Research Article Open Access Alidadi and Oryan, Trop Med Surg 2014, 2:2 http://dx.doi.org/10.4172/2329-9088.1000e114 Editorial Open Access Tropical Medicine & Surgery Volume 2 • Issue 2 • 1000e114 Trop Med Surg ISSN: 2329-9088 TPMS, an open access journal Despite zoonotic leishmaniasis is considered as a public health problem worldwide, it is one of the most neglected diseases [1,2]. his disease is identiied by an annual incidence of about 2 million cases and a prevalence of 12 million cases globally [3]. Leishmaniasis is the third most important vector-borne disease ater malaria and ilariasis [4]. he disease is caused by the intracellular protozoa of the genus Leishmania, is common in tropical and subtropical regions of the world and transmitted by phlebotomine sand lies [5]. he numbers of the leishmaniasis cases are increasing throughout because of some factors such as the lack of vaccines, the increased parasites resistance to chemotherapy and inability to controlling vectors. Depending on the tropism, leishmaniasis can be divided into at least four forms namely cutaneous leishmaniasis (CL), muco-cutaneous leishmaniosis (MCL) or mucosal leishmaniasis (ML), visceral leishmaniosis (VL) also known as kala-azar, and post kala-azar dermal leishmaniasis (PKAL) [6,7]. Approximately three-quarters of incidence cases of leishmaniasis are related to CL [6]. Leishmaniasis can vary from a self-limiting cutaneous disease to a fatal visceral disease depending on the efecting species [8]. CL is characterized by the presence of one or more ulcers which may heal spontaneously or persist for period of some months [4]. Rarely, CL may be transformed into ML at the advanced stages, if untreated [9]. In the Old World, CL is caused by primarily Leishmania major, and then L. tropica, L. infantum, and L. aethiopica [1,10,11], while in the New World, it is caused by L. Mexicana, L. braziliensis, and L. guyanensis species [6,12]. he parasite Leishmania exists in the extracellular promastigote form, inside the midgut of the vector and culture media, and in the intracellular amastigote form, in the mammalian host [2,13]. Diagnosis of the disease is made based on demonstration of the parasite by methods such as ine-needle biopsy of lymph nodes, bone marrow aspiration, splenic puncture, skin scraping cytology and culture [3,10]. Cytology including touch smear and needle aspiration is cheap and performed with high sensitivity for the typical cases, but it may be unable to detect the atypical cases of leishmaniasis [14,15]. he serology tests are limited because of the probable cross reaction of antibodies with some diseases like toxoplasmosis and trypanosomiasis [15]. Other methodologies such as immunohistochemistry (ICH) and polymerase chain reaction (PCR) are preferably applied for supplementary diagnosis of the disease in particularly CL form [1,15-17]. Treatment of CL may be topical or systemic, on the basis of several factors such as Leishmania species, geographic regions and clinical manifestations [18]. For focal therapy, thermotherapy, cryotherapy, paromomycin ointment, local iniltration with antimonials may be promising options with less systemic toxicity. Systemic treatment is provided by using azole drugs, miltefosine, pentavalent antimonials, pentamidine and amphotericin B and its liposomal formulation [18,19]. Early diagnosis and appropriate treatment are important for the management and control of CL and due to the risk of developing the ML or MCL [4]. Since, the control and prevention of leishmaniasis based on chemotherapeutic treatments is expensive, toxic, and associated with high recurrence and resistance rate therefore, it is performed based on vector and reservoir control and vaccines [8]. However sand lies possess the biomechanical defensive mechanisms, they are suspected to insecticides [4,20]. Indeed, the application of insecticide-impregnated clothing and curtains and also implementing training programs for early diagnosis are promising and cost-efective preventive strategies for reducing leishmaniasis transmission [4]. Disease control and prevention are diicult and challenging because of the complexity of the control of the vectors and the reservoir hosts especially rodents and asymptomatic dogs [13,20-22]. Meanwhile, the protection of canine populations as an important reservoir of Leishmania species is crucial. herefore, considerable attempts should be made towards monitoring of the prevalence and incidence of canine leishmaniasis and developing cost-efecting control strategies against this disease [20]. Development of a safe, eicient and cost-efective vaccine is the critical global public-health propriety [8]. An ideal vaccine developed against the disease should be eicient, safe, reproducible, and cost-efective and used for efective therapeutic and anaphylactic indications. Moreover, it must contain antigens sharing among several species, protect against infection and disease, and induce relevant T helper 1 and 2 cell responses [7,8]. Vaccine antigens should be maintained between species and thus cross-protective against diferent Leishmania parasite species [7]. Vaccines based on live Leishmania promastigotes harvested from cultures or leishmanization have adverse side efects including persistent lesions, psoriasis, as well as concerns of standardization and quality control, and immunosuppression [8]. he live-attenuated antileishmanial vaccines are still at their early stages of development [8] and the advances in the development of these live attenuated parasites may make a promising vaccine approach [7]. hese vaccines ofer a new approach to immunization against leishmaniasis, while there are concerns that the parasite may revert to a virulent form, and the destruction of the parasite due to deletion of essential virulence genes [7,8]. So, these may make the use of killed parasites more attractive for vaccine options [8]. Formulation of the irst generation vaccines against leishmaniasis include whole killed or fractions of the Leishmania parasites is diicult to standardize [6,8]. hese vaccines are inadequate to produce long lasting and relevant immune responses required for protection [6]. Second-generation vaccines composed of vaccines using recombinant viruses and bacteria as delivery vehicles expressing Leishmania parasite antigens [6,8]. hese vaccines are safe because of they do not contain any pathogenic organism [8]. hird- generation vaccines or DNA vaccines have some advantages such Cutaneous Leishmaniasis and the Strategies for Its Prevention and Control Alidadi S and Oryan A* Department of Pathology, School of Veterinary Medicine, Shiraz University, Iran *Corresponding author: Oryan A, Department of Pathology, School of Veterinary Medicine, Shiraz University, Shiraz, Iran, Tel: 0711-2286950; E-mail: oryan@shirazu.ac.ir Received February 25, 2014; Accepted February 27, 2014; Published February 28, 2014 Citation: Alidadi S, Oryan A (2014) Cutaneous Leishmaniasis and the Strategies for Its Prevention and Control. Trop Med Surg 2: e114. doi:10.4172/2329- 9088.1000e114 Copyright: © 2014 Alidadi S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.