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RESEARCH ARTICLE
Year : 2019  |  Volume : 56  |  Issue : 2  |  Page : 159-165

A retrospective study on demographic and clinical characteristics of cutaneous leishmaniasis suspected cases in southern Israel, 2013-2016: Comparison between confirmed and negative cases


1 Pediatric Infectious Disease Unit; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
2 Faculty of Health Sciences, Ben-Gurion University of the Negev; Parasitology Laboratory, Soroka University Medical Center, Beer-Sheva, Israel
3 Faculty of Health Sciences, Ben-Gurion University of the Negev; Virology Laboratory, Soroka University Medical Center, Beer-Sheva, Israel

Correspondence Address:
Shalom Ben-Shimol
Pediatric Infectious Disease Unit, Virology Laboratory, Soroka University Medical Center, P.O. Box 151, Beer-Sheva–84101
Israel
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-9062.263723

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Background & objectives: Clinical diagnosis of cutaneous leishmaniasis (CL) may bear a high rate of false diagnosis. This study assessed CL-suspected episodes, in an attempt to differentiate confirmed CL and non-CL diagnoses. Methods: In this retrospective, case-control study, medical files of CL-suspected episodes, tested by a biopsy for Leishmania-PCR, from 2013 to 2016, were collected and analysed statistically. Results: Of 324 suspected CL episodes, 48.8% were PCR-confirmed CL (96.2% Leishmania major) and 51.2% were non-CL (57.1% bacterial infections). Overall, 59.3% episodes were in males. Mean (± SD) duration until diagnosis was 3.7 ± 7.2 months. Lesions (mean 2.9 ± 3.8 per episode) were mostly (60.8%) sampled from September through February. Ulcer, pain, itching, purulent discharge and fever were recorded in 55.2, 47, 42.9, 18.2 and 4.7% of episodes, respectively. Univariate analysis showed that male gender, multiple lesions, ulcer, >1-month duration until diagnosis, and seasonality were associated with CL. Empiric CL treatment was recorded in 63.4 and 16% of CL-confirmed and non-CL episodes, respectively (p <0.001); and was observed to be associated with Jewish ethnicity, seasonality, multiple lesions, ulcer, absence of fever and duration of >1-month until diagnosis. In multivariate analysis, seasonality (odds ratio, OR = 2.144), empiric CL treatment (OR = 5.144) and ulcer (OR = 2.459) were associated with CL. Empiric CL treatment was associated with Jewish ethnicity (OR = 2.446) and duration of >1-month until diagnosis (OR = 3.304). Interpretation & conclusion: CL diagnosis should be laboratory confirmed, as clinical appearance is often misleading. Seasonality, ulcer appearance and gender may aid in correct identification and treatment of CL cases.


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