Identification of etiologic agents of cutaneous Leishmaniasis in palpebral position followed by effective therapy

CONTEXT: Cutaneous Leishmaniasis (CL) is a self-healing lesion but prevention of complications and involvement of vital organs such as palpebra requires proper treatment. AIMS: The main objectives were to detect agents of CL in palpebral region and estimate the proportion of palpebral lesion also possible complications among CL patients in a zoonotic CL endemic area. SETTINGS AND DESIGN: The study was performed from April 2012 to March 2013 in a total of 1613 CL suspected patients by interview and physically exam. SUBJECTS AND METHODS: The samples were used for direct smear using Giemsa stain method, or cultured in Novy-McNeal-Nicol medium. For further checked, nested polymerase chain reaction (PCR) was used for negative palpebral samples. Of the 1613 examined samples, 848 (81.4%) by direct smear, 188 (18%) by culture and 6 (0.6%) by nested PCR were positive, respectively. A total of 233 of the patients showed lesions on the face of whom 15 (male = 5, female = 10, 1.43% of all and 6.43% of facial lesions) presented with palpebral CL. The results of nested PCR indicated that all the palpebral cases were due to Leishmania major. CONCLUSIONS: About 93% of the patients with palpebral lesion were under 5 years old and were infected in the hyper endemic regions, but no ocular complication was seen in any of them. Based on the results, it seems that early referring to the medical center for proper diagnosis and treatment is the main reason for prevention of further complications.