Cutaneous leishmaniasis and its clinical spectrum. An overview from the Old World

Cutaneous Leishmaniasis (CL), which was found in ancient Egyptian and Christian Nubian mummies from 2000 BC, described for the first time in the 9th century by Avicenna (Balkh sore), still remains a major world health problem. It is considered by the World Health Organization (WHO) an emerging and uncontrolled disease (1-3). Leishmaniasis is a widespread disease which is endemic in the “Old World” (Europe, Middle East, Africa, Central Asia, and India) and in the “New World” (Central and South America) (Figure 1). It is caused by several different species of an intracellular protozoa belonging to the genus Leishmania, which was identified in the early twentieth century, and is transmitted by the bite of an infected female sandfly (3). Following infection of man by these parasites, there will be some individuals naturally resistant to this infection, and others with a different degree of susceptibility. Depending on the species of Leishmania, host genetics, and immune factors, a spectrum of clinical forms of the disease develops: the result of infection can vary from a chronic skin ulcer, nodule or plaque (cutaneous leishmaniasis, CL), to erosive mucosal disease with progressive facial disfiguring (mucocutaneous leishmaniasis, MCL), to generalized cutaneous lesions (anergic diffuse cutaneous leishmaniasis, ADCL), to a life threatening systemic infection with hepato-splenomegaly (visceral leishmaniasis, VL, also called kala azar, meaning “black fever” in Hindi) (4-8). The aim of this review is to provide an update on the clinical and immunological spectrum of cutaneous leishmaniasis, with special reference to the disease in the Old World. Diagnostic and therapeutic options are also briefly showed.