Emerging Cutaneous Leishmaniasis Caused by Leishmania major in a Non-Endemic Area of Iran: A Case Report

Abstract

Background: Leishmaniasis is a neglected tropical disease transmitted by vectors, ranking among the top 10 infectious diseases globally in terms of morbidity and mortality. The cutaneous form (CL) is the most common and is endemic in 19 of Iran's 31 provinces. In non-endemic regions, however, both physician familiarity and patient encounters with the disease are rare.
Methods: This study reports a case of CL in a nine-year-old boy from Sardasht County, West Azerbaijan Province, a non-endemic area for ​​CL in Iran and with no history of travel to endemic areas. The patient presented with purulent wounds on his hands and feet that did not respond to broad-spectrum antibiotics. Diagnosis was confirmed by identify­ing the vacuolated amastigote forms of Leishmania parasites through Giemsa staining. For species identification, DNA was extracted from the slide scraping according to the manufacturer’s instructions (Bioneer, Korea). The species of the Leishmania parasite was determined using PCR-RFLP, Fast Digest BsuR1 enzyme, ITS1 and Kinetoplast genes.
Results: The parasite was identified as Leishmania major. Treatment with Meglumine antimoniate and cryotherapy, in accordance with the Iranian CL surveillance guideline, led to full recovery after 2 months, with no relapse at 9 months post-treatment. Extensive local screening found no additional cases, indicating a likely sporadic infection.
Conclusion: This case highlights the need for rapid and accurate diagnosis, effective treatment, and ongoing surveil­lance to prevent the emergence of leishmaniasis in non-endemic regions. More attention must be paid to this disease by the healthcare system and physicians, even in non-endemic areas.