Cutaneous Leishmaniasis Caused by Leishmania killicki, Algeria

Streptococcus suis serotypes characterized by analysis of chaperonin 60 gene sequences. Use of polyvalent coagglutination re-agents for serotyping of Streptococcus suis. 14 new capsular types of Streptococcus suis. Cutaneous Leishmaniasis Caused by Leishmania killicki, Algeria To the Editor: Cutaneous leish-maniasis (CL) is a widespread and resurging vector-borne disease caused by a protozoan parasite belonging to genus Leishmania (1). After Afghani-stan, Algeria is the second largest focus of CL in the world. Although CL is a serious public health problem in Algeria, few data are available from this country. During 2004–2008, an average of ≈44,050 CL cases were reported per year, and the estimated annual incidence ranged from 123,300 to 202,600 cases. Two main forms of CL have been described for more than a century in Algeria, the zoonotic, caused by L. major and the sporadic, caused by L. infantum. Since 2004, 11 strains belonging to the L. tropica complex, including L. killicki (2), were identified in 1 focus in the northern part of the Sahara (3) and in 2 foci in the northeastern Algeria (4,5). We report here a recent outbreak of CL, including infection with L. killicki strains, in the Tipaza area of northern Algeria. Patients who sought treatment at Hajout hospital in Hajout, Algeria (a community of ≈51,000 persons), from January 2010 through April 2013 with cutaneous lesions consistent with leishmaniasis, underwent clinical examination. For each patient (146 total), we collected epidemiologic data (geographic origin, traveling history, especially to other leishmaniasis-en-demic areas) and clinical data (number and size of lesions and clinical forms). Informed consent was obtained from all patients or their legal guardians. A particular characteristic of the infections was the unusual duration of some episodes, one of which persisted for >4 years, which is compatible with leishmaniasis recidivans (6). Microbiological data were obtained as follows. Tissue samples, obtained by scraping the internal border of skin lesions from patients, were smeared onto a glass slide, fixed with methanol, stained with Giemsa, and examined by microscopy. Slides showing Leishmania amastigote forms were then processed further for molecular analyses. The immersion oil used to examine each slide was wiped off the smear with tissue paper, and then the dry smear was scraped from its slide by using a sterile scalpel. DNA extraction from smear scrapings was performed with the NucleoSpin Tissue kit (Macherey-Nagel, Düren, Germany). Species identification was performed by amplifying the topoi-somerase II gene, followed by DNA sequencing …