Determination of leishmania species and their clinical manifestations in the southeastern anatolia

Objective: Cutaneous leishmaniasis (CL) is endemic both in the southeastern provinces and Cukurova regions in Turkey and in the neighboring Middle Eastern countries. Together with the cases due to Syrian refugees, it has become a growing public health problem in Turkey. In this study, it was aimed to define the Leishmania spp. that cause cutaneous leishmaniasis in the southeastern Anatolia Region, and determine their epidemiological and clinical features. Materials and Methods: A total of 100 CL patients who were admitted to Dicle University Hospital Dermatology outpatient clinic, and diagnosed by microscopic examination between October 2019-January 2022 were enrolled in the study. Demographic data (age, sex etc.) address, travel history, type, number and location of lesions were obtained from each patient using a standardized questionnaire. The material taken from the lesions of the patients by dermal scraping was inoculated into modified NNN medium. DNA isolation was done using the promastigotes obtained from the medium. Real-time PCR testing was performed using primers and probes specific to the Leishmania ITS1 region to identify the Leishmania species. Results: According to the results of the study, Leishmania tropica was detected in 72 cases, L. major in 17 cases, L. infantum in 7 cases, L. donovani in 3 cases, and L. aethiopica in one case. Eghty-three of the cases were autochthonous and 17 were imported. Among the imported cases, L. tropica was identified in 8, L. major in 8, and L. aethiopica in one. Ninety-five of the cases had acute, while 5 cases had chronic infection. Among the patients infected with L. tropica, the most common lesions were papulonodule, ulcerative, and plaque (respectively 95, 38, 22) whereas in the L. major group, the most common lesions were ulcerative and papulonodular lesions (respectively 35, 13). Of the cases, 62 (62%) had only facial localization, 24 (24%) only extremity localization, and 14 (14%) had both face and extremity localization. Only extremity localization was more common in the L. major group compared to the L. tropica group (47%, and 18%, respectively). While all lesions were inflamed in the L. major group, only 21.9% of the lesions were inflamed in the L. tropica group. Conclusion: It is concluded that international commercial transportation to Central Asian and Middle Eastern countries and refugee influx from Syria affect Leishmania species and CL epidemiology in the Southeastern Anatolia region of Turkey. When the clinical features were evaluated according to the species, although a statistically significant difference was found in the L. major group, no specific clinical symptoms specific to the species were determined. Keywords: Leishmaniasis, species, clinic, manifestations