INTRODUCTION: Leishmania tropica cutaneous leishmaniasis is usually described as dry, small and self-healing lesions, mainly located on the face and occurring in stable endemic foci. In 1989, similar aspects were observed in a rural hypoendemic focus in center Morocco where about 60 cases were diagnosed. In contrast, an epidemic urban focus in Taza-North Morocco--was identified in 1995 with peculiar clinical aspects. Our objectives is to describe these clinical characteristics. PATIENTS AND METHODS: From October 1995 to November 1996, 132 cases were diagnosed from this new focus during a monthly active survey. Age, sex, duration of lesions, clinical aspects and therapeutic regimen were detailed for each patient. RESULTS: Among the patients, 56.8 p. 100 were women. Mean age was 24.6 +/- 21.5 years (range: 8 months to 85 years). The mean duration of lesions was 6.9 +/- 6.5 months and 91.4 p. 100 evoluted for less than one year. Impetiginized, ulcerocrusted and noduloulcerative forms were predominant (61 p. 100). Furthermore, severe, vegetant inflammatory and multiple lesions were observed in infants and elderly patients. Limbs were involved in 30 p. 100 of cases. Eighty-six patients were treated with intralesional glucantime regimen and cured in 72 p. 100 of cases. Intramuscular treatment by glucantime was required in case of multiple lesions and failure of local therapy. DISCUSSION: In this study, the high frequency of severe lesions in infants and elderly patients suggests that the introduction of the parasite occurred recently in this area. The brief duration of lesions confirms the acute character for cutaneous leishmaniasis related to L. tropica in this epidemic focus. The host immune status associated with parasite intrinsic factors probably plays a role in these perculiar clinical manifestations.
INTRODUCTION:Leishmania tropica cutaneous leishmaniasis is usually described as dry, small and self-healing lesions, mainly located on the face and occurring in stable endemic foci. In 1989, similar aspects were observed in a rural hypoendemic focus in center Morocco where about 60 cases were diagnosed. In contrast, an epidemic urban focus in Taza-North Morocco--was identified in 1995 with peculiar clinical aspects. Our objectives is to describe these clinical characteristics. PATIENTS AND METHODS: From October 1995 to November 1996, 132 cases were diagnosed from this new focus during a monthly active survey. Age, sex, duration of lesions, clinical aspects and therapeutic regimen were detailed for each patient. RESULTS: Among the patients, 56.8 p. 100 were women. Mean age was 24.6 +/- 21.5 years (range: 8 months to 85 years). The mean duration of lesions was 6.9 +/- 6.5 months and 91.4 p. 100 evoluted for less than one year. Impetiginized, ulcerocrusted and noduloulcerative forms were predominant (61 p. 100). Furthermore, severe, vegetant inflammatory and multiple lesions were observed in infants and elderly patients. Limbs were involved in 30 p. 100 of cases. Eighty-six patients were treated with intralesional glucantime regimen and cured in 72 p. 100 of cases. Intramuscular treatment by glucantime was required in case of multiple lesions and failure of local therapy. DISCUSSION: In this study, the high frequency of severe lesions in infants and elderly patients suggests that the introduction of the parasite occurred recently in this area. The brief duration of lesions confirms the acute character for cutaneous leishmaniasis related to L. tropica in this epidemic focus. The host immune status associated with parasite intrinsic factors probably plays a role in these perculiar clinical manifestations.