Yıldız Zeyrek Fadile, Töz Seray, Uluca Nermin, Doni Nebiye, Toprak Şahin, Özbel Yusuf
Harran University Faculty of Medicine, Department of Medical Microbiology, Şanlıurfa,Turkey.
Ege University Faculty of Medicine, Department of Parasitology, İzmir, Turkey.
Mikrobiyol Bul. 2020 Oct;54(4):647-656. doi: 10.5578/mb.69909.
Leishmaniases are a group of vector-borne diseases, and two clinical forms, visceral (VL) and cutaneous leishmaniasis (CL, Oriental sore), are seen in Turkey. While VL cases are recorded as 20-25 per year, CL cases are reported around 2000 per year, and nearly half of CL cases were recorded in Şanlıurfa province. Therefore, by knowing the epidemiology of the disease in Şanlıurfa province, it is possible to develop control measures and reduce the total number of cases across the country. Although Leishmania tropica is known as the main causative agent in Şanlıurfa, other Leishmania species have also been identified as a result of mass human movements in the last 10 years. In this study, we aimed to present the first CL cases caused by Leishmania infantum in Şanlıurfa. A total of 14 cases, which were admitted with the suspicion of CL and diagnosed as positive by direct microscopy and/or real-time ITS1-PCR using lesion aspiration samples are included in the study. Two or more smears were prepared from the samples taken from the lesions of the patients by fine needle aspiration. One of the smears was stained with Giemsa stain after fixation with methyl alcohol and examined under the light microscope at x1000 magnification for the presence of Leishmania amastigotes. DNA isolation was made from the other unstained preparations with a commercial kit (Qiagen DNeasy, Germany) according to the recommendations of the manufacturer. The real-time ITS1-PCR method was performed by using the Old World species-specific primers and probes. As a result, by the identification of the species with real-time ITS1-PCR, it was determined that the causative agent was L.infantum in five cases, L.major in one case and L.tropica in eight cases. It was learned that four of the cases in which L.infantum was detected as the causative agent were local, one was Syrian and they lived in the city center. Also two of the eight cases, which were identified as L.tropica, were Syrian and six of them were domestic cases and all of them lived in the city center. While all 14 patients included in the study were positive with real-time ITS1-PCR, amastigotes were detected in 10 cases only. The cases of CL presented in this study are the first cases caused by L.infantum reported from Şanlıurfa, and are important in terms of concretely demonstrating the effect of mass human mobility and migration on the epidemiology of the infection.
利什曼病是一组媒介传播疾病，在土耳其可见两种临床类型，即内脏利什曼病（VL）和皮肤利什曼病（CL，东方疖）。虽然每年记录的VL病例为20 - 25例，但CL病例每年报告约2000例，其中近一半的CL病例记录在尚勒乌尔法省。因此，通过了解尚勒乌尔法省该疾病的流行病学情况，有可能制定控制措施并减少全国的病例总数。虽然热带利什曼原虫被认为是尚勒乌尔法的主要病原体，但在过去10年中，由于大规模人口流动，其他利什曼原虫物种也已被鉴定出来。在本研究中，我们旨在呈现尚勒乌尔法首例由婴儿利什曼原虫引起的CL病例。本研究纳入了总共14例因疑似CL入院、通过病变抽吸样本的直接显微镜检查和/或实时ITS1-PCR诊断为阳性的病例。通过细针穿刺从患者病变部位采集的样本制备两张或更多涂片。其中一张涂片用甲醇固定后用吉姆萨染色，在光学显微镜下以1000倍放大观察是否存在利什曼无鞭毛体。根据制造商的建议，使用商业试剂盒（德国Qiagen DNeasy）从另一张未染色的涂片制备物中提取DNA。使用旧世界物种特异性引物和探针进行实时ITS1-PCR方法。结果，通过实时ITS1-PCR鉴定物种，确定病原体在5例中为婴儿利什曼原虫，1例为硕大利什曼原虫，8例为热带利什曼原虫。据悉，在检测到病原体为婴儿利什曼原虫的病例中，有4例是当地病例，1例是叙利亚人，他们居住在市中心。在被鉴定为热带利什曼原虫的8例病例中，也有2例是叙利亚人，6例是国内病例，他们都居住在市中心。虽然本研究纳入的所有14例患者实时ITS1-PCR均为阳性，但仅在10例中检测到无鞭毛体。本研究中呈现的CL病例是尚勒乌尔法报告的首例由婴儿利什曼原虫引起的病例，对于具体证明大规模人口流动和迁移对感染流行病学的影响具有重要意义。
