98.3%) in all patients. There were no difference between young and elderly CL cases in terms of mean number of lesions, average lesion duration, average lesion size, lesion location, clinical forms of lesions, and treatments options (P > 0.05). CONCLUSIONS: Based on the results of our study, it can be said that the clinical and demographic characteristics of CL are similar in young and old patients and systemic MA treatment shows similar clinical benefit in both age groups. In addition, it can be said that systemic MA therapy can be used safely in young patients and elderly patients without contraindications. IL MA therapy can be used in elderly patients where systemic MA therapy is contraindicated.

MicroRNA-21 Deficiency Promotes the Early Th1 Immune Response and Resistance toward Visceral Leishmaniasis.

MicroRNA-21 (miR-21) inhibits IL-12 expression and impairs the Th1 response necessary for control of Leishmania infection. Recent studies have shown that Leishmania infection induces miR-21 expression in dendritic cells and macrophages, and inhibition of miR-21 restores IL-12 expression. Because miR-21 is known to be expressed due to inflammatory stimuli in a wide range of hematopoietic cells, we investigated the role of miR-21 in regulating immune responses during visceral leishmaniasis (VL) caused by Leishmania donovani infection. We found that miR-21 expression was significantly elevated in dendritic cells, macrophages, inflammatory monocytes, polymorphonuclear neutrophils, and in the spleen and liver tissues after L. donovani infection, concomitant with an increased expression of disease exacerbating IL-6 and STAT3. Bone marrow dendritic cells from miR-21 knockout (miR-21KO) mice showed increased IL-12 production and decreased production of IL-10. On L. donovani infection, miR-21KO mice exhibited significantly greater numbers of IFN-γ- and TNF-α-producing CD4+ and CD8+ T cells in their organs that was associated with increased production of Th1-associated IFN-γ, TNF-α, and NO from the splenocytes. Finally, miR-21KO mice displayed significantly more developing and mature hepatic granulomas leading to reduction in organ parasitic loads compared with wild type counterparts. Similar results were noted in L. donovani-infected wild type mice after transient miR-21 depletion. These observations indicate that miR-21 plays a critical role in pathogenesis of VL by suppressing IL-12- and Th1-associated IFN-γ and also inducing disease-promoting induction of the IL-6 and STAT-3 signaling pathway. miR-21 could therefore be used as a potential target for developing host-directed treatment for VL.

Evaluation of inflammatory parameters in patients with cutaneous leishmaniasis.

Cutaneous leishmaniasis (CL) is a vector-borne parasitic disease characterized by various skin lesions that can cause deformities when healed. Our aim in this study is to show the utility of parameters such as neutrophil/lymphocyte ratio (NLR), thrombocyte/lymphocyte ratio (TLR), and mean thrombocyte volume (MTV) as auxiliary laboratory methods in CL patients. About 107 patients who were admitted to our dermatological and venereal diseases outpatient clinic between January 2018 and January 2019 and were diagnosed with CL by microscopic examination and 74 healthy individuals were included in the study. There were no significant differences between the patient and control group in terms of neutrophil counts, leukocyte counts, platelet counts, and NLR values (P values: .271, .053, .263, and .459, respectively). When the TLR and MTV values of patients with CL and those of the healthy controls were compared, it was found that TLR and MTV values were statistically higher in patients with CL (P values of .010 and .044, respectively). Based on these data, NLR was not considered to be a suitable parameter for demonstrating inflammation in CL patients, but TLR and MTV were held to be an appropriate parameter for demonstrating inflammation in CL patients. In addition, we think that the increase in MTV and TLR, can be used as an auxiliary laboratory test in the diagnosis of CL disease.

Clinical spectrum of nasal involvement in cutaneous leishmaniasis.

BACKGROUND: The clinical appearance of cutaneous leishmaniasis (CL) lesions located in the nasal area can be confused with many inflammatory or tumoral diseases. In this study, we aimed to determine the frequency of nasal involvement and the morphological variants of CL lesions located in the nasal region. METHODS: In this retrospective study, we included patients who presented to our Skin and Venereal Diseases Clinic in the province of Sanliurfa, located in the Southeastern Anatolia region of Turkey between September 2022 and October 2023, and were diagnosed with CL with nasal involvement. From the records of CL patients with nasal involvement in our clinic, we evaluated the clinical (lesion location, lesion type, lesion diameter, lesion duration, treatment) and demographic characteristics (age, gender). RESULTS: Of the patients (n = 278) diagnosed with CL using microscopic examination, 34 had nasal involvement, and the nasal involvement rate was 12.2%. Nineteen (55.8%) of the patients with nasal involvement were male, and 15 (44.2%) were female. Acute CL was detected in 28 patients (16 patients with dry-type lesions, 12 patients with wet-type lesions), and chronic CL was detected in six patients (four patients with lupoid and two patients with recidivant type lesions). According to the frequency distribution of clinical appearance, the most common lesions were eczema-like lesions, erysipeloid-type lesions, rhinophyma-like lesions, and lymphoma-like lesions. CONCLUSION: Physicians working in CL-endemic regions should strictly consider CL in the differential diagnosis of nasal lesions. Early diagnosis and treatment of CL might prevent possible scarring and mucosal spread.

An operational study on implementation of mobile primary healthcare services for seasonal migratory farmworkers, Turkey.

Maternal and child health is affected by exposure to unhealthy living and working conditions, by increased exposure to health hazards, and by poor utilization of primary healthcare services. The objective of this operational study was to implement mobile primary healthcare services (MPHS) for migratory seasonal farmworkers. This study, conducted in Sanliurfa, Turkey, between March 2008 and April 2009, examined multiple stages of MPHS implementation in both a permanent settlement (336 children aged 5 and under; 580 women of reproductive age) and a working settlement (85 living units; 217 children and 257 women). The stages included: (1) identifying the problem, (2) identifying a potential solution and a quasi-experimental study to evaluate the effect of intervention, (3) utilizing and disseminating results to stakeholders, and (4) implementing sustainable MPHS county-wide. Rates of selected outcome measures, including full childhood and tetanus vaccination, phenylketonuria screening, and safer usage of pesticides, iodine salt, and sanitary toilet facilities, increased significantly following the intervention in both the permanent and temporary settlements (P < 0.05). The majority of cases of anemia (children: 16.6%, women: 17.8%) and parasitic infections (55.4%) were treated. The study results indicate that MPHS are necessary to ensure healthcare access for migratory farmworkers and to establish a stronger public health infrastructure for this risk group.

Molecular identification of Leishmania spp. isolates causes cutaneous leishmaniasis (CL) in Sanliurfa Province, Turkey, where CL is highly endemic.

Cutaneous leishmaniasis (CL) is an important public health problem in Turkey. CL has been most frequently seen in Sanliurfa. There is an expectation of increase in the population of leishmaniasis cases with the influence of Syrian refugees arriving in Turkey. In this study we aimed to diagnosis of CL and identifying of parasite from Leishmania isolates by using ITS 1 PCR RFLP. Samples were collected from 135 CL patients in Sanliurfa. After the specimens were inoculated in medium NNN, the ones which were cultures positive were cultivated in RPMI 1640 followed by PCR-RFLP. Genomic DNA was extracted phenol-chloroform procedure. Samples were examined by using ITS 1 PCR followed by RFLP analysis. Our results indicated that two species, L. tropica (132 samples) and L. major (3 samples), are responsible for cutaneous leishmaniasis in Sanliurfa. Our study is the first scientific study in which it is reported molecular analyses of cutaneous leishmaniasis cases caused by L. major in Sanliurfa in Southestern Anatolia Region. Because CL cases caused by L.major are detected in our study, it is considered that genotyping is important for diagnosis of Leishmania and following change of epidemiology.

[Comparison of direct microcopy and antigen casette tests for the detection of Giardia and Cryptosporidium]. / Giardia ve Cryptosporidium Tanisinda Direkt Mikroskobi ve Antijen Tarama Testlerinin Karsilastirilmasi

OBJECTIVE: The aim of this study was to compare the direct microscopy used for detection of intestinal parasites with antigen casette tests used in diagnosis of giardiasis and crypyosporidiasis. METHODS: Forty-six children who lived in the Sanliurfa Orphanage were enrolled in this study. The stool specimens were taken in the morning and examined by using native-lugol, modified formalin-ethylacetate concentration methods and cellophane tape method on the same day at the Microbiology laboratory of Harran University. Also Kinyoun-acid fast stained preparations were used for the detection of Cryptosporidium. R-biopharm Cryptosporidium/Giardia casette antigen test was used for the determinaton of giardiasis and crytosporidiasis. RESULTS: The mean age of the children enrolled in this study was 8.61±3.45 and the distribution of gender was 24 female (52.2%), 22 male (47.8%), respectively. According to stool examinations, 9 of 46 examples (19.60%) were determined as Giardia intestinalis, Cryptosporidium spp. had never been found. The result of the antigen screening casette test showed 9 of 46 samples (19.60%) were positive for G. intestinalis. Also Cryptosporidium spp. had never been found by the antigen casette test. CONCLUSION: When we compared the results of the direct microscopy and antigen casette tests, we found no significant difference between them for test reliability (p > 0.05). Antigen tests have higher sensitivity (100%) and specifity (100%) than the modified acid-fast staining technique, therefore, it is a preferred reference method . However, an experienced staff working accurately might access the same conclusion. Considering the cost of antigen tests, direct microscopic examination is cheaper, andeasier when it used by an experienced person.