Al-Alousy Noor Waleed, Al-Nasiri Fatima Shihab
Department of Biology, College of Science, University of Tikrit, Iraq.
Department of Biology, College of Science, University of Tikrit, Iraq.
Microb Pathog. 2025 Jan;198:107144. doi: 10.1016/j.micpath.2024.107144. Epub 2024 Nov 22.
Bacterial co-infection with cutaneous leishmaniasis (CL) can effect on the clinical appearance of lesions and delay the healing process. The pattern of bacterial pathogens involved has rarely been investigated in Iraq. The aim of present study was to identify the bacterial agents contaminating CL and their susceptibility to commonly used antibiotics. Four hundred cases of CL were diagnosed in Salah El-Din General Hospital, Iraq. A total of 424 ulcer samples obtained from 400 patients of CL were cultured, and all isolates were diagnosed based on phenotypic characteristics of colonies, bacterial cells and using biochemical tests. No bacterial growth appeared in 124 cases (29.25 %) of the total number of examined ulcer samples, whereas 300 cases (70.75 %) were contaminated. Both Gram-positive (Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pyogenes) and Gram-negative bacterial species (Escherichi coli, Klebsiella spp., Pseudomonas aeruginosa) were present. The infection with S. aureus represented the highest percentage (26.42 %), while Ps. aeruginosa had the lowest percentage (2.83 %) compared with other bacterial infections. The sensitivity of the isolated bacteria associated with CL was tested against a number of antibiotics (Amoxicillin, Ampicillin, Cefixime, Chloramphenlcol, Doxycycline, Tetracycline). Resistance to Amoxicillin, Ampicillin, and Cefixime was generally high. While, Chloramphenicol showed absolute effectiveness against isolated bacteria. The results of the current study show that bacterial infections should be considered in diagnosing and treating CL lesions, with Chloramphenicol demonstrating the highest efficiency in treating such bacterial infections. The present study also suggests that hygiene, use of suitable disinfectants, controlling of antibiotic administration and prescription in hospitals and pharmacies must be ensured. In addition, regular surveillance in the endemic area will help control bacterial co-infection and hamper the occurrence of drug-resistant pathogens. The lesion care and management of secondary bacterial infection are essential and anti -leishmanial therapy in CL may be more effective when combined with antibiotics. Future molecular studies are needed to identify the species of Leishmania causing CL in Iraq to gain a better understanding of their clinical manifestations (dry or moist ulcers) and their associated bacteria.
皮肤利什曼病（CL）合并细菌感染会影响病变的临床表现并延缓愈合过程。伊拉克很少对所涉及的细菌病原体模式进行研究。本研究的目的是鉴定污染CL的细菌病原体及其对常用抗生素的敏感性。在伊拉克萨拉赫丁总医院诊断出400例CL病例。从400例CL患者中获取了424份溃疡样本进行培养，所有分离株均根据菌落、细菌细胞的表型特征并使用生化试验进行诊断。在所检查的溃疡样本总数中，124例（29.25%）未出现细菌生长，而300例（70.75%）被污染。革兰氏阳性菌（金黄色葡萄球菌、表皮葡萄球菌、化脓性链球菌）和革兰氏阴性菌（大肠杆菌、克雷伯菌属、铜绿假单胞菌）均有存在。与其他细菌感染相比，金黄色葡萄球菌感染的比例最高（26.42%），而铜绿假单胞菌的比例最低（2.83%）。对与CL相关的分离细菌针对多种抗生素（阿莫西林、氨苄西林、头孢克肟、氯霉素、多西环素、四环素）进行了敏感性测试。对阿莫西林、氨苄西林和头孢克肟的耐药性普遍较高。而氯霉素对分离细菌显示出绝对有效性。当前研究结果表明，在CL病变的诊断和治疗中应考虑细菌感染，氯霉素在治疗此类细菌感染方面显示出最高效率。本研究还表明，必须确保卫生、使用合适的消毒剂、控制医院和药店的抗生素给药及处方。此外，在流行地区进行定期监测将有助于控制细菌合并感染并阻碍耐药病原体的出现。CL病变的护理和继发性细菌感染的管理至关重要，CL中的抗利什曼病治疗与抗生素联合使用时可能更有效。未来需要进行分子研究以鉴定在伊拉克引起CL的利什曼原虫种类，以便更好地了解其临床表现（干性或湿性溃疡）及其相关细菌。
