Survey of Cutaneous Leishmaniasis in Mexico: Leishmania Species, Clinical Expressions and Risk Factors

Abstract

Leishmaniasis is caused by Leishmania sp., which is transmitted to human beings and reservoirs by phlebotomine sand flies, with worldwide prevalence of approximately 12 million cases with population at risk of approximately 350 million. Cutaneous leishman-iasis (CL) is the most widespread form, causing localized skin lesions (LCL), mucocuta-neous leishmaniasis (MCL), or nodular lesions in diffused cutaneous leishmaniasis (DCL). American CL includes LCL and DCL caused by Leishmania mexicana complex and MCL caused by the Leishmania braziliensis complex. In Mexico, CL is distributed in three endemic areas, Gulf of Mexico, Pacific of Mexico, and Central Mexico. In order to monitor clinical outcome and adequately target treatment as well as epidemiologic stud-ies, diagnostic kinetoplast DNA (kDNA), polymerase chain reaction (PCR), Southern and dot blotting, and ITS1 PCR-RFLP of Leishmania DNA were evaluated in samples and Leishmania isolates from patients with cutaneous ulcers from several endemic areas. In Mexico, LCL can be caused by the L. mexicana, L. braziliensis, or both complexes. DCL is caused by L. (L.) mexicana or Leishmania (L.) amazonensis and visceral leishmaniasis (VL) by Leishmania (L.) chagasi and L. (L.) mexicana in immunocompromised patients. The geographic range in which CL is endemic has increased due to urbanization, new settle-ments, and ecological, social, and educative conditions, which favors its permanence and transmission.