Cutaneous Leishmaniasis due to ThreeLeishmaniaSpecies Among Syrian Refugees in Sanliurfa, Southeastern Turkey

Abstract

Sanliurfa, a city in southeastern Turkey, is host to 477,166 Syrian refugees. The incidence of cutaneous leishmaniasis (CL) may be on the rise in areas affected by a refugee crisis, like Sanliurfa; thus, consequently, local uncommon species ofLeishmaniamay be encountered in these regions. This might potentially make diagnosis and treatment more challenging over time. In this study, it was aimed to identify the causative agents of CL in clinical samples. A total of 154 patients (60 Syrian and 94 Turkish) who were diagnosed with CL via microscopical examination and PCR were enrolled this study. All of the samples were analyzed using internal transcribed spacer 1 genes, restriction fragment length polymorphism, DNA-sequencing, and phylogenetic analyses. In this study,Leishmania tropicawas determined to be the predominant species in 140 of the patients (90.9%), followed byLeishmania majorin 12 patients (7.8%), andLeishmania infantumin 2 patients (1.3%). Of the 94 Turkish patients, 94.7% were infected withL. tropicaand 5.3% were infected withL. major, while none were infected withL. infantum.However, of the 60 Syrian patients, 85% were infected withL. tropica, 11.7% were infected withL. major, and 3.3% were infected withL. infantum. There was a significant association between theLeishmaniaspecies and the nations (Turkish-Syrian) (P < 0.001). The sequences were numbered from MH347941 to MH347953 and submitted to GenBank. This study confirmed thatL. tropica,L. major, andL. infantumcoexisted in Sanliurfa. This was the first time that the speciesL. infantumwas reported among recent immigrants from Syria in Sanliurfa. Therefore, it is necessary to discriminate theLeishmaniaspecies for diagnosis, treatment, and controlled studies in hyper-endemic regions.