<b>Common Risk Factors Involved in Cutaneous Leishmaniasis and Its Management: A Review</b>: Review Article
PDF

Keywords

Cutaneous, Leishmaniasis, Management, Risk factors, Sand fly

How to Cite

Common Risk Factors Involved in Cutaneous Leishmaniasis and Its Management: A Review: Review Article. (2025). Pak-Euro Journal of Medical and Life Sciences, 8(4), 977-990. https://doi.org/10.31580/pjmls.v8i4.3160

Abstract

Cutaneous leishmaniasis (CL) is a common parasitic infection and a major public health concern in endemic regions. The disease is transmitted through the bites of infected female Phlebotomus or Lutzomyia sandflies. Several risk factors contribute to its spread, including poor housing conditions, inadequate hygiene, close proximity to animals, climate change, deforestation, travel, and population displacement. Host-related factors such as age, malnutrition, and immunosuppression further increase susceptibility to infection. Effective management of CL requires accurate diagnosis, timely treatment, and appropriate preventive measures. Local therapeutic options include cryotherapy, thermotherapy, topical paromomycin, and intralesional antimonial therapy, whereas more severe or complicated cases require systemic treatment with pentavalent antimonials, amphotericin B, or miltefosine. Early detection, improved awareness of risk factors, access to effective healthcare, and implementation of vector control strategies are essential to reduce transmission and to prevent relapse and chronic complications.

PDF

References

1. Van Griensven J, Gadisa E, Aseffa A, Hailu A, Beshah AM, Diro E. Treatment of cutaneous leishmaniasis caused by Leishmania aethiopica: a systematic review. PLoS Neglected Tropical Diseases. 2016;10(3):e0004495

2. Alvar J, Vélez ID, Bern C, Herrero M, Desjeux P, Cano J, WHO Leishmaniasis Control Team. Leishmaniasis worldwide and global estimates of its incidence. PLoS One. 2012;7(5):e35671.

3. Bennis I, Thys S, Filali H, De Brouwere V, Sahibi H, Boelaert M. Psychosocial impact of scars due to cutaneous leishmaniasis. Infectious Diseases of Poverty. 2017;6(1):46.

4. Bilgic-Temel A, Murrell DF, Uzun S. Cutaneous leishmaniasis: a neglected disfiguring disease for women. International Journal 0f Women’s Dermatology. 2019;5(3):158-165.

5. Kassi M, Kassi M, Afghan AK, Rehman R, Kasi PM. Marring leishmaniasis: the stigmatization and the impact of cutaneous leishmaniasis in Pakistan and Afghanistan. PLoS Neglected Tropical Diseases. 2008;2(10):e259.

6. Haddad MHF, Kassiri H, Kasiri N, Panahandeh A, Lotfi M. Prevalence and epidemiologic profile of acute cutaneous leishmaniasis in an endemic focus, southwestern Iran. Journal of Acute Disease. 2015;4(4):292-297.

7. Lu C, Ullah Z, Khan K, Shah SU, Jamal M, Khan NH. Environmental and socio-demographic factors associated with cutaneous leishmaniasis in District Khyber, Pakistan: alarming spread of the disease to new foci. Heliyon. 2024;10(8):e32145.

8. Kayani B, Sadiq S, Rashid HB, Ahmed N, Mahmood A, Khaliq MS, Chaudhry M. Cutaneous leishmaniasis in Pakistan: a neglected disease needing a One Health strategy. BMC Infectious Diseases. 2021;21(1):622.

9. Khan A, Sajid R, Gul S, Hussain A, Zehri MT, Naz S, Ahmed H. Epidemiological and pathological characteristics of cutaneous leishmaniasis from Balochistan Province of Pakistan. Parasitology. 2021;148(5):591-597.

10. Nighat S, Malik AY, Mehmood A, Hashmi M, Irfan E, Tahir I, et al. Prevalence of cutaneous leishmaniasis in Muzaffargarh, Punjab, Pakistan. Journal of Pharmaceutical Negative Results. 2022;13:1–6.

11. Burza S, Croft SL, Boelaert M. Leishmaniasis. The Lancet. 2018;392(10151):951-970.

12. Adhikari RC, Shah M. Cutaneous leishmaniasis. Journal of Pathology of Nepal. 2017;7(2):1212-1217.

13. Bates PA. Leishmania–sand fly interaction: progress and challenges. Current Opinion in Microbiology. 2008;11(4):340-344.

14. Jahanifard E, Navidpour S, Vazirianzadeh B. Study on phlebotominae of two big marshlands of Khoozestan province, Iran. Journal of Experimental Zoology. 2009;12(2):407-408.

15. Akhoundi M, Kuhls K, Cannet A, Votýpka J, Marty P, Delaunay P, Sereno D. A historical overview of the classification, evolution, and dispersion of Leishmania parasites and sandflies. PLoS Neglected Tropical Diseases. 2016;10(3):e0004349.

16. Durrani AZ, Durrani HZ, Kamal N, Mehmood N. Prevalence of cutaneous leishmaniasis in humans and dogs in Pakistan. Pakistan Journal of Zoology. 2011;43(2):263-271.

17. Al-Dhafiri M, Alhajri A, Alwayel ZA, Alturaiki JA, Bu Izran SA, Alhammad FA, Aljumaiah RM. Cutaneous leishmaniasis prevalence and clinical overview: a single-center study from Saudi Arabia. Tropical Medicine and Infectious Disease. 2023;8(12):1-10.

18. World Health Organization. Report on the interregional meeting on leishmaniasis among neighboring endemic countries in the Eastern Mediterranean, African and European regions, Amman, Jordan, 23–25 September 2018. World Health Organization. 2019.

19. Bhutto AM, Soomro FR, Katakura K. Leishmaniasis in Sindh, Pakistan. Journal of Pakistan Association of Dermatologists. 2008;18(4):212-219.

20. Reithinger R, Mohsen M, Leslie T. Risk factors for anthroponotic cutaneous leishmaniasis at the household level in Kabul, Afghanistan. PLoS Neglected Tropical Diseases. 2010;4(3):e639.

21. Ullah K, Khan NH, Sepúlveda N, Munir A, Wahid S. Assessing incidence patterns and risk factors for cutaneous leishmaniasis in Peshawar region, Khyber Pakhtunkhwa, Pakistan. Journal of Parasitology. 2016;102(5):501–506.

22. Brooker S, Mohammed N, Adil K, Agha S, Reithinger R, Rowland M, Kolaczinski J. Leishmaniasis in refugee and local Pakistani populations. Emerging Infectious Diseases. 2004;10(9):1681-1684.

23. Kent A, Ramkalup P, Mans D, Schallig H. Is the dog a possible reservoir for cutaneous leishmaniasis in Suriname? Journal of Tropical Medicine. 2013;2013:324140.

24. Abdalla NM, Abdelgani AM, Osman AA, Mohamed MN. Demographical and population dynamics impact on public health of cutaneous leishmaniasis in Al-Madinah Almonawra, Saudi Arabia. African Health Sciences. 2019;19(3):2421-2430.

25. Jamal Q, Shah A, Ali N, Ashraf M, Awan MM, Lee CM. Prevalence and comparative analysis of cutaneous leishmaniasis in Dargai region, Pakistan. Pakistan Journal of Zoology. 2013;45(2):353-360.

26. Khan F, Uddin B, Saqib S, Yasmin S, Usman M. Risk factors and spatial distribution of cutaneous leishmaniasis in District Chitral, Pakistan. Journal of Primeasia. 2024;5(1):1-11.

27. Talari SA, Talaei R, Shajari G, Vakili Z, Taghaviardakani A. Childhood cutaneous leishmaniasis: report of 117 cases from Iran. Korean Journal of Parasitology. 2006;44(4):355–360.

28. Svobodová M, Alten B, Zídková L, Dvořák V, Hlavačková J, Myšková J, et al. Cutaneous leishmaniasis caused by Leishmania infantum transmitted by Phlebotomus tobbi. International Journal for Parasitology. 2009;39(2):251–256.

29. Müller GC, Kravchenko VD, Rybalov L, Schlein Y. Characteristics of resting and breeding habitats of adult sand flies in the Judean Desert. Journal of Vector Ecology. 2011;36(Suppl 1):S195–S205.

30. Votýpka J, Kasap OE, Volf P, Kodym P, Alten B. Risk factors for cutaneous leishmaniasis in the Cukurova region, Turkey. Transactions of the Royal Society of Tropical Medicine and Hygiene. 2012;106(3):186–190.

31. Ngere I, Boru WG, Isack A, Muiruri J, Obonyo M, Matendechero S, et al. Burden and risk factors of cutaneous leishmaniasis in a peri-urban settlement in Kenya, 2016. PLoS One. 2020;15(1):e0227697.

32. Reithinger R, Dujardin JC, Louzir H, Pirmez C, Alexander B, Brooker S. Cutaneous leishmaniasis. The Lancet Infectious Diseases. 2007;7(9):581–596.

33. Zeb I, Ali A, Nawab J, Khan MQ, Kamil A, Tsai KH. Cutaneous leishmaniasis in male schoolchildren in the upper and lower Dir districts of Khyber Pakhtunkhwa, and a review of previous records in Pakistan. Acta Tropica. 2020;209:105578.

34. Chandra RK. Nutrition and the immune system: an introduction. The American Journal Of Clinical Nutrition. 1997;66(2):460S-463S.

35. Soong L, Henard CA, Melby PC. Immunopathogenesis of non-healing American cutaneous leishmaniasis and progressive visceral leishmaniasis. Seminars in Immunopathology. 2012;34(6):735–751.

36. Caldas AJM, Silva DRC, Pereira CCR, Nunes PMS, Silva BP, Silva AAM, Costa JML. Leishmania (Leishmania) chagasi infection in children from an endemic area of American visceral leishmaniasis on São Luís Island, Maranhão, Brazil. Revista Da Sociedade Brasileira De Medicina Tropical. 2001;34(5):445-451.

37. Weigel MM, Armijos RX, Zurita C, Racines J, Reddy A, Mosquera J. Nutritional status and cutaneous leishmaniasis in rural Ecuadorian children. Journal of Tropical Pediatrics. 1995;41(1):22–28.

38. Cunha DFD, Lara VC, Monteiro JP, Romero HD, Cunha SFDC. Growth retardation in children with positive intradermal reaction to leishmaniasis: preliminary results. Revista Da Sociedade Brasileira De Medicina Tropical. 2001;34:25-27.

39. Hotz C, Lowe NM, Araya M, Brown KH. Assessment of the trace element status of individuals and populations: the example of zinc and copper. The Journal of Nutrition. 2003;133(5):1563S-1568S.

40. Prasad AS. Effects of zinc deficiency on immune functions. Journal of Trace Elements in Experimental Medicine. 2000;13(1):1–20.

41. Shetty P. Zinc deficiency and infections. In: Nutrition, Immunity and Infection. Wallingford: CABI Publishing; 2010. p. 101–113.

42. Taylor CE, Higgs ES. Micronutrients and infectious diseases: thoughts on integration of mechanistic approaches into micronutrient research. Journal of Infectious Diseases. 2000;182(1):1–4.

43. Tulchinsky TH. Micronutrient deficiency conditions: global health issues. Public Health Reviews. 2010;32(1):243–255.

44. Van Weyenbergh J, Santana G, D’Oliveira Junior A, Santos Junior AF, Costa CH, Carvalho EM, Barral-Netto M. Zinc/copper imbalance reflects immune dysfunction in human leishmaniasis: an ex vivo and in vitro study. BMC Infectious Diseases. 2004;4(1):50.

45. Amini M, Nahrevanian H, Khatami S, Farahmand M, Mirkhani F, Javadian S. Biochemical association between essential trace elements and susceptibility to Leishmania major. Brazilian Journal of Infectious Diseases. 2009;13:83-85.

46. Confalonieri UE, Margonari C, Quintão AF. Environmental change and the dynamics of parasitic diseases in the Amazon. Acta Tropica. 2014;129:33-41.

47. da Silva AF, Latorre MDRD, Galati EAB. Factors relating to occurrences of cutaneous leishmaniasis in the Ribeira Valley. Revista Da Sociedade Brasileira De Medicina Tropical. 2010;43(1):46-51.

48. Hartley MA, Drexler S, Ronet C, Beverley SM, Fasel N. The immunological, environmental, and phylogenetic perpetrators of metastatic leishmaniasis. Trends in Parasitology. 2014;30(8):412-422.

49. Araujo Filho NAD. Leishmaniose tegumentar americana e o desmatamento da Amazônia. Acta Amazonica. 1981;11(1):187-189.

50. Rosales JC, Yang HM, Avila Blas OJ. Variability modeling of rainfall, deforestation, and incidence of American tegumentary leishmaniasis in Oran, Argentina, 1985–2007. Interdisciplinary Perspectives on Infectious Diseases. 2014;2014:461013.

51. Pérez-Flórez M, Ocampo CB, Valderrama-Ardila C, Alexander N. Spatial modeling of cutaneous leishmaniasis in the Andean region of Colombia. Memórias do Instituto Oswaldo Cruz. 2016;111(7):433–442.

52. Ocampo CB, Ferro MC, Cadena H, Gongora R, Pérez M, Valderrama-Ardila CH, et al. Environmental factors associated with American cutaneous leishmaniasis in a new Andean focus in Colombia. Tropical Medicine and International Health. 2012;17(10):1309–1317.

53. Dias ES, França-Silva JC, Silva JCD, Monteiro ÉM, Paula KMD, Gonçalves CM, Barata RA. Phlebotomine sand flies (Diptera: Psychodidae) in a focus of cutaneous leishmaniasis in Minas Gerais State, Brazil. Revista Da Sociedade Brasileira De Medicina Tropical. 2007;40:49-52.

54. Yaghoobi-Ershadi MR, Moosa-Kazemi SH, Zahraei-Ramazani AR, Jalai-Zand AR, Akhavan AA, Arandian MH, Hosseini M. Evaluation of deltamethrin-impregnated bed nets and curtains for control of zoonotic cutaneous leishmaniasis. Bulletin de la Société de Pathologie Exotique. 2006;99(1):43–48.

55. Chowdhury R, Chowdhury V, Faria S, Akter S, Dash AP, Bhattacharya SK, Banu Q. Effect of insecticide-treated bed nets on visceral leishmaniasis incidence in Bangladesh: a retrospective cohort analysis. PLoS Neglected Tropical Diseases. 2019;13(9):e0007724.

56. Alvar J, Yactayo S, Bern C. Leishmaniasis and poverty. Trends In Parasitology. 2006;22(12):552-557.

57. Wijerathna T, Gunathilaka N, Gunawardena K, Rodrigo W. Socioeconomic, demographic and landscape factors associated with cutaneous leishmaniasis in Kurunegala District, Sri Lanka. Parasites and Vectors. 2020;13(1):244.

58. Valero NNH, Prist P, Uriarte M. Environmental and socioeconomic risk factors for visceral and cutaneous leishmaniasis in São Paulo, Brazil. Science of the Total Environment. 2021;797:148960.

59. González U, Pinart M, Sinclair D, Firooz A, Enk C, Vélez ID, Alvar J. Vector and reservoir control for preventing leishmaniasis. Cochrane Database of Systematic Reviews. 2015;(8):CD008736.

60. Wilson AL, Dhiman RC, Kitron U, Scott TW, van den Berg H, Lindsay SW. Benefit of insecticide-treated nets, curtains and screening on vector-borne diseases, excluding malaria: a systematic review and meta-analysis. PLoS Neglected Tropical Diseases. 2014;8(10):e3228.

61. Mondal D, Huda MM, Karmoker MK, Ghosh D, Matlashewski G, Nabi SG, et al. Reducing visceral leishmaniasis by insecticide impregnation of bed nets in Bangladesh. Emerging Infectious Diseases. 2013;19(7):1131–1134.

62. Ejov M, Dagne D. Strategic framework for leishmaniasis control in the WHO European Region 2014–2020. WHO Regional Office for Europe. 2014:1-23.

63. Dantas-Torres F, Brandão-Filho SP. Visceral leishmaniasis in Brazil: revisiting paradigms of epidemiology and control. Revista Do Instituto De Medicina Tropical De São Paulo. 2006;48:151-156.

64. Salman SM, Rubeiz NG, Kibbi AG. Cutaneous leishmaniasis: clinical features and diagnosis. Clinics in Dermatology. 1999;17(3):291–296.

65. Sharif F, Ahmad I, Ghazi RR. Human cutaneous leishmaniasis in three districts of Sindh in Pakistan. Journal of Basic and Applied Sciences. 2017;13:611–615.

66. Ullah S. Prevalence of cutaneous leishmaniasis in Lower Dir District (NWFP), Pakistan. Journal of Pakistan Association of Dermatologists. 2009;19:212–215.

67. Bari AU. Clinical spectrum of nasal leishmaniasis in Muzaffarabad. Journal of The College of Physicians and Surgeons Pakistan. 2009;19(3):146-149.

68. Desjeux P. The increase in risk factors for leishmaniasis worldwide. Transactions of The Royal Society of Tropical Medicine and Hygiene. 2001;95(3):239-243.

69. Grimaldi G Jr, Tesh R. Leishmaniases of the New World: current concepts and implications for future research. Clinical Microbiology Reviews. 1993;6(3):230-250.

70. Karmaoui A, Sereno D, El Jaafari S, Hajji L. Seasonal patterns of zoonotic cutaneous leishmaniasis caused by Leishmania major and transmitted by Phlebotomus papatasi in North Africa: a systematic review and meta-analysis. Microorganisms. 2022;10(12):2391.

71. Rocha R, Pereira A, Maia C. Non-endemic leishmaniases reported globally in humans between 2000 and 2021: a comprehensive review. Pathogens. 2022;11(8):921.

72. Ullah Z, Ullah S, Muhammad B, Khan J, Shah G. Prevalence and risk factors of cutaneous leishmaniasis in Tehsil Muslim Bagh, District Killa Saifullah, Balochistan, Pakistan. Pakistan's Multidisciplinary Journal for Arts and Science. 2024;5(1):26–40.

73. Ghatee MA, Taylor WR, Karamian M. The geographical distribution of cutaneous leishmaniasis causative agents in Iran and its neighboring countries: a review. Frontiers In Public Health. 2020;8:11.

74. Rostamian M, Niknam HM. Leishmania tropica: what we know from its experimental models. Advances in Parasitology. 2019;104:1–38.

75. Piroozi B, Moradi G, Alinia C, Mohamadi P, Gouya MM, Nabavi M, et al. Incidence, burden, and trend of cutaneous leishmaniasis over four decades in Iran. Iranian Journal of Public Health. 2019;48(1):28–35.

76. Ahmad S, Akhtar MJ, Munir A. Epidemiology and clinical features of parasitic disease leishmaniasis: a case study from Pakistan. Medical Reports. 2024;6:1-10.

77. Arif M, Kalsoom, Shah AA, Badshah M, Hasan F, Rehman AU, Khan S. Positivity, diagnosis and treatment follow-up of cutaneous leishmaniasis in war-affected areas of Bajaur, Pakistan. Parasitology Research. 2022;121(3):991-998.

78. Iqbal W, Iram U, Nisar S, Musa N, Alam A, Khan MR, Ali I. Epidemiology and clinical features of cutaneous leishmaniasis in Khyber Pakhtunkhwa, Pakistan. Brazilian Journal of Biology. 2022;84:e257340.

79. Ihsanullah, Yousuf MJ, Ahmad N, Masood Z, Majeed S, Hassan HU, Shaikh FM. Prevalence of cutaneous leishmaniasis in the largest populated city Karachi, Pakistan. Brazilian Journal of Biology. 2021;83:e249388.

80. Shaikh FM, Raja S, Ali A, Raja A, Rasool IA, Asad A, et al. Epidemiology of cutaneous leishmaniasis in Karachi, Pakistan. JAAD International. 2025;21:9–15.

81. Bukhari SA, Shafqat L, Bilal K, Hussain A, Gul S, Naz S, et al. Incidence of cutaneous leishmaniasis in humans during the COVID-19 pandemic in Baluchistan Province, Pakistan. The Journal of Infection in Developing Countries. 2024;18(6):862–869.

82. Kasi FK, Ahmed H, Khan N, Ali S, Ullah S, Kumar C, Khan N. Ratio of incidence of cutaneous leishmaniasis and site of lesions in different age groups of patients of District Quetta, Balochistan, Pakistan. Pak-Euro Journal of Medical and Life Sciences. 2023;6(4):515-526.

83. Hepburn NC. Management of cutaneous leishmaniasis. Current Opinion in Infectious Diseases. 2001;14(2):151-154.

84. Sundar S, Rai M. Laboratory diagnosis of visceral leishmaniasis. Clinical and Vaccine Immunology. 2002;9(5):951–958.

85. Rioux JA, Lanotte G, Serres E, Pratlong F, Bastien P, Perieres J. Taxonomy of Leishmania: use of isoenzymes and suggestions for a new classification. Annales de Parasitologie Humaine et Comparée. 1990;65(3):111–125.

86. Motazedian H, Karamian M, Noyes HA, Ardehali SD. DNA extraction and amplification of Leishmania from archived Giemsa-stained slides for the diagnosis of cutaneous leishmaniasis by PCR. Annals of Tropical Medicine and Parasitology. 2002;96(1):31–34.

87. Schönian G, Kuhls K, Mauricio IL. Molecular approaches for a better understanding of the epidemiology and population genetics of Leishmania. Parasitology. 2011;138(4):405–425.

88. Hosseinzadeh M, Omidifar N, Lohrasb MH. Use of fine needle aspiration cytology in the diagnosis of cutaneous leishmaniasis: a comparison with the conventional scraping method. Tropical Doctor. 2012;42(2):112-113.

89. Goto H, Lindoso JAL. Current diagnosis and treatment of cutaneous and mucocutaneous leishmaniasis. Expert Review of Anti-Infective Therapy. 2010;8(4):419-433.

90. Stockdale L, Newton R. A review of preventative methods against human leishmaniasis infection. PLoS Neglected Tropical Diseases. 2013;7(6):e2278.

91. Saberi S, Zamani A, Motamedi N, Nilforoushzadeh MA, Jaffary F, Rahimi E, et al. Knowledge, attitude, and prevention practices regarding cutaneous leishmaniasis in a hyperendemic region. Vector-Borne and Zoonotic Diseases. 2012;12(4):306–309.

92. Orellano PW, Vazquez N, Salomon OD. Cost-effectiveness of prevention strategies for American tegumentary leishmaniasis in Argentina. Cadernos de Saúde Pública. 2013;29:2459–2472.

93. Sundar S, Singh B. Identifying vaccine targets for anti-leishmanial vaccine development. Expert Review of Vaccines. 2014;13(4):489–505.

94. Sacks DL. Vaccines against tropical parasitic diseases: a persisting answer to a persisting problem. Nature Immunology. 2014;15(5):403–405.

95. Wilson AL, Courtenay O, Kelly-Hope LA, Scott TW, Takken W, Torr SJ, Lindsay SW. The importance of vector control for the control and elimination of vector-borne diseases. PLoS Neglected Tropical Diseases. 2020;14(1):e0007831.

96. Das ML, Roy L, Rijal S, Paudel IS, Picado A, Kroeger A, Boelaert M. Comparative study of kala-azar vector control measures in eastern Nepal. Acta Tropica. 2010;113(2):162-166.

97. Alexander B, Maroli M. Control of phlebotomine sandflies. Medical and Veterinary Entomology. 2003;17(1):1-18.

98. de Almeida Rocha D, da Costa LM, Pessoa GDÁC, Obara MT. Methods for detecting insecticide resistance in sand flies: a systematic review. Acta Tropica. 2021;213:105747.

99. Huda MM, Ghosh D, Alim A, Almahmud M, Olliaro PL, Matlashewski G, Mondal D. Intervention packages for early visceral leishmaniasis case detection and sandfly control in Bangladesh: a comparative analysis. The American Journal of Tropical Medicine and Hygiene. 2018;100(1):97-107.

100. Chowdhury R, Huda MM, Kumar V, Das P, Joshi AB, Banjara MR, Das ML. The Indian and Nepalese programmes of indoor residual spraying for the elimination of visceral leishmaniasis: performance and effectiveness. Annals of Tropical Medicine and Parasitology. 2011;105(1):31-35.

101. Faraj C, Adlaoui EB, Ouahabi S, Elkohli M, Elrhazi M, Laqraa L, Ameur B. Field evaluation of alphacypermethrin in indoor residual spraying for leishmaniasis control in northern Morocco. Parasites & Vectors. 2013;6(1):354.

102. Dinc R. New developments in the treatment of cutaneous leishmaniasis. Asian Pacific Journal of Tropical Medicine. 2022;15(5):196-205.

103. Brito NC, Rabello A, Cota GF. Efficacy of pentavalent antimoniate intralesional therapy. PLoS One. 2017;12(9):e0184777.

104. Firdous R, Yasinzai M, Ranja K. Efficacy of glucantime in the treatment of Old World cutaneous leishmaniasis. International Journal of Dermatology. 2009;48(7):758-762.

105. World Health Organization. Report of a meeting of the WHO Expert Committee on the Control of Leishmaniases, Geneva, Switzerland, 22–26 March 2010. WHO Technical Report Series. 2010;949.

106. Uzun S, Uslular C, Yücel A, Acar MA, Özpoyraz M, Memişoğlu HR. Cutaneous leishmaniasis: evaluation of 3074 cases in the Cukurova region of Turkey. British Journal of Dermatology. 1999;140(2):347–350.

107. Hodiamont CJ, Kager PA, Bart A, de Vries HJ, van Thiel PP, Leenstra T, van Gool T. Species-directed therapy for leishmaniasis in returning travellers: a comprehensive guide. PLoS Neglected Tropical Diseases. 2014;8(5):1–16.

108. Mohebali M, Fotouhi A, Hooshmand B, Zarei Z, Akhoundi B, Rahnema A, et al. Comparison of miltefosine and meglumine antimoniate for the treatment of zoonotic cutaneous leishmaniasis by a randomized clinical trial in Iran. Acta Tropica. 2007;103(1):33–40.

109. van Thiel PPAM, Leenstra T, Kager PA, de Vries HJ, van Vugt M, van der Meide WF, de Vries PJ. Miltefosine treatment of Leishmania major infection: an observational study involving Dutch military personnel returning from northern Afghanistan. Clinical Infectious Diseases. 2010;50(1):80–83.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Copyright (c) 2025 Pak-Euro Journal of Medical and Life Sciences