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Original Article

An Epidemiological Study of Cutaneous Leishmaniasis in Al-Jabal Al-Gharbi, Libya

Manal Z. M. Abdellatif1,2, Khamis El-Mabrouk3, Ashraf A. Ewis4
The Korean Journal of Parasitology 2013;51(1):75-84.
Published online: February 18, 2013

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Corresponding author (ashraf_ewis@yahoo.com)
• Received: May 16, 2012   • Revised: August 17, 2012   • Accepted: September 7, 2012

© 2013, Korean Society for Parasitology and Tropical Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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An Epidemiological Study of Cutaneous Leishmaniasis in Al-Jabal Al-Gharbi, Libya
Korean J Parasitol. 2013;51(1):75-84.   Published online February 18, 2013
DOI: https://doi.org/10.3347/kjp.2013.51.1.75
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An Epidemiological Study of Cutaneous Leishmaniasis in Al-Jabal Al-Gharbi, Libya
Korean J Parasitol. 2013;51(1):75-84.   Published online February 18, 2013
DOI: https://doi.org/10.3347/kjp.2013.51.1.75
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An Epidemiological Study of Cutaneous Leishmaniasis in Al-Jabal Al-Gharbi, Libya
Image Image Image Image Image Image
Fig. 1 Libyan map showing the location of Aljabal Algharbi province and some of its subprovinces (inside the red circle).
Fig. 2 (A) Giemsa-stained skin smear showing amastigote forms (arrow) of Leishmania species inside a macrophage (×1,000), (B, C) Giemsa-stained skin smears showing scattered ovoid or round amastigotes (arrows) measuring 1.5-3.0 µm in diameter with a thin cell membrane, a relatively large nucleus, and a rod-shaped kinetoplast (×1,000). (D) A single nodulo-ulcerated cutaneous leishmaniasis lesion on the back of an adult patient.
Fig. 3 Different forms of cutaneous leishmaniasis lesions among children cases. (A) Typical single nodulo-ulcerated lesion on the cheek of a child with raised indurated border and central depression. (B) Two nodulo-ulcerated lesions on the forehead and cheek of a child. (C) Multiple lesions on the arm and forearm with necrotic tissue and plaque formation. (D) Two large ulcerated lesions on both legs with erythema, dark dry plaques and secondary infection.
Fig. 4 Different forms of cutaneous leishmaniasis lesions among adult patients. (A) Multiple lesions on the left side of an adult's face (the upper 2 are nodulo-ulcerated while the lower one is a papulo-ulcerated lesion). (B) Two large lesions (a nodulo-ulcerated lesion on the forehead and a crater-like one on a patient's cheek). (C) A single large nodulo-ulcerated inflamed lesion on the forearm. (D) A single crusted lesion on the dorsum of the hand with erythematous dry plaques.
Fig. 5 Different forms of cutaneous leishmaniasis lesions affecting various body sites of adult patients. (A) Multiple indurated ulcerated scaly plaque lesions on the forearm of an adult. (B) Two indurated ulcerated scaly plaque lesions on the leg of an adult. (C) Satellite form, crusted nodular lesions on the posterior aspect of an ankle joint. (D) Multiple ulcerated lesions on the leg of an adult with erythematous dry plaques, inflammation and secondary infection.
Fig. 6 Age-group and gender distribution of the cutaneous leishmaniasis cases of Al-jabal Al-gharbi, Libya.

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Fig. 6

An Epidemiological Study of Cutaneous Leishmaniasis in Al-Jabal Al-Gharbi, Libya
Gender Male patients No. (%) Female patients No. (%) Total No. (%) Age group 0-10 years 24 (17.1) 17 (12.2) 41 (29.3) > 10 years 56 (40.0) 43 (30.7) 99a (70.7) Total 80b (57.1) 60b (42.9) 140 (100.0) Gender Male patients No. (%) Female patients No. (%) Total No. (%) Subprovinces Al-Kawasem 19 (23.8) 20 (33.3) 39 (27.9)a Bani Khalifa 12 (15.0) 11 (18.3) 23 (16.4) Asabaa 6 (7.5) 6 (10.0) 12 (8.6) Al orban 7 (8.8) 4 (6.7) 11 (7.9) Rabtah 11 (13.8) 7 (11.7) 18 (12.9) Taghasat 7 (8.8) 4 (6.7) 11 (7.9) El-hera 4 (5.0) 4 (6.7) 8 (5.7) Mezdah 4 (5.0) 0 (0.0) 4 (2.9) Kekla 2 (2.5) 2 (3.3) 4 (2.8) Zantan 1 (1.3) 2 (3.3) 3 (2.1) Anser 3 (3.8) 0 (0.0) 3 (2.1) Neismah 1 (1.3) 0 (0.0) 1 (0.7) Elraianah 1 (1.3) 0 (0.0) 1 (0.7) Jadu 1 (1.3) 0 (0.0) 1 (0.7) Elgwalish 1 (1.25) 0 (0.0) 1 (0.7) Total 80 (100.0) 60 (100.0) 140 (100.0) Occupation No. of adult CL patients (%) Farm workers 19 (26.0)a Students "high school and university" 18 (24.7) Housewives 17 (23.3) Artisans 5 (6.8) Teachers 4 (5.5) Businessmen 3 (4.1) Policemen 3 (4.1) Pensioners 3 (4.1) Nurses 1 (1.4) Total 73 (100.0) Educational stage No. of children cases (%) Z test P-value Preschool children 18 (26.9) 4.3 0.0001 School children 49 (73.1) Gender Male patients
Female patients
Total
Age group Single lesion Multiple lesions Single lesion Multiple lesions Single lesion Multiple lesions Children 20 19 14 14 34 33 Adults 14 28 11 19 25 48a Total 34 47 25 33 59 81 X2 1.99 0.37 3.90 P-value 0.07 0.27 0.035 Age group Children
Adults
Lesion type No. of males (%) No. of females (%) No. of males (%) No. of females (%) Nodulo-ulcerative 21 (31.3)a 20 (29.9)a 22 (30.1)a 20 (27.4)a Papulo-ulcerated 17 (25.4)b 8 (11.9)b 16 (21.9)b 9 (12.3)b Indurated ulcerated scaly plaque 1 (1.5) 0 (0.0) 3 (4.1) 3 (4.1) Total 67 (100%) 73 (100%) P-value 0.001a and 0.001b 0.0001a and 0.002b Age group Children
Adults
Lesion type No. of males (%) No. of females (%) No. of males (%) No. of females (%) Wet CL 38 (56.7)a 38 (56.7)a 38 (56.7)a 38 (56.7)a Dry CL 1 (1.5) 1 (1.5) 1 (1.5) 1 (1.5) Total 67 (100%) 73 (100%) P-value 0.0001 0.001 Site of lesion Gender No. male patients (%)
No. male patients (%)
Total (%)
Child Adult Child Adult Child Adult Upper extremities 12 (14.5) 27 (27.6) 10 (12.1) 21 (21.4) 22 (26.5) 48 (48.9) Lower extremities 11 (13.5) 23 (23.5) 9 (10.8) 16 (16.3) 20 (24.1) 39 (39.8) Face 24 (29.0) 4 (4.1) 14 (16.9) 2 (2.04) 38 (45.8) 6 (6.1) Back 2 (2.0) 2 (2.0) 1 (1.2) 0 (0.00) 3 (3.6) 2 (2.0) Neck 0 (0.0) 2 (2.0) 0 (0.0) 1 (1.02) 0 (0.0) 3 (3.1) Total 49 (59.0) 58 (59.2) 34 (41.0) 40 (40.8) 83 (100.0) 98 (100.0) X2 23.9 14.4 38.3 P-value 0.0001 0.001 0.0001 Patients’ answer Present No. (%) Absent No. (%) Z-test P-value Item Presence of rodents 126 (90.0) 14 (10.0) 15.8 0.0001 Presence of sandflies 131 (93.6) 9 (6.4) 21.1 0.0001 Presence of lesions in other members of the same family 56 (40.0) 84 (60.0) -2.42 0.007
Table 1. Age and sex distribution of cutaneous leishmaniasis patients in Al-jabal Al-gharbi, Libya

No. of patients whose age is more than 10 years was significantly higher than that of younger patients (Z=5.39, P=0.0001).

No. of male patients is significantly higher than that of female patients (Z=1.71, P=0.043).

Table 2. Distribution of cutaneous leishmaniasis (CL) cases among different subprovinces of Al-jabal Al-gharbi, Libya

CL patients from Al-Kawasem were significantly overrepresented than those of other subprovinces at Al-Jabal Al-gharbi, Libya (Z=4.69, P=0.0001).

Table 3. Occupational distribution of adult cutaneous leishmaniasis (CL) cases reported at Al-jabal Al-gharbi, Libya

Farm workers and those who assist in farm activities as wives and students were significantly overrepresented among CL reported cases (Z=2.89, P=0.001).

Table 4. Distribution of cutaneous leishmaniasis children cases according to school attendance at Al-jabal Al-gharbi, Libya
Table 5. Distribution of cutaneous leishmaniasis lesions (single or multiple) by sex among the reported children and adult cases at Aljabal Algharbi, Libya

Significant difference between adults and children regarding occurrence of single or multiple lesions (Chi-square=3.90, P-value=0.035).

Table 6. Types of cutaneous leishmaniasis lesions (nodulo-ulcerated, Papulo-ulcerated, and indurated ulcerated scaly plaque) by sex among the reported children and adult cases at Aljabal Algharbi, Libya

a,bThere were significant differences between the no. of nodulo-ulcerative lesions in all ages and both sexes when compared with the papulo-ulcerated lesions.

Table 7. Types of cutaneous leishmaniasis (CL) lesions (wet and dry) by sex among the reported children and adult cases at Aljabal Algharbi, Libya

In all ages and both sexes the no. of wet lesions was significantly higher than that of dry lesions.

Table 8. Frequency distribution of the affected body sites of cutaneous leishmaniasis presented as comparisons between children and adults in both sexes among patients of Al-jabal Al-gharbi, Libya
Table 9. Frequency distribution of cutaneous leishmaniasis patients according to their reports of having similar lesions in other family members and presence of sandflies and rodents in the areas of their residence at Al-jabal Al-gharbi, Libya

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PHD : Parasites, Hosts and Diseases

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