Accumulating evidence, persistent uncertainty: Leishmania RNA virus 2 in Old-World cutaneous leishmaniasis - from detection to decision-useful surveillance.

Leishmania RNA virus 2 (LRV2) has emerged as a potential molecular co-determinant of clinical outcomes in Leishmania major infections, particularly within the Old-World cutaneous leishmaniasis (CL) belt. Recent molecular investigations from Iran and adjacent endemic regions (2024-2025) have revealed extensive LRV2 diversity and phylogeographic structure. However, the lack of standardized assays, incomplete clinical metadata, and inconsistent reporting frameworks have hindered translation of detection findings into actionable public-health insights. This commentary synthesizes these findings and proposes a six-point, standards-based micro-protocol for harmonizing molecular detection, metadata collection, and clinical outcome recording, aimed at enhancing decision-useful surveillance and global comparability.