Epidemiological and clinical criteria for the diagnosis of cutaneous leishmaniasis in Tunisia

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Published Jun 1, 2025
https://doi.org/10.62438/tunismed.v103i6.5724
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Vol. 103 No. 6 (2025): Tunis Med June 2025

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Karim Aoun
Parasite Epidemiology and Ecology Laboratory, Institut Pasteur de Tunis, Tunis, Research Laboratory 16-IPT-06 ‘Medical Parasitology, Biotechnology and Biomolecules’, Institut Pasteur de Tunis, Tunis El Manar University, Tunis, Tunisia
Fida Maatallah
Parasite Epidemiology and Ecology Laboratory, Institut Pasteur de Tunis, Tunis, Research Laboratory 16-IPT-06 ‘Medical Parasitology, Biotechnology and Biomolecules’, Institut Pasteur de Tunis, Tunis El Manar University, Tunis, Tunisia
Wafa Aissi
National Center for the Promotion of Organ Transplantation, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
Olfa Souissi
Parasitology-Mycology Laboratory, Pasteur Institute, Tunis, Tunisia
Nada Boulehmi
Parasitology-Mycology Laboratory, Pasteur Institute, Tunis, Tunisia
Emna Siala
Research Laboratory 16-IPT-06 ‘Medical Parasitology, Biotechnology and Biomolecules’, Parasitology-Mycology Laboratory, Pasteur Institute, University of Tunis El Manar, Tunis, Tunisia
Rym Ben Abdallah
Research Laboratory 16-IPT-06 ‘Medical Parasitology, Biotechnology and Biomolecules’, Parasitology-Mycology Laboratory, Pasteur Institute, University of Tunis El Manar, Tunis, Tunisia
Aïda Bouratbine
Research Laboratory 16-IPT-06 ‘Medical Parasitology, Biotechnology and Biomolecules’, Parasitology-Mycology Laboratory, Pasteur Institute, University of Tunis El Manar, Tunis, Tunisia

Abstract

Introduction: Biological confirmation of cutaneous leishmaniosis (CL) and identification of species involved are not always available. Zoonotic CL (ZCL) in the center-south and sporadic CL (SCL) in the north are the main forms of the disease in Tunisia. They have recently spread and are now coexisting in several regions.


Aim: To establish simple epidemiological and clinical criteria to improve CL diagnosis and to assess the CL form.


Methods: Dermal smears of 227 patients suspected of CL were examined by microscopy and then scrapped, the DNAs were extracted and tested by PCR. Epidemiological and clinical data were anonymously collected.


Results: The diagnosis of CL was confirmed by at least one biological test in 76 patients infected in the center-south (ZCL) and 24 patients infected in the north (SCL). CL cases consulted mainly between october and january (66.3% versus 46%; p=0.003). Their lesions were more multiple (48.5% versus 32.5%; p=0.002).


Compared to SCL cases, a higher proportion of ZCL cases consulted between october and january (73.7% versus 45.8%; p<0.01). Their number of lesions was higher (3.3±0.4 versus 1.2±0.1; p<0.0001), with a preferential limb location (80.3% versus 25%; p<0.001). Lesions of SCL cases were older (6±1.2 versus 2.2±0.2 months; p<0.001) with less ulcerative-crusted presentation (41.6% versus 77.6%; p=0.009).


Conclusion: Some easy to collect epidemiological and clinical data would be suggestive of the diagnosis and the form of CL. Collecting these data could improve surveillance of the disease and case management especially in rural areas with few diagnostic facilities.

Keywords:

Cutaneous leishmaniasis, Epidemiological data, Clinical symptoms, Diagnosis, Tunisia

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