Cutaneous leishmaniasis (CL) is the most common parasitic disease transmitted by vectors in Iran. CL is endemic in many urban and rural parts of Iran and usually caused by two species of Leishmania as L. major and L. tropica transmitted to humans from parasite reservoirs by the bite of female sandflies. We report a case of ocular leishmaniasis with eyelid involvement presentation. The patient was a 70-yr-old housewife woman referred to Health Care Center in city of Kashan, central Iran in 2012. The disease was diagnosed by direct smear, culture, and PCR from the lesion. PCR was positive for L. major. Her lesion was treated with systemic meglumine antimonate (Glucantime) (20 mg/kg/day) for 20 days. © 2017, Iranian Journal of Public Health. All rights reserved

Doroodgar, A.

Doroodgar, M.

kashan university of medical sciences

  
Iran J Public Health, Vol. 46, No.2, Feb 2017, pp.261-264                                                        Case Report 
261                                                                                                        Available at:    http://ijph.tums.ac.ir 
 
 
Eyelid Cutaneous Leishmaniasis: A Case Report 
 
Moein DOROODGAR 1, Masoud DOROODGAR 1, *Abbas DOROODGAR 2 
 
1. School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran 
2. Dept. of Medical Parasitology, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran 
 
*Corresponding Author: Email: adoroudgar@gmail.com 
 
(Received 18 Jul 2016; accepted 15 Oct 2016) 
 
 
 
Introduction 
 
Leishmaniasis is used to describe the diseases as-
sociated with known species of Leishmania para-
site. The parasites are transmitted by the bite of 
sandflies (Family: Psychodidae. Subfamily: Phle-
botominae). Due to species of the Leishmania and 
the host immune response it can cause different 
clinical entities (1, 2). Leishmaniasis is endemic in 
98 countries with more than 350 million people 
at risk. CL is the most common form with 1.5 
million new cases per year (3). In the old world, 
common parasites were L. major and L. tropica 
transmitted by Phlebotomus papatasi and P. sregenti 
respectively. In The new world, CL is caused by 
L. Braziliensis, L. amazonensis and L. mexicana 
which vectors are Lutzomyia wellcomei and L. flavis-
cutellata (1). 
Up to 90% of cases of CL occur in Afghanistan, 
Algeria, Islamic Republic of Iran, Saudi Arabia 
and the Syrian Arab Republic, in Bolivia and Bra-
zil, Colombia, Nicaragua and Peru (3). Both form 
of rural and urban CL, Zoonotic CL (ZCL) and 
Anthroponotic CL (ACL) are existing in foci of 
the disease in Iran (4). About 20,000 cases of CL 
are reported every year and the actual number 
may be 4 or 5 times higher (4-6). In fact, CL is 
considered one of the most important parasitic 
diseases in Iran with a few reports of atypical 
clinical forms (7).  
Annually several cases of CL are reported in en-
demic area of Kashan (Isfahan Province, central 
Iran). 
Here a case of ocular leishmaniasis (OL) with 
eyelid involvement is reported. The disease was 
diagnosed by direct smear, culture of lesion, and 
PCR for L. major, and L. tropica by RAPD-PCR 
method which compared to reference stocks: L. 
tropica (MHOM/IR/IR/99) and L. major 
(MHOM/IR/75/ER) and the results were ob-
tained. The data related to the patient was ana-
lyzed by descriptive statistics and bands of PCR 
product was compared to the standard marker 
(XIV) strains (Fig. 1). 
Abstract 
Cutaneous leishmaniasis (CL) is the most common parasitic disease transmitted by vectors in Iran. CL is endemic in 
many urban and rural parts of Iran and usually caused by two species of Leishmania as L. major and L. tropica transmit-
ted to humans from parasite reservoirs by the bite of female sandflies. We report a case of ocular leishmaniasis with 
eyelid involvement presentation. The patient was a 70-yr-old housewife woman referred to Health Care Center in city 
of Kashan, central Iran in 2012. The disease was diagnosed by direct smear, culture, and PCR from the lesion. PCR 
was positive for L. major. Her lesion was treated with systemic meglumine antimonate (Glucantime) (20 mg/kg/day) 
for 20 days.  
 
Keywords: Eyelid cutaneous leishmaniasis, Leishmania major, Ocular leishmaniasis 
 
 
 
Doroodgaret al.: Eyelid Cutaneous Leishmaniasis… 
 
Available at:    http://ijph.tums.ac.ir                                                                                                        262 
 
 
Fig. 1: RAPD-PCR technique results in isolated strain 
and standards: 1- L. tropica (MHOM/IR/IR/99), 2- L. 
major (MHOM/IR/75/ER), 3- Marker (100 bp), 4-
Unknown strain 
 
Case report 
 
A 70-year-old housewife woman with a com-
plaint of an ulcerative lesion on her upper lid of 
left eye which was non pruritic was referred to a 
health center of Kashan (Fig. 2). The lesion size 
was about 2 cm in 1 cm, was not tender, and was 
crusty and painless. Her wound was a small no-
dule initially, enlarged slowly, and after about a 
month became to current form. At the beginning, 
the antibiotic treatment was performed for 10 
days that failed to heal the lesion. Direct smears 
were taken from the edge of skin lesion of patient 
by using vaccine style and were fixed with pure 
methanol. Following the staining of samples by 
Giemsa, CL was confirmed by observation of the 
leishman bodies (amastigotes) by a light micro-
scopy (Fig. 3). After culture examination on 
NNN medium, PCR was positive for L. major.  
The patient treated with systemic meglumine an-
timonate (Glucantime) for 20 days (20 
mg/kg/day). Three months after treatment, the 
lesion healed and only a small scar was remained 
on the surface of the eyelid. 
 
 
 
Fig. 2: A 70-yr-old woman with lesion of left eyelid 
 
 
 
Fig. 3: Direct Smear was positive for Leishman bo-
dies (Giemsa stain) 
 
Discussion 
 
Cutaneous leishmaniasis is transmitted by the bite 
of infected female sand flies with Leishmania para-
sites. Because of sandflies, mouthparts are very 
short; they are unable to bite through clothing. 
Therefore, CL usually occurs in an uncovered 
part of body (1, 8). Although the face is an ex-
posed area, but it is an unusual site specially eye-
lids (6, 9). The possibility of presence of eyelash-
es and the frequent movements of the eyelids 
prevent sand fly bites (8, 10). In the season of 
sandflies activity, more blood sucking is occurred 
from sunset to sunrise (1). Although bite of eye-
lids is possible during the rest and sleep, but inci-
Iran J Public Health, Vol. 46, No.2, Feb 2017, pp.261-264  
263Available at:    http://ijph.tums.ac.ir 
dence of cases is much less than bites of the oth-
er body parts such as hands and feet. The studies 
on epidemiology of ocular leishmaniasis confirm 
the reality that this disease has low incidence (2). 
In Turkey, 33 ocular leishmaniasis in 987 (1.93%) 
and 2 out of 718 (0.3%) patients with CL respec-
tively were reported (11, 12). In Iran, Modarres-
Zadeh et al. reported four cases of OL from 1950 
to 2005 that two of them ended in blindness (2). 
L. major was the main agent of the unusual leish-
maniasis in this study and in some cases reported 
from Iran (6, 10, 13, 14). 
Although CL is a self-limiting disease, but un-
treated ocular leishmaniasis may cause ophthal-
mologic side effects and can potentially be very 
serious for eyes. Early diagnosis and vigorous 
treatment may prevent blindness (2, 15). Now 
there is no effective vaccine to prevent the dis-
ease and treatment is done with drugs (16, 17). 
The Pentavalent antimonial compounds are the 
first line drugs of treatment for all forms of 
leishmaniasis (18).  
CL is endemic in many parts of Iran and ocular 
leishmaniasis should be considered in these areas. 
In recent years some cases of ocular leishmaniasis 
has been reported in Iran (2, 9, 15).  Diagnosis 
and treatment of leishmaniasis is done free in 
Iran. North of Isfahan Province is one the en-
demic areas for CL caused by L. major (19). The 
described case is a native person who is living in 
endemic area Kashan County and had no history 
of trip to other endemic areas of Iran.  
 
Ethical considerations 
 
Ethical issues (Including plagiarism, informed 
consent, misconduct, data fabrication and/or fal-
sification, double publication and/or submission, 
redundancy, etc.) have been completely observed 
by the authors.  
 
Acknowledgments 
 
All collaborators with this case are appreciated 
especially the patient for her cooperation. The au-
thors declare that there is no conflict of interest.  
 
References 
 
1. Service M (2009). Medical entomology for students. 4th 
ed. Cambridge University Press. UK. pp.: 93-
102. 
2. Modarres Zadeh M, Manshai K, Shaddel M, 
Oormazdi H (2006). Ocular Leishmaniasis, 
Review Article. Iran J Ophthalmol, 19(3): 1-5. 
3. World Health Organization (2010). Control of 
the leishmaniases. Geneva [Online] 
http://whqlibdoc.who.int/trs/WHO_TRS_9
49_eng.pdf  
4. Ministry of Health and Medical Education of 
Iran (2012). Care Guide Cutaneous Leishma-
niasis in Iran. 
http://health.behdasht.gov.ir/?fkeyid=&sitei
d=435&pageid=53871&catid=289&dview=1
189 
5. Doroodgar A, Sayyah M, Doroodgar M, Mah-
bobi S, Nemetian M, Rafizadeh S, Rassi Y 
(2012). Progressive increasing of cutaneous 
leishmaniasis in Kashan district, central of 
Iran. Asian Pac J Trop Dis, 2(4): 260-263. 
6. Hajjaran H, Mohebali M, Akhavan AA, Taheri 
A, Barikbin B, Nassiri S (2013). Unusual pres-
entation of disseminated cutaneous leishma-
niasis due to Leishmania major: Case reports 
of four Iranian patients. Asian Pac J Trop Med, 
6(4):333-336. 
7. Shiee MR, hajjaran H, Mohebali M, Doroodgar 
A, Hashemisaadat M, Teimouri A, AfzaliH, 
Shirzadi MR (2012). A molecular and parasi-
tological survey on cutaneous leishmaniasis 
patients from historical city of Kashan in Is-
fahan province, center of Iran. Asian Pac J 
Trop Dis, 2(6): 421-425. 
8. Veraldi S, Bottini S, Curr`o N , Gianotti R 
(2010). Leishmaniasis of the eyelid mimicking 
an infundibular cyst and review of the litera-
ture on ocular leishmaniasis. Int J Infect Dis, 14 
(Suppl 3): e230–2. 
9. Ayatollahi J, Ayatollahi A and Shah Cheraghi H 
(2013). Cutaneous Leishmaniasis of the Eye-
lid: A Case Report. Case Rep Infect 
Dis,2013:214297. 
10. Sadeghian G, NilforooshZadeh MA, Ansari N 
(2004). Palpebral Leishmaniasis with Trichia-
sis: A case report. Iran J Dermatol, 7(2): 112-
115. 
11. Satici A, Gurler B, Aslan G, Ozturk I (2004). 
Ocular involvement in cutaneous leishmania-
Doroodgaret al.: Eyelid Cutaneous Leishmaniasis… 
 
Available at:    http://ijph.tums.ac.ir                                                                                                        264 
sis: four cases with blepharoconjunctivitis. 
Eur J Epidemiol, 19(3): 263–266. 
12. Ul Bari A, Rahman S.B (2008). Many faces of cu-
taneous leishmaniasis. Indian J Dermatol Ve-
nereol Leprol, 74(1):23-7. 
13. Mortazavi H, Mohebali M, Taslimi Y, Sadeghi-
pour P, Ansari M, Kamyab K, Talebi M, 
Khamesipour A (2015). Hoarseness as the 
Presenting Symptom of Visceral Leishmania-
sis with Muco-Cutaneous Lesions: A Case 
Report. Iran J Parasitol, (10)2: 296-300. 
14. Moravvej H, Barzegar M, Nasiri S, Abolhasani 
E, Mohebali M (2013). Cutaneous Leishma-
niasis with Unusual Clinical and Histological 
Presentation: Report of Four Cases. Acta Med 
Iran, 51(4): 274-8. 
15. Abrishami M, Soheilian M, Farahi A, Dowlati Y 
(2002). Successful treatment of ocular leish-
maniasis. Eur J Dermatol, 12(1): 88-9. 
16. Khanjani Jafroodi S, Farazmand A, Amin M, 
Doroodgar A, Shirzadi MR, Razavi MR 
(2015). Methanolic Extract’s Activity of Ar-
temisia absinthium, Vitexagnus-castus and 
Phytolaca americana Against Leishmania ma-
jor; in vitro and in vivo. Int Arch Health Sci, 
2(2): 69-74. 
17. Griewank K, Gazeau C, Eichhorn A, Von Ste-
but E (2010). Miltefosine efficiently eliminates 
Leishmania major amastigotes from infected 
murine dendritic cells without altering their 
immune functions. Antimicrob Agents Chemoth-
er, 54(2):652-9 
18. Haldar AK,  Sen P,  Roy S (2011). Use of Anti-
mony in the Treatment of Leishmaniasis: 
Current Status and Future Directions. Mol Biol 
Int, 2011:571242. 
19. World Health Organization (2010).  Leishmania-
sis: Country profiles.  
http://www.who.int/leishmaniasis/resources
/IRAN.pdf?ua=1 
 
 


Eyelid cutaneous leishmaniasis: A case report

http://eprints.kaums.ac.ir/2691/1/Eyelid%20cutaneous%20leishmaniasis%20A%20case%20report.pdf

Eyelid cutaneous leishmaniasis: A case report

Abstract

Similar works

Full text

Available Versions

kashan university of medical sciences