Clinical and Bacteriological Characteristics of Cutaneous Leishmaniasis at the Outpatient Clinic, Tripoli Central Hospital, Libya

Abstract

Leishmaniasis is a common health problem worldwide, endemic in almost 90 countries, mostly tropical and subtropical regions in four continents. An increase in the number of cutaneous leishmaniasis (CL) cases has been reported over a wide area of the South and West of Tripoli. Since most of the CL cases referred for slit and smear and management if infected, the aim of our study was to determine the clinical aspects of CL, to isolate and identify bacteria responsible for secondary infection in the lesions, and to study the antibiotic susceptibility of the isolated organisms to commonly used antibacterial agents. A total of 450 patients with suspected CL attending the dermatology outpatient clinic in Tripoli Medical Center (TMC) and Tripoli Central Hospital (TCH) over a one-year period (June 2003 to June 2004) were examined. In each case, a detailed history and clinical examination were performed according to a protocol prepared for this study. The majority of patients were males (52%) with a male-to-female ratio of 1.1:1. Children, adolescents, and young adults—especially students and housewives—were the main age groups affected. Most patients were from the northwestern region and coastal area of Libya, and 96.7% of them were Libyans. Furunculoid and nodulo-ulcerating lesions (36.4% and 33.6%, respectively) were the main clinical types of CL reported, and most of the patients had either one or two lesions on exposed parts of the body. Samples from CL lesions for bacteriological examination were taken from 246 cases, and a positive culture was obtained in 37.4% of cases. Among the bacterial infections found, Staphylococcus aureus (S. aureus) was the most frequent isolate (62%) among children in the 0–10 years age group and young adults in the 21–30 years age group, while Staphylococcus epidermidis (S. epidermidis) was isolated less frequently (20.7%) in the 11–30 years age group. This study revealed that CL in Libya is endemic in certain areas and has a seasonal pattern, and S. aureus was the main isolate from CL lesions.