First Autochthonous case of Emerged Zoonotic Cutaneous Leishmaniasis in Mazandaran Province, Northern Iran: kDNA-PCR Evidence Base

Background: In the last decade, several cases of cutaneous leishmaniasis (CL) have been recorded by the provincial health center of Mazandaran Province, northern Iran. However, there is no documented report of autochthonous CL in the province yet. Case Presentation: The patient, a 59-year-old female, known case of diabetes mellitus, lived in therural area of Kiasar district (in theeastern part of the Mazandaran) with 5 skin lesions suspected of having vasculitis, without ahistory of traveling to the endemic areas of CL,was admitted to Imam Khomeini teaching hospital, Sari. To rule out CL, fine needle aspiration(FNA)procedure was used aseptically for the patient. Laboratory investigations showed Leishman bodies (amastigotes) by direct smear preparation, and species identification confirmed Leishmania major (L. major) by polymerase chain reaction (PCR)molecular method. Accordingly, this is the first documented report of autochthonous CL in Mazandaran Province. Conclusion: Overall, due to the abundance of probable rodent reservoir hosts and confirmation of infectionof sandflies (Phlebotomus papatasi) withL. major in the Kiasar district, where our patient was livingthere, it seems that CL emerged in the eastern part of the province. Therefore, further studies on rodents and sandflies fauna in terms of emerging leishmanial infection in the area is recommended.