Background:
Cutaneous leishmaniasis (CL) constitutes a real public health problem in Tunisia mainly due to its consequences in terms of quality of life. The identification of the clinical and epidemiological characteristics of the different forms of CL will facilitate the differentiation between them and will be useful for the therapeutic management, the prognostic evaluation and the adjustment of control measures. The aim of this study was to identify the different forms of CL in the city of Ghomrassen in Southern Tunisia according to parasite species and to describe the epidemiological and clinical profile of each form.

Methods:
A prospective descriptive study was conducted between 07/02/2018 and 12/06/2020 at Ghomrassen primary healthcare facility in Tataouine. Adult volunteers between 18 and 65 years of age with CL were included in this study. Each participant was followed until lesions were healed with a maximum follow-up time of one year from the date of the first visit. Species were identified using the PCR-RFLP (Polymerase chain reaction- Restriction fragment length polymorphism).

Results:
A total of 262 patients were included. Parasite species were identified in 64.1% of participants, of whom 83.9% were infected by L. major. L. major lesions occurred mainly in autumn (54.6%), were mostly multiple (58.2%) and situated on limbs (94.3%). On the other hand, L. tropica lesions occurred mainly in winter (44.4%, p=0.02) and were mostly single (63.0%, p=0.05). The duration of lesion evolution was comparable between L. major and L. tropica (151 days±4.5 vs 148±3.8, p=0.9).

Conclusions:
The coexistence of two species of leishmaniasis in the same geographical area argues for the promotion of species identification by encouraging the development of sensitive, specific, and easy-to-use tests that can be used in primary health care facilities in endemic rural regions.