{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T20:07:08Z","timestamp":1779394028964,"version":"3.53.1"},"update-to":[{"DOI":"10.1371\/journal.pntd.0012006","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2024,3,14]],"date-time":"2024-03-14T00:00:00Z","timestamp":1710374400000}}],"reference-count":55,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2024,3,4]],"date-time":"2024-03-04T00:00:00Z","timestamp":1709510400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81702018"],"award-info":[{"award-number":["81702018"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Beijing High Level Public Health Training Project","award":["Backbone Programme-20-05"],"award-info":[{"award-number":["Backbone Programme-20-05"]}]}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"\nBackground<\/jats:title>\nImported cutaneous leishmaniasis (CL) is a growing problem with increasing global travel to endemic areas. Returned travelers with CL are easy to be misdiagnosed and mistreated due to the lack of awareness for the disease to the physicians in non-endemic region that may lead to unfavorable outcome. Our study intends to summarize the characteristics of Leishmania<\/jats:italic> infection imported from Iraq, so as to help Chinese physicians diagnose and treat the disease. All CL patients were treated with intralesional injection of antimony.<\/jats:bold><\/jats:p>\n<\/jats:sec>\n\nMethods<\/jats:title>\nThe definitive diagnosis of CL is based on the parasite identification by microscopic examination directly on lesion smear or parasite culture, PCR amplification of Leishmania<\/jats:italic>-specific internal transcribed spacer 1 (ITS-1). The phylogenetic analysis, the immunopathological examination and<\/jats:bold> the cytokine detection were proceeded after the diagnosis.<\/jats:p>\n<\/jats:sec>\n\nResults<\/jats:title>\nWe have identified 25 CL cases in migrant Chinese workers returned from Iraq for the first time with L<\/jats:italic>. major<\/jats:italic> as the major species of infected Leishmania<\/jats:italic> parasite. Clinical features of the Iraq-imported CL include the history of skin exposure to sandflies bite and the lesions mostly on the exposed limbs. More ulcerative wet lesion was observed than nodular dry lesion. PCR is not only used to detect Leishmania<\/jats:italic> parasite with high sensitivity, but also to identify the species of infected parasite through sequencing the amplified Leishmania<\/jats:italic>-specific ITS-1 gene. The phylogenetic analysis based on the amplified ITS-1 sequences revealed that the infected Leishmania<\/jats:italic> was closed related to the species and strains endemic in Iraq. The immunopathological examination revealed the T-cell filtrated cellular immune response with less B cells and NK cells involved. The cytokine profile measured in the skin lesion also confirmed the Th1 cellular response with higher expression levels of IFN-\u03b3, IL-6 and IL-8. The skin lesions in CL patients were healed after being treated locally with antimony.<\/jats:p>\n<\/jats:sec>\n\nConclusions<\/jats:title>\nThe clinical and parasitological features of these Chinese CL cases imported from Iraq provide useful information for the diagnosis and treatment of CL that is not commonly seen in Chinese local population.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pntd.0012006","type":"journal-article","created":{"date-parts":[[2024,3,4]],"date-time":"2024-03-04T18:33:30Z","timestamp":1709577210000},"page":"e0012006","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":6,"title":["Clinical and laboratory characterization of cutaneous leishmaniasis in Chinese migrant workers returned from Iraq"],"prefix":"10.1371","volume":"18","author":[{"given":"Kuo","family":"Bi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoli","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyan","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fei","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Zou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8829-0246","authenticated-orcid":true,"given":"Lei","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,3,4]]},"reference":[{"issue":"10151","key":"pntd.0012006.ref001","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1016\/S0140-6736(18)31204-2","article-title":"Leishmaniasis","volume":"392","author":"S Burza","year":"2018","journal-title":"Lancet"},{"key":"pntd.0012006.ref002","author":"WHO","year":"2023","journal-title":"Leishmaniasis"},{"key":"pntd.0012006.ref003","doi-asserted-by":"crossref","first-page":"e55","DOI":"10.1590\/s1678-9946202365055","article-title":"Genetic variability of Leishmania (Leishmania) infantum causing human visceral leishmaniasis in the Southeastern Brazil.","volume":"65","author":"VA Lima","year":"2023","journal-title":"Rev Inst Med Trop Sao Paulo"},{"issue":"3","key":"pntd.0012006.ref004","doi-asserted-by":"crossref","first-page":"489","DOI":"10.4269\/ajtmh.15-0408","article-title":"Social and Economic Burden of Human Leishmaniasis","volume":"94","author":"I Okwor","year":"2016","journal-title":"Am J Trop Med Hyg"},{"issue":"4","key":"pntd.0012006.ref005","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1093\/labmed\/lmac134","article-title":"Review of the Clinical Presentation, Pathology, Diagnosis, and Treatment of Leishmaniasis.","volume":"54","author":"BA Mathison","year":"2023","journal-title":"Lab Med."},{"issue":"1","key":"pntd.0012006.ref006","doi-asserted-by":"crossref","first-page":"113","DOI":"10.55460\/IMV2-JGWD","article-title":"Cutaneous Leishmaniasis.","volume":"21","author":"EM Crecelius","year":"2021","journal-title":"J Spec Oper Med"},{"issue":"6","key":"pntd.0012006.ref007","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1016\/j.jaad.2014.09.014","article-title":"Cutaneous and mucocutaneous leishmaniasis: Differential diagnosis, diagnosis, histopathology, and management","volume":"73","author":"MZ Handler","year":"2015","journal-title":"J Am Acad Dermatol"},{"issue":"1","key":"pntd.0012006.ref008","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/2049-9957-3-10","article-title":"Historical experience in the elimination of visceral leishmaniasis in the plain region of Eastern and Central China.","volume":"3","author":"LR Guan","year":"2014","journal-title":"Infect Dis Poverty"},{"issue":"1","key":"pntd.0012006.ref009","first-page":"51","article-title":"Achievement on the epidemiology and control of kala-azar in China.","volume":"21","author":"W Zhao","year":"2000","journal-title":"Chin. J. Epidemiol"},{"key":"pntd.0012006.ref010","author":"WHO","year":"2024","journal-title":"WHO Global Health Observatory"},{"key":"pntd.0012006.ref011","first-page":"49","article-title":"Leishmaniasis in China-present status of prevalence and some suggestions on its control.","volume":"15","author":"LR Guan","year":"2000","journal-title":"End Dis Bull."},{"key":"pntd.0012006.ref012","doi-asserted-by":"crossref","first-page":"959901","DOI":"10.3389\/fmicb.2022.959901","article-title":"Epidemiological features and spatial-temporal clustering of visceral leishmaniasis in mainland China from 2019 to 2021.","volume":"13","author":"Y Li","year":"2022","journal-title":"Front Microbiol."},{"issue":"4","key":"pntd.0012006.ref013","first-page":"803","article-title":"Eight cutaneous leishmaniasis cases detected in Karamay, Xinjiang Uygur Autonomous region","volume":"23","author":"LR Guan","year":"1992","journal-title":"China. Southeast Asian J Trop Med Public Health"},{"issue":"1","key":"pntd.0012006.ref014","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/2049-9957-2-20","article-title":"Discovery and study of cutaneous leishmaniasis in Karamay of Xinjiang, West China.","volume":"2","author":"LR Guan","year":"2013","journal-title":"Infect Dis Poverty"},{"issue":"4","key":"pntd.0012006.ref015","first-page":"257","article-title":"Leishmaniasis in Karamay. XIV. Identification of promastigote isolates from naturally infected Phlebotomus major wui","volume":"12","author":"LR Guan","year":"1994","journal-title":"Chin J Parasitol Parasitic Dis"},{"issue":"2","key":"pntd.0012006.ref016","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1017\/S0031182022001640","article-title":"Revisiting epidemiology of leishmaniasis in central Asia: lessons learnt","volume":"150","author":"V Yurchenko","year":"2023","journal-title":"Parasitology"},{"issue":"4","key":"pntd.0012006.ref017","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1080\/20477724.2022.2133452","article-title":"Prevalence of cutaneous Leishmaniasis in the Middle East: a systematic review and meta-analysis.","volume":"117","author":"M Karami","year":"2023","journal-title":"Pathog Glob Health"},{"key":"pntd.0012006.ref018","unstructured":"Nedopil C. China Belt and Road Initiative (BRI) Investment Report 2021. 2022."},{"issue":"3","key":"pntd.0012006.ref019","first-page":"295","article-title":"Pathogen Identification in an Imported Case of Cutaneous Leishmaniasis.","volume":"34","author":"DH Lai","year":"2016","journal-title":"Chin J Parasitol Parasitic Dis"},{"issue":"6","key":"pntd.0012006.ref020","first-page":"461","article-title":"Detection and species identification of two imported cases of cutaneous leishmaniasis","volume":"29","author":"YT Yang","year":"2011","journal-title":"Chin J Parasitol Parasitic Dis"},{"issue":"4","key":"pntd.0012006.ref021","first-page":"418","article-title":"Epidemiological screening of an epidemic of imported cutaneous leishmaniasis in Luoyang City.","volume":"31","author":"Z Yan-Ling","year":"2019","journal-title":"Chin J Schisto Control"},{"issue":"3","key":"pntd.0012006.ref022","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1590\/abd1806-4841.20163820","article-title":"Imported cutaneous leishmaniasis caused by Leishmania major in a Chinese laborer who worked in Saudi Arabia.","volume":"91","author":"M Zhang","year":"2016","journal-title":"An Bras Dermatol"},{"issue":"3","key":"pntd.0012006.ref023","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.tmaid.2009.03.003","article-title":"A practical approach to common skin problems in returning travellers.","volume":"7","author":"BM O\u2019Brien","year":"2009","journal-title":"Travel Med Infect Dis."},{"issue":"9","key":"pntd.0012006.ref024","first-page":"513","article-title":"Clinical Expert Consensus on diagnosis and treatment of Leishmaniasis in China.","volume":"35","author":"Diseases EBOC","year":"2017","journal-title":"Chin J Infect Dis"},{"issue":"12","key":"pntd.0012006.ref025","doi-asserted-by":"crossref","first-page":"e202","DOI":"10.1093\/cid\/ciw670","article-title":"Diagnosis and Treatment of Leishmaniasis: Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH).","volume":"63","author":"N Aronson","year":"2016","journal-title":"Clin Infect Dis"},{"key":"pntd.0012006.ref026","doi-asserted-by":"crossref","first-page":"581639","DOI":"10.3389\/fcimb.2020.581639","article-title":"Application of Quantitative PCR in the Diagnosis and Evaluating Treatment Efficacy of Leishmaniasis.","volume":"10","author":"Y Wu","year":"2020","journal-title":"Front Cell Infect Microbiol"},{"issue":"6","key":"pntd.0012006.ref027","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1007\/s40257-022-00726-8","article-title":"Cutaneous Leishmaniasis: A 2022 Updated Narrative Review into Diagnosis and Management Developments.","volume":"23","author":"HJC de Vries","year":"2022","journal-title":"Am J Clin Dermatol."},{"issue":"3","key":"pntd.0012006.ref028","first-page":"7","article-title":"Comparative cellular immune host response in acute vs healed lesions of cutaneous leishmaniasis.","volume":"18","author":"SB Rahman","year":"2006","journal-title":"J Ayub Med Coll Abbottabad"},{"issue":"4","key":"pntd.0012006.ref029","first-page":"371","article-title":"Immunophenotypic pattern and cytokine profiles of dry type cutaneous leishmaniasis","volume":"12","author":"S Meymandi","year":"2009","journal-title":"Arch Iran Med"},{"issue":"1","key":"pntd.0012006.ref030","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1007\/s40506-015-0038-4","article-title":"Cutaneous Leishmaniasis: Current Treatment Practices in the USA for Returning Travelers.","volume":"7","author":"DP Eiras","year":"2015","journal-title":"Curr Treat Options Infect Dis."},{"key":"pntd.0012006.ref031","doi-asserted-by":"crossref","first-page":"685296","DOI":"10.3389\/fcimb.2021.685296","article-title":"Mechanisms of Immunopathogenesis in Cutaneous Leishmaniasis And Post Kala-azar Dermal Leishmaniasis (PKDL).","volume":"11","author":"G Volpedo","year":"2021","journal-title":"Front Cell Infect Microbiol"},{"issue":"2","key":"pntd.0012006.ref032","doi-asserted-by":"crossref","first-page":"123","DOI":"10.3855\/jidc.59","article-title":"Cutaneous leishmaniasis in Iraq.","volume":"3","author":"AM AlSamarai","year":"2009","journal-title":"J Infect Dev Ctries"},{"issue":"2","key":"pntd.0012006.ref033","first-page":"111","article-title":"Challenge and strategy of prevention and control of important parasitic diseases under the Belt and Road Initiative.","volume":"30","author":"C Chun-Li","year":"2018","journal-title":"Chin J Schisto Control"},{"issue":"3","key":"pntd.0012006.ref034","first-page":"247","article-title":"Investigating the Aggregation of Imported Cutaneous Leishmaniasis in Henan, Central China","volume":"34","author":"YL Zhao","year":"2021","journal-title":"Biomed Environ Sci"},{"issue":"4","key":"pntd.0012006.ref035","first-page":"456","article-title":"Laboratory diagnosis of an imported case of visceral leishmaniasis in Henan Province.","volume":"31","author":"L Su-Hua","year":"2019","journal-title":"Chin J Schisto Control"},{"issue":"4","key":"pntd.0012006.ref036","first-page":"428","article-title":"Transmission risk matrix assessment of imported leishmaniasis","volume":"30","author":"H Yu-Wan","year":"2018","journal-title":"China. Chin J Schisto Control"},{"issue":"4","key":"pntd.0012006.ref037","first-page":"1","article-title":"A case of imported visceral leishmaniasis in Tengchong County of Yunnan","volume":"32","author":"JZ Wang","year":"2014","journal-title":"Chin J Parasitol Parasitic Dis"},{"issue":"4","key":"pntd.0012006.ref038","first-page":"1","article-title":"Two imported cases of visceral leishmaniasis in Kunming.","volume":"28","author":"ZJ Deng","year":"2010","journal-title":"Chin J Parasitol Parasitic Dis"},{"issue":"3","key":"pntd.0012006.ref039","first-page":"1","article-title":"First imported case of visceral leishmaniasis in Hainan Province.","volume":"26","author":"FL Jiang","year":"2008","journal-title":"Chin J Parasitol Parasitic Dis"},{"key":"pntd.0012006.ref040","first-page":"1","article-title":"Control of the leishmaniases.","volume":"xiii","author":"WHO","year":"2010","journal-title":"World Health Organ Tech Rep Ser"},{"key":"pntd.0012006.ref041","doi-asserted-by":"crossref","first-page":"105327","DOI":"10.1016\/j.meegid.2022.105327","article-title":"Serological and molecular detection of Leishmania species in dog peripheral blood from Bobo-Dioulasso city, a confirmation of canine leishmaniasis enzootic area for Burkina Faso","volume":"103","author":"AD Djibougou","year":"2022","journal-title":"Infect Genet Evol"},{"key":"pntd.0012006.ref042","doi-asserted-by":"crossref","first-page":"100026","DOI":"10.1016\/j.vpoa.2020.100026","article-title":"Experimental assessment of permethrin-fipronil combination in preventing Leishmania infantum transmission to dogs under natural exposures","volume":"3","author":"E Papadopoulos","year":"2020","journal-title":"Vet Parasitol X"},{"issue":"10","key":"pntd.0012006.ref043","doi-asserted-by":"crossref","first-page":"e3208","DOI":"10.1371\/journal.pntd.0003208","article-title":"Leishmaniasis in the Middle East: incidence and epidemiology.","volume":"8","author":"N Salam","year":"2014","journal-title":"PLoS Negl Trop Dis."},{"issue":"1","key":"pntd.0012006.ref044","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1186\/s40249-023-01103-1","article-title":"High-risk spatiotemporal patterns of cutaneous leishmaniasis: a nationwide study in Iran from 2011 to 2020.","volume":"12","author":"N Firouraghi","year":"2023","journal-title":"Infect Dis Poverty."},{"issue":"Suppl 1:","key":"pntd.0012006.ref045","doi-asserted-by":"crossref","first-page":"S62","DOI":"10.1016\/j.ijantimicag.2010.06.023","article-title":"Leishmaniasis in the World Health Organization Eastern Mediterranean Region.","volume":"36","author":"JA Postigo","year":"2010","journal-title":"Int J Antimicrob Agents."},{"issue":"2","key":"pntd.0012006.ref046","first-page":"326","article-title":"Typing of Leishmania Species Causing Cutaneous Leishmaniasis by Sybr Green Based ITS-1 Real Time Polymerase Chain Reaction Method.","volume":"56","author":"G Gurses","year":"2022","journal-title":"Mikrobiyol Bul"},{"issue":"3","key":"pntd.0012006.ref047","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1007\/s12223-017-0556-1","article-title":"Molecular identification of Leishmania spp. isolates causes cutaneous leishmaniasis (CL) in Sanliurfa Province, Turkey, where CL is highly endemic.","volume":"63","author":"G Gurses","year":"2018","journal-title":"Folia Microbiol (Praha)"},{"key":"pntd.0012006.ref048","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1051\/parasite\/2014014","article-title":"Cutaneous leishmaniasis in North Africa: a review.","volume":"21","author":"K Aoun","year":"2014","journal-title":"Parasite"},{"key":"pntd.0012006.ref049","doi-asserted-by":"crossref","first-page":"1197149","DOI":"10.3389\/fpubh.2023.1197149","article-title":"Leishmania donovani visceral leishmaniasis diagnosed by metagenomics next-generation sequencing in an infant with acute lymphoblastic leukemia: a case report","volume":"11","author":"L Chang","year":"2023","journal-title":"Front Public Health"},{"issue":"11","key":"pntd.0012006.ref050","doi-asserted-by":"crossref","first-page":"e0009944","DOI":"10.1371\/journal.pntd.0009944","article-title":"Clinical and laboratory characteristics of hemophagocytic lymphohistiocytosis induced by Leishmania infantum infection.","volume":"15","author":"Q Shi","year":"2021","journal-title":"PLoS Negl Trop Dis"},{"key":"pntd.0012006.ref051","doi-asserted-by":"crossref","first-page":"e00240","DOI":"10.1016\/j.parepi.2022.e00240","article-title":"Molecular-based assay for genotyping Leishmania spp. from clinically suspected cutaneous leishmaniasis lesions in the Garmian area, Kurdistan Region of Iraq.","volume":"17","author":"HM Tawfeeq","year":"2022","journal-title":"Parasite Epidemiol Control"},{"issue":"2","key":"pntd.0012006.ref052","first-page":"99","article-title":"A Historic Review of the Role of CD4+ T-Cell Subsets in Development of the Immune Responses against Cutaneous and Visceral Leishmaniases","volume":"26","author":"MH Alimohmmadian","year":"2022","journal-title":"Iran Biomed J"},{"key":"pntd.0012006.ref053","doi-asserted-by":"crossref","first-page":"155320","DOI":"10.1016\/j.cyto.2020.155320","article-title":"Cytokines in the immunity and immunopathogenesis in leishmaniases","volume":"145","author":"B Saha","year":"2021","journal-title":"Cytokine"},{"issue":"11","key":"pntd.0012006.ref054","doi-asserted-by":"crossref","first-page":"e0007865","DOI":"10.1371\/journal.pntd.0007865","article-title":"Lymphocytes influence Leishmania major pathogenesis in a strain-dependent manner.","volume":"13","author":"MA Musa","year":"2019","journal-title":"PLoS Negl Trop Dis"},{"key":"pntd.0012006.ref055","doi-asserted-by":"crossref","first-page":"155247","DOI":"10.1016\/j.cyto.2020.155247","article-title":"Th1 concomitant immune response mediated by IFN-gamma protects against sand fly delivered Leishmania infection: Implications for vaccine design","volume":"147","author":"N Seyed","year":"2021","journal-title":"Cytokine"}],"updated-by":[{"DOI":"10.1371\/journal.pntd.0012006","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2024,3,14]],"date-time":"2024-03-14T00:00:00Z","timestamp":1710374400000}}],"container-title":["PLOS Neglected Tropical Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0012006","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,14]],"date-time":"2024-03-14T17:55:11Z","timestamp":1710438911000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0012006"}},"subtitle":[],"editor":[{"given":"Gabriele","family":"Sch\u00f6nian","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,3,4]]},"references-count":55,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2024,3,4]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pntd.0012006","relation":{"new_version":[{"id-type":"doi","id":"10.1371\/journal.pntd.0012006","asserted-by":"object"}]},"ISSN":["1935-2735"],"issn-type":[{"value":"1935-2735","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,4]]}}}