Possible Diagnostic Improvement for Cutaneous Leishmaniasis: Is It Achievable?

The parasite, Leishmania, is the causative agent of the disease leishmaniasis and is highly endemic in 98 countries spread across the tropics, subtropics and Mediterranean Basin. It is a vector-borne disease transmitted by the bite of infected sand flies, and it appears in three clinical manifestations namely:  cutaneous, mucocutaneous, and visceral leishmaniasis. It is known that at least 21 species are pathogenic to humans. To control the disease, there is no human vaccine, and the sole approach is through chemotherapy. Unfortunately, the available anti-leishmanial drugs are problematic due to their high toxicity, as well as increased parasite resistance. Therefore, making accurate diagnostic decisions for clinical treatment is highly important. Old World cutaneous leishmaniasis (CL) is mostly caused by two Leishmania species, named as L. major and L. tropica that produce skin ulcers. It is also important to note that the symptoms of CL can be confused with other skin diseases. Similar clinical symptoms such as sarcoidosis, lupus vulgaris, leprosy, and bacterial ulcer may have common clinical signs with CL ulcer. Therefore, the diagnostic confirmation of the parasite is mandatory before starting an appropriate treatment strategy.