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Journal of Tropical Medicine
Volume 2014 (2014), Article ID 170859, 8 pages
http://dx.doi.org/10.1155/2014/170859
Research Article

Concomitant Infection with Leishmania donovani and L. major in Single Ulcers of Cutaneous Leishmaniasis Patients from Sudan

1Istituto Zooprofilattico Sperimentale delle Venezie, Viale dell'Università, 10-35020 Legnaro (PD), Italy
2Department of Public Health and Comparative Pathology, University of Padua, Viale dell'Università, 16-35030 Legnaro, Italy
3Tropical Medicine Research Institute, National Centre for Research, P.O. Box 1304, Khartoum, Sudan
4Institute of Endemic Diseases, University of Khartoum, Medical Campus, Qasr Avenue, P.O. Box 45235, 11111 Khartoum, Sudan

Received 28 October 2013; Accepted 29 January 2014; Published 12 March 2014

Academic Editor: Lukasz Kedzierski

Copyright © 2014 A. M. Babiker et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

In Sudan human leishmaniasis occurs in different clinical forms, that is, visceral (VL), cutaneous (CL), mucocutaneous (ML), and post-kala-azar dermal leishmaniasis (PKDL). Clinical samples from 69 Sudanese patients with different clinical manifestations were subjected to a PCR targeting the cytochrome oxidase II (COII) gene for Leishmania species identification. Mixed infections were suspected due to multiple overlapping peaks presented in some sequences of the COII amplicons. Cloning these amplicons and alignment of sequences from randomly selected clones confirmed the presence of two different Leishmania species, L. donovani and L. major, in three out of five CL patients. Findings were further confirmed by cloning the ITS gene. Regarding other samples no significant genetic variations were found in patients with VL (62 patients), PKDL (one patient), or ML (one patient). The sequences clustered in a single homogeneous group within L. donovani genetic group, with the exception of one sequence clustering with L. infantum genetic group. Findings of this study open discussion on the synergetic/antagonistic interaction between divergent Leishmania species both in mammalian and vector hosts, their clinical implications with respect to parasite fitness and response to treatment, and the route of transmission with respect to vector distribution and or adaptation.