Table 1.
Overview of publications on clinical studies on cutaneous leishmaniasis due to L. aethiopica.
| Ref | Location | Study type | Population | N | Age (years) | Sex distribution | Type and location of lesion | Diagnostic method | Species subtyping | Duration of lesion reported by patient | Comment |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Community-based | |||||||||||
| [9] Bryceson 1966 | Dembidollo area (SW Ethiopia) 1700 m | Survey | Villages where CL cases have previously been seen. Total surveyed not reported | 14 active lesions 12 scars |
Active lesions: Mean 25·1, median 23 Scars: mean 15·9 median 14·5 Total: mean 18·5 median 17 |
Active lesions: Male 5 (38·5%) Female 8 (61·5%) Scars: Male 8 (61·5%) Female 6 (38·5%) |
2 MCL (14·3%), one ‘chiclero ulcer’, 23 ‘oriental sore’ (9 active, 13 scars, 1 active &scar) 96·4% of lesions on the head/neck, 92·3% single lesion |
Clinical, Leishmania antigen test done on some, 7/14 ‘active’ cases smear positive 2 random biopsies done |
No | Means: scar: 20·7 months Active: 12·9 months |
Numbers table and text inconsistent Authors proposed natural evolution |
| [11] Lemma 1969 | Dessie area (NE Ethiopia), Wolega Province (W Ethiopia) Dembidollo area (SW Ethiopia), Shewa Province, Meta Abo (C Ethiopia), Rift valley lake area (S Ethiopia) All > 1800 m |
Survey | 2 areas chosen with known CL cases, one by chance observation, selection of the last area is not described. Mostly schoolchildren, also peasants, farmers and villagers. > 2000 surveyed | 57 active CL, 58 scars, (Prevalence active +/− 2·9%, total +/− 5·8%) |
For active CL: all age groups affected, mostly children and young adults | Except for one area, no male predominance in active CL/scars | Almost all oriental sore, a ‘few’ with MCL, no new DCL 97·6% of lesions on the head, 75–93% single lesion |
Parasite positivity was tested by Giemsa stained smears or culture. 22/61 tested were positive | No | 22/61 < 6 months, 21/61 6–12 months, 18 > 12 months | LST done in whole population surveyed, positivity ranging from 5·5 to 52% (52% in family of DCL patient); Numbers do not add up. Authors proposed natural evolution for CL |
| [10] Wilkins 1971 | Meta Abo (C Ethiopia) 2250–2500 m | Survey | All villagers of Meta Abo valley (estimated 95% included), a region home to CL cases. 1635 surveyed | 9 active cases, 52 past cases (Prevalence active 0.6%, total 3·7%) |
Cases: 3–70, mean 22·6, median 35 Mean whole population 27 |
Male 3 (33·3%) Female 6 (66·7%) |
9 LCL (100%), [8] 88·9% lesion on the head, [8] 88·9% single lesion | Clinical, 7 parasitologically confirmed by Giemsa Stained smears, culture or biopsy | No | NA | |
| [13] Ashford 1973 | Kutaber (C Ethiopia)2500 m, Ochollo (S Ethiopia)2100 m |
Survey | Villages with infected sandflies and hyraxes. Kutaber 357/370 compounds surveyed In Ochollo around 1/5 of compounds were visited 895 surveyed, areas were chosen by geographical features (steep slopes and flatter areas) |
Kutaber 28 cases (16 locally acquired of which 13 active) prevalence active 0·9% Ochollo: 96 active, 272 scars (prevalence 10·7% & 41·1% resp.) |
Kutaber: 8/13 between 6 and 15, none < 6, one elderly male Ochollo: 82·7% of active lesions < 16 years. 41·2% < 6 years, also < 1 year encountered |
NA | NA | Clinical, cases were checked by laboratory confirmation ‘as much as possible’ | No | NA | The Aleku focus is already described in Lemma et al. [11] |
| [12] Mengistu 1992 | Ochollo (S Ethiopia) >2000 m |
Repeated cross-sectional survey with 3 consecutive visits over 3 years | Residents of Ochollo district (> 95% surveyed). CL cases have been reported here in previous studies. 3022 surveyed. | 120 active cases, 1037 scars, Prevalence active 4·0%, total 38·3% |
80·0% of active infections in 0–10 years, 3 children 6 months, one woman > 60 | ‘both sexes equally affected’ | 2 DCL (1·7%), 2 MCL (1·7%), 116 LCL (active cases). 85·1% of lesions are above the neck, 67·6% had one lesion | Clinical, skin smears and culture for some active CL cases | L. aethiopica found in vector and in 6 patients by isoenzyme essay | For 50% of patients' duration 9·6 +/− 5·7 months, in 10% > 3 years | 65 (54%) of 120 schoolchildren positive for LST |
| [18] Sang 1993 | Mt Elgon (3 sites) (W Kenya) >1700 m |
Survey | Villages where CL had previously been reported, compared to a general population survey in the same area, not described in detail. 1979 and 18,525 surveyed respectively | 43 active cases. Prevalence 0·01–1·9% | No conclusions on age due to small sample size | NA | 3 DCL, rest LCL. 84·7% of lesions were on the head | Clinical, 19 parasitologically confirmed by Giemsa stained smear or culture | Two tested L. aethiopica by Isoenzyme assay | NA | Numbers in table and text are inconsistent |
| [16] Negera 2008 | Silti (C Ethiopia) | Survey | Simple random sampling of villagers in towns with previous reports of skin lesions. 1907 surveyed | 92 active cases (prevalence 4·8%) | Cases: Mean 17·9 − + 1.5SE range 2–70. Significantly more CL cases in 11–20 age group | Male 44 (47·8%) Female 48 (52·2%) |
14/73 MCL (19·2%), others presumably LCL. 68·5% had a lesion on the head, 46·7% had one lesion | Clinical, 73/92 confirmed by skin smear/culture/histopathology | Yes, all L. aethiopica by PCR | 69/92 > 6 months | Multivariate Risk Factor analysis: presence of adhatoda shrubs and presence of hyraxes near house significantly associated with CL |
| [20] Lemma 2009 | Addis Ababa (C Ethiopia) three localities in/around gorges of Bulbula-Akaki river (close to international airport) >2326 m |
Survey | Survey population not described. Total surveyed not reported | 35 cases (9 active, 26 healed). | Age group 0–9 and 10–19 years were the most affected. 4 of the 12 > 30 years were employed as night guards | Active lesions & scars combined: Male 17 (48·6%) Female 18 (51·4%) |
3 DCL (33·3%), 6 LCL (66·7%). 97% of scars were in the face | Clinical suspicion with parasitological confirmation for all by Giemsa stained smear or culture | L. aethiopica found in 3 hyraxes by PCR, not done on human samples | NA | |
| [32] Negera 2012 | Silti (C Ethiopia) | Prospective cohort identified by active and passive case finding | Survey population not described. Total surveyed not reported | 92 active cases from survey (31 from HC). | For all (including HC) Mean age 18·6 |
For all (including HC): Male 67 (54·5%) Female 56 (45·5%) |
Subtypes not described, 78·9% had a lesion on the head, 51·2% had one lesion | Clinical, 48/85 were culture positive, 44/54 positive for histopathology, 59/71 positive for PCR | All infections identified by PCR due to L. aethiopica | Of 54 described, 26% < 3 months, 48% 3–12 months, 26% > 12 months | Data from passive and active case finding is combined |
| [52] Buggsa 2014 | Ochollo (S Ethiopia) > 2000 m | Survey | Schoolchildren (all in 1 school) age 6–25 (523/600 participated) where previous CL studies had been done. 523 surveyed | 21 active lesions, 313 scars, and 8 active & scar Prevalence active 5·5%, total 65·4 |
For all: more prominent in 11–15 (49·7%), and 6–10 (41·8%), for active: unclear distribution | Active lesions & scars combined: Male 165 (48·2%) Female 177 (51·8%) |
1 MCL, 4 ‘recidivans’ (definition unclear), 4 MCL + LCL, rest (168) LCL 82·2% of scars and 84·9% of lesions on the face, 64·1% of scars and 41·4% of lesions singular |
Clinical, 4 active cases culture positive, 1 DAT positive, 1 smear positive | NA | NA | Numbers inconsistent for MCL and total prevalence |
| [21] Bsrat 2015 | Saesie Tsaeda-emba (N Ethiopia) > 2350 m | Survey | 6 randomly (multistage random sampling) selected peasant associations and a house to house survey 2011–2012. 2106 surveyed | 331 CL (141 active, 154 scar) Prevalence active 6·7%, total 14·0% |
Highest prevalence active lesion in age group 10–19 (12·8%, 64), followed by 0–9 (9·8%, 51). Central measure NA | Active lesions: Male 74 (52·5%) Female 67 (47·5%) Scars: Male 74 (48·1%) Female 80 (51·9%) |
Subtypes not described, 83·2% are at the head/neck, and 78·7% had one active lesion | Clinical, 10 culture confirmed, 30 smear confirmed | Yes, unmentioned number of PCR subtyping all L. aethiopica | NA | Univariate Risk factor analysis: age, study peasant organization, presence of cliff/gorge, walls with cracks and/or holes, presence of hyrax, animal burrow, animal dung and farm land near the residents' houses |
| Health center or hospital-based | |||||||||||
| [7] Poirier 1964 | Princess Zenebework Hospital, Addis Ababa (C Ethiopia) | Case series with passive case finding | Patients hospitalized in leprosy hospital in Addis Ababa, where later the diagnosis CL was made | 8 | Mean 21, Median 25, range 10–30 | Male 4 (50%) Female 4 (50%) |
3 lepromatous leprosy, 1 tuberculoid leprosy, 1 intermediate leprosy, 1 erythematous lupus, 1 tuberculoid lupus, 1 oriental sore | All parasitologically confirmed (microscopy or culture) | No | Mean(years) 10.4, median 6, range 2–20 years | |
| [8] Price 1965 | Princess Zenebework Hospital, Addis Ababa (C Ethiopia) | Case series with passive case finding | Patients falsely diagnosed as lepromatous leprosy | 22 | Range 4–52 (mainly 4–12) | ‘no sex predominance’ | 8 “lepromatoid type”, 2 “tuberculoid type”, 12 “intermediate type”. 10/21 (47·6%) lesions on head. | Histological, classification of CL in different categories over a spectrum, as done for leprosy | No | NA | Two of the 22 cases have been described in another paper (which is unclear) |
| [61] Bryceson 1969 | Princess Zenebework Hospital, Addis Ababa (C Ethiopia) | Case series with passive case finding | DCL patients admitted at Addis Ababa leprosarium | 33 | Range 8–40. Mean age at presentation is 20, all disease started before age 28 | Male 21 (63·6%) Female 12 (36·4%) |
33 DCL, 4 having mucosal involvement. Primary lesion: 14 on face (42·4%), 10 (42·4%) legs, 6 arms. 100% finally had lesions on the face |
Parasitological. In all leishmaniasis was confirmed by skin smears stained with Leishman's stain. NNN culture was done for a few cases | No | Range 1–20 years | The article itself has mapped the cases but not reported the location. Please see the article itself for the distribution of cases 16 of the 33 cases have been described elsewhere |
| [53] Lindtjorn 1981 | Sidamo Regional Hospital, Yirga Alem (SE Ethiopia) | Case series with passive case finding | Patients presenting with CL symptoms and parasitologically proven | 25 | 14 (56%) were < 20, 7 (28%) < 10, one (4%) 51-year-old | Male 14 (56%) Female 11 (44%) |
24 LCL (96%), one DCL (4%). 21/25 (84%) lesions on the face | Parasitological: 19 biopsied, 6 smear | No | Mean 7.1 months, range 1 month–3 years | |
| [33] Sarojini 1984 | ALERT, Addis Ababa (C Ethiopia) | Case series with passive case finding | All patients presenting to Alert | 104 | Range 4–70, 6·7% in 0–9 30·8% in 10–19 28·8% in 20–29 14·4% in 30–39 12·5% in 40–49 2·9% in 50–59 3·9% in 60 + |
Male 64 (61·5%) Female 40 (38·5%) |
98 LCL (94·2%), 6 DCL (5·8%). 120/124 (96·8%) of all lesions were on the head/neck. 73 (74·5%) had single lesions | Parasitological: By histology of smears or isolation of promastigotes from tissue obtained at biopsy or smear taking. Numbers not reported | All cultured samples had isoenzyme analysis done. All 20 were L. aethiopica | Range 1 month − 10 years. 83·7% had < 1 year, for DCL mean > 5 years | |
| [57] Padovese 2009 | IDC Mekele (N Ethiopia) | Case series with passive case finding | Patients presenting at IDC | 167 | High prevalence among adolescents. By category: 24·0% in 5–14 67·7% in 15–44 1·2% < 5 7·2% > 45 |
Male 126 (75·4%) Female 41 (24·6%) |
123 LCL (73·7%), 11 DCL (6·6%), 2 RCL (1·2%), 29 MCL (17·4%), 1 ML (only lips) (0·6%). 5 (5·6%) HIV +, 1 (0·6%) PKDL. 115 (68·9%) had a lesion on the head | Parasitological. Fine needle aspirates for skin smear microscopy and biopsy for histopathology | No | Range 12 weeks to 2 years | |
| [58] Morrone 2011 | IDC, Mekele, cases from all over Tigray (N Ethiopia) > 2000 m | Case series with passive case finding | Patients with clinical diagnosis of CL presenting to IDC during the study period | 471 | Mean 23·7. By category: 59·9% in 15–44 28% in < 14 |
Male 335 (71·1%) Female 136 (28·9%) |
405 LCL (86·0%), 52 MCL (11·0%), 11 DCL (2·3%), 3 PKDL (0·6%) 15 HIV positive (3·2%). Location and number of lesions not reported | All confirmed by either skin smear microscopy, FNAC or histopathology (skin smear microscopy and FNAC done on all, histopathology on FNAC negative) | No | NA | Recruitment from 2005 to 2008 which overlaps with Padovese et al. [57] who recruited from 2005 to 2007 |
| [65] Bekele 2014 | ALERT, 96 from Addis, Oromia-71(30·3) Amhara- 35 (15%) SNNP- 26 (11·1%) Tigray − 6 (2·6%) |
Case series with passive case finding | CL cases diagnosed at ALERT | 234 (14·2%) diagnosed from 1651 suspected | Mean 25, range 1–78. Age group 11–20 and 21–30 were most affected |
Male 133 (56·8%) Female 101 (43·2%) |
21 (9·0%) DCL, 24 (10·3%) MCL, 8 (3·4%) LCL, mostly not recorded (191). >48·3% of lesions on the face (26·1% on arms and legs). # of single lesions NA |
All Giemsa and/or histopathology confirmed (no numbers reported) | No | 15·0% < 3 months 18·4% 4–6 months 7·7% 7–9 months 16·7% 10–12 months 42·3% > 12 months |
The locations described are not detailed enough to map, so for this article only the cases in Addis are displayed on the map |
| [56] Tilahun 2014 | Ayder Referral Hospital, Mekele, (N Ethiopia) | Case series with passive case finding | CL cases diagnosed at Ayder Referral Hospital | 35 diagnosed from 486 patents visiting the dermatology OPD | By category 6 (17·1%) 1–15 24 (68·6%) 16–45 5 (14·3%) > 46 |
Male 26 (74·3%) Female 9 (25·7%) | 18 LCL(51·4%), 9 (25·7%) MCL, 8 (22·9%) DCL. 16(45·7%) had facial, 16 (45·7) had mucosal lesions, and 3 (8·6%) had lesions on extremities. |
11 (31·4%) were confirmed with skin slit microscopy, while 24 (68·6%) were negative for skin slit microsocpy | No | NA | The numbers and percentages indicated for overall prevalence and prevalence per type of disease are not consistent, therefore there is some doubt regarding the numbers reported here. |
| [59] Fikre 2017 | Leishmania Research and Treatment Center, Gondar (NW Ethiopia) | Case series with passive case finding | Cases of confirmed CL (one with strong clinical suspicion but negative smear) presenting to the LRTC | 154 | Median 23, IQR 16–38. By category: 6·5% < 10 20·1% 11–17 54·5% 18–44 18·8% > 45 |
Male 110 (71·4) Female 44 (28·6%) |
80 LCL (51·9%), 67 MCL (43·5%), 7 DCL (4·6%), 4 concomitant leprosy; 5 (3·2%) HIV +, 80·5% of lesions on head/neck, 61% had 1 lesion | Parasitological (99·3%), 0·7% (1 case) clinical diagnosis with negative aspirate | No | Median: 12 months (IQR 6–24), for MCL 12 (6–24), for DCL 13 (12–84) | |
| [106] Seife, 2018 | Boru Meda Hospital, dessie (NE Ethiopia) | Case series with passive case finding | Leishmaniasis patients presenting at Boru Meda dermatology department | 97 | By category < 15: 33 (35%) 16–45: 45 (45.4%) >45: 19 (19.6%) |
Male 62 (63.9%) Female 35 (36.1%) | 52 (53.6%) LCL, 28 (28.9%) MCL, 17 (17.5%) DCL. | 91 (93.8%) parasitologically confirmed 82 (84.5%) with skin slit smear, 9 (9.3%) with negative skin slit smear but positive FNAC, 6 (6.2%) negative for skin slit and FNAC (clinical diagnosis). | No | NA | Numbers for age are inconsistent, whether the numbers reported here are correct is not certain. |