Clinical feactures of cutaneous leishmaniasis due to Leishmania tropica inan emerging focus in North Morocco.

introduction. Leishmania tropica cutaneous leishmaniasis is usually describ ed as dry, small and self-healing lesions, mainly located on the face and o ccurring in stable endemic Foci. In 1989, similar aspects were observed in a rural hypoendemic focus in center Morocco where about 60 cases were diagn osed. In contrast, an epidemic urban focus in Taza - North Morocco - was id entified in 1995 with peculiar clinical aspects. Our objectives is to descr ibe these clinical characteristics. Patients and methods. From October 1995 to November 1996, 132 cases were di agnosed From this new focus during a monthly active survey. Age, sex, durat ion of lesions, clinical aspects and therapeutic regimen were detailed for each patient. Results. Among the patients, 56.8 p. 100 were women. Mean age was 24.6 +/- 21.5 years (range: 8 months to 85 years). The mean duration of lesions was 6.9 +/- 6.5 months and 91.4 p. 100 evoluted for less than one year. Impetig inized, ulcerocrusted and noduloulcerative forms were predominant (61 p. 10 0). Furthermore, severe, vegetant inflammatory and multiple lesions were ob served in infants and elderly patients. Limbs were involved in 30 p. 100 of cases. Eighty-six patients were treated with intralesional glucantime regi men and cured in 72 p. 100 of cases. intramuscular treatment by glucantime was required in case of multiple lesions and failure of local therapy. Discussion. In this study, the high frequency of severe lesions in infants and elderly patients suggests that the introduction of the parasite occurre d recently in this area. The brief duration of lesions confirms the acute c haracter For cutaneous leishmaniasis related to L. tropica in this epidemic focus. The host immune status associated with parasite intrinsic factors p robably plays a role in these perculiar clinical manifestations.