Noor Talal Ali (1), Shahad Saad Daham (2), Lubna Arkan Yonis (3), Abdul Rahman Jihad Mansour (4)
General Background: Cutaneous leishmaniasis is a prevalent parasitic disease in endemic regions and is increasingly recognized as a systemic condition associated with metabolic and nutritional disturbances beyond skin manifestations. Specific Background: Alterations in liver function, lipid metabolism, trace elements, and vitamin status have been reported in parasitic infections; however, integrated biochemical and molecular evidence in cutaneous leishmaniasis remains limited. Knowledge Gap: There is insufficient empirical data linking molecular identification of Leishmania species with comprehensive biochemical, trace element, and vitamin profiles in affected patients. Aims: This study aimed to evaluate biochemical markers, trace elements, and vitamins in patients with cutaneous leishmaniasis and to confirm Leishmania species using PCR. Results: Compared with controls, patients showed significantly elevated liver enzymes (AST, ALT, ALP) and lipid parameters, reduced iron and zinc levels, increased copper levels, and significantly lower vitamin D3 and B12 concentrations. Nested PCR identified Leishmania tropica as the predominant species, followed by L. major. Novelty: The study integrates serological, nutritional, and molecular data, providing a holistic profile of systemic alterations associated with cutaneous leishmaniasis. Implications: These findings underscore the importance of biochemical and nutritional monitoring alongside molecular diagnosis to improve clinical management and therapeutic strategies for cutaneous leishmaniasis.Highlight :
Cutaneous leishmaniasis was associated with significant elevations in liver enzymes and serum lipid levels compared to controls.
Marked alterations in trace elements were observed, characterized by reduced iron and zinc levels alongside increased copper concentrations.
Patients exhibited significantly lower vitamin D3 and B12 levels, indicating a potential link between nutritional status and disease severity.
Rafique, A., Sani, S. S., Sultana, S., Sultana, T., Ashraf, A., and Mahmood, M. S., “Cutaneous Leishmaniasis,” in Leishmania Parasites: Epidemiology, Immunopathology and Hosts, London, UK, IntechOpen, 2023, pp. 1–21, doi: 10.5772/intechopen.
Al-Hassani, S. J. M., and Al-Bsherawee, A. I. M., “Epidemiological and Histological Study of Cutaneous Leishmaniasis in Humans in Al-Najaf Al-Ashraf Governorate,” International Journal of Health Sciences, vol. 18, no. 1, pp. 24–34, 2022.
Mann, S., Frasca, K., and Scherrer, S., “A Review of Leishmaniasis: Current Knowledge and Future Directions,” Current Tropical Medicine Reports, vol. 8, no. 2, pp. 121–132, 2021, doi: 10.1007/s40475-021-00233-9.
Ali, H. M. T., Epidemiological, Immunological and Molecular Study of Cutaneous Leishmania Parasite in Kirkuk Governorate, Ph.D. dissertation, College of Education for Pure Sciences, Tikrit University, Tikrit, Iraq, 2020.
Mancy, A., Awad, K. M., Abd-Al-Majeed, T., and Jameel, N. F., “The Epidemiology of Cutaneous Leishmaniasis in Al-Ramadi, Iraq,” Our Dermatology Online, vol. 13, no. 4, pp. 412–418, 2022, doi: 10.7241/ourd.20224.
World Health Organization, “Leishmaniasis,” 2024. Available: [https://www.who.int/health-topics/leishmaniasis](https://www.who.int/health-topics/leishmaniasis)
Balahbib, A., Hmamouch, A., El Allam, A., Douhri, H., Dahaieh, N., El Omari, N., and Bouyahya, A., “Cutaneous Leishmaniasis: Physiopathology, Molecular Diagnostic, and Therapeutic Approaches,” Progress in Microbes and Molecular Biology, vol. 6, no. 1, 2023, doi: 10.36877/pmmb.a000028.
Jayasena, K. T. D., Campbell, P. M., Wickremasinghe, R., Ranasinghe, S., Yasawardene, S., and Weerasekera, M. M., “Distinct Microbiome Profiles and Biofilms in Leishmania donovani-Driven Cutaneous Leishmaniasis Wounds,” Scientific Reports, vol. 11, no. 1, Art. no. 23181, 2021, doi: 10.1038/s41598-021-02684-1.
Flaih, M. H., Al-Abady, F. A., and Hussein, K. R., “Phylogenetic Analysis of Kinetoplast DNA of Leishmania tropica in Thi-Qar Province, Iraq,” Comparative Immunology, Microbiology and Infectious Diseases, vol. 78, Art. no. 101696, 2021, doi: 10.1016/j.cimid.2021.101696.
Alamri, Z. A., “Experimental Study on the Efficacy of Syzygium aromaticum Against Cutaneous Leishmaniasis Compared with Pentostam,” Journal of Medical and Pharmaceutical Sciences, vol. 4, no. 2, pp. 58–84, 2020.
Al-Zubaidi, W. A. S., Inhibitory Effect of Alcoholic Extract of Azadirachta indica and Zinc Oxide Nanoparticles on Cutaneous Leishmania Parasite, College of Veterinary Medicine, Tikrit University, Tikrit, Iraq, 2021.
Fahriye, E. K., Orhan, O., Tekin, K., and Mustafa, A., “Patients with Cutaneous Leishmaniasis in South-Eastern Turkey,” Journal of International Medical Research, vol. 45, no. 1, pp. 114–122, 2017, doi: 10.1177/0300060516678441.
Izadi, S., Mirhendi, H., Jalalizand, N., Khodadadi, H., Mohebali, M., and Nekoeian, S., “Molecular Epidemiological Survey of Cutaneous Leishmaniasis in Two Highly Endemic Metropolises of Iran,” Jundishapur Journal of Microbiology, vol. 9, no. 2, Art. no. e28524, 2016.
Maniatis, T., Fritsch, E. F., and Sambrook, J., Molecular Cloning: A Laboratory Manual, 2nd ed., Cold Spring Harbor, NY, USA, Cold Spring Harbor Laboratory Press, 2001.
Al-Mubashae, N. A., Effect of Cutaneous Leishmaniasis Infection on Some Physiological and Immunological Variables with a Therapeutic Trial Using Gold Nanoparticles, Ph.D. dissertation, College of Education, University of Samarra, Samarra, Iraq, 2022.
Mahshid, M., Iraj, S., Gholamreza, A., Nozar, N., Sina, K., Mohammad, R. A., and Mehdi, B., “The Impact of Diabetes on Cutaneous Leishmaniasis: A Case–Control Field Assessment,” Parasitology Research, vol. 120, no. 11, pp. 3865–3874, 2021, doi: 10.1007/s00436-021-07271-6.
Yavcini, O., Askin, L., Secen, O., Turkmen, S., Akturk, E., Tanriverdi, O., and Dagli, M. N., “Copeptin Levels in Patients with Coronary Artery Ectasia,” Interventional Medicine and Applied Science, vol. 11, no. 2, pp. 112–116, 2019.
Ahmed, A. A., Abdelrahman, M. M., Attia, H. M., Hafez, A., Rashed, S. A., Amin, Y. A., and Hemdan, S. B., “Decreased Serum Zinc, Selenium, and Vitamin E as Possible Risk Factors of Hepatic Fibrosis in Non-Alcoholic Fatty Liver Disease,” Nutrition and Health, 2022, doi: 10.1177/02601060221103032.
Isa, A. N., Harman, M., and Hakim, Ç., “The Effect of Pentavalent Antimonial Compounds Used in the Treatment of Cutaneous Leishmaniasis,” Cutaneous and Ocular Toxicology, vol. 38, no. 3, pp. 294–297, 2019.
Dufour, D., “Evaluation of Liver Function and Injury,” in Clinical Diagnosis and Management by Laboratory Methods, J. Henry, Ed., Philadelphia, PA, USA, W. B. Saunders, 2001, pp. 264–280.
Shaymaa, Z. A., Luma, R. L., Alyaa, A. H., and Bassad, A. A., “Hematological and Biochemical Levels in Patients with Cutaneous Leishmaniasis in Thi-Qar Province, Iraq,” International Journal of Research, vol. 4, no. 1, pp. 45–52, 2017.
Tountas, V., Clicerio, G., James, B., and Ferrannini, E., “Hypertension and Diabetes Mellitus Coprediction and Time Trajectories,” Hypertension, vol. 71, no. 3, pp. 422–428, 2018.
Rabhi, S., Rammal, I., Tawk, B., Piquemal, D., Rachidi, B., and Guizani, I., “Lipid Droplet Formation, Localization and Dynamics During Leishmania major Macrophage Infection,” PLoS One, vol. 11, no. 2, Art. no. e0148640, 2016.
Borén, J., and Adiels, M., “Metabolism of Triglyceride-Rich Lipoproteins,” in Handbook of Experimental Pharmacology, vol. 270, Berlin, Germany, Springer, 2020.
Martínez, R. C., Ruiz, S., and Cristian, J., “Alterations in Host Lipid Metabolism Produced During Visceral Leishmaniasis Infections,” Current Tropical Medicine Reports, vol. 6, pp. 250–255, 2019.
Al-Hassani, M. K., and Al-Mayali, H. M. H., “Evaluation of Some Biochemical Levels in Patients with Cutaneous Leishmaniasis Serum and Their Relationship with Antioxidant Enzyme,” Eurasian Journal of Biosciences, vol. 14, no. 1, pp. 1999–2006, 2020.
Dighal, A., Mukhopadhyay, D., Sengupta, R., and Moulik, S., “Iron Trafficking in Patients with Indian Post Kala-Azar Dermal Leishmaniasis,” PLoS Neglected Tropical Diseases, vol. 14, no. 2, Art. no. e0007991, 2020.
Melo, R. D., Guarneri, A. A., and Silber, A. M., “The Influence of Environmental Cues on the Development of Trypanosoma cruzi in Triatominae Vector,” Frontiers in Cellular and Infection Microbiology, vol. 10, Art. no. 27, 2020.
Mozzi, A., Forni, D., Clerici, M., Cagliani, R., and Sironi, M., “The Diversity of Mammalian Hemoproteins and Microbial Heme Scavengers Is Shaped by an Arms Race for Iron Piracy,” Frontiers in Immunology, vol. 9, Art. no. 2086, 2018.
Laranjeira-Silva, M. F., Hamza, I., and Perez-Victoria, J. M., “Iron and Heme Metabolism at the Leishmania–Host Interface,” Trends in Parasitology, vol. 36, no. 3, pp. 279–289, 2020.
Al-Jubouri, A. A. F., Diagnosis of Intestinal Parasites and Cutaneous Leishmaniasis and Measurement of Trace Elements in Serum of Infected Patients in Al-Shirqat City, M.Sc. thesis, Tikrit University, Tikrit, Iraq, 2020.
Tamara, S. T., Ali, F. R., and Al-Niaimi, F., “Zinc in Dermatology,” Journal of Dermatological Treatment, pp. 1–4, 2022.
Al-Hassani, M. K. K., Trace Element Levels and Their Relationship with Antioxidant Enzymes and Immune Factors in Cutaneous Leishmaniasis, Ph.D. dissertation, College of Education, University of Al-Qadisiyah, Iraq, 2020.
Zarebavani, M., Dargahi, D., Einollahi, N., Dashti, N., Mohebali, M., and Rezaeian, M., “Serum Levels of Zinc, Copper, Vitamin B12, Folate and Immunoglobulins in Individuals with Giardiasis,” Iranian Journal of Public Health, vol. 41, no. 12, pp. 47–54, 2012.
Fartusie, F. S., and Mohssan, S. N., “Essential Trace Elements and Their Vital Roles in the Human Body,” Indian Journal of Advances in Chemical Science, vol. 5, no. 3, pp. 127–136, 2017.
Salem, F. A., Al-Salahy, M. B., Gadalla, D., and Al-Nemari, H. H., “Vitamin D Status, Vitamin D Receptor Gene Polymorphism and Haplotype in Patients with Cutaneous Leishmaniasis,” PLoS Neglected Tropical Diseases, vol. 17, no. 7, Art. no. e0011515, 2023.
Rawal, G., Yadav, S., and Shokeen, P., “Health and the Vitamin D,” International Journal of Health Sciences Research, vol. 5, pp. 416–423, 2015.
Ross, A. C., Abrams, S. A., Aloia, J. F., Brannon, P. M., Clinton, S. K., and Durazo-Arvizu, R. A., Dietary Reference Intakes for Calcium and Vitamin D, Washington, DC, USA, National Academies Press, 2011.
Samanta, S., Roy, S., Saha, S., and Ashif, A. S., “Assessment of Nutritional Status Among Post Kala-Azar Dermal Leishmaniasis Patients in Northern West Bengal, India,” Journal of Parasitic Diseases, vol. 49, no. 1, pp. 42–51, 2025.
Alvar, J., Vélez, I. D., Bern, C., Herrero, M., Desjeux, P., Cano, J., Jannin, J., and den Boer, M., “Leishmaniasis Worldwide and Global Estimates of Its Incidence,” PLoS One, vol. 7, no. 5, Art. no. e35671, 2012.
Flaih, M. H., Al-Abady, F. A., and Hussein, K. R., “Detection of Leishmania tropica Using Nested PCR and Some of Their Virulence Factors in Thi-Qar Province, Iraq,” Baghdad Science Journal, vol. 18, no. 1, pp. 1–10, 2021.
Mohammed, B. O., “Prevalence and Molecular Detection of Cutaneous Leishmaniasis in Tikrit,” Journal of Parasitic Diseases, vol. 45, no. 2, pp. 123–130, 2021.
Rahi, A. A., Hashim, Z. K., and Al-Jamea, A. M., “Epidemiological Study of Cutaneous Leishmaniasis in Wasit Province,” Journal of Toxicology, vol. 15, no. 4, pp. 526–529, 2021.
Mirahmadi, H., Rahimi, M., and Hoesseni, S., “Molecular Detection of Leishmania Species in Human Cutaneous Lesions Using Nested PCR in Sistan and Baluchestan, Iran,” Journal of Advanced Genetics, vol. 14, no. 3, pp. 145–152, 2022.