Cutaneous Leishmaniasis in

PakistanShifa Ul Haq

PhD Scholar

UVAS, Lahore

Leishmaniasis

Leishmaniasis are a group of infections of the viscera, skin and mucous membrane caused by protozoan of the genus Leishmania.

Leishmania are transmitted by sand flies of the genera Phlebotomus (Old World leishmaniasis) and Lutzomyia (New World leishmaniasis).

Sand flies live in dark, damp places. These flies have a range of only 50 meters from their breeding site.

Leishmaniasis

According to WHO leishmaniasis is endemic in 88 countries, with a total of 350 million people at risk.

It is believed that worldwide 12 million people are affected by leishmaniasis.

There are about 1.5 million reported cases of cutaneous Leishmaniasis each year worldwide, with the bulk reported from Afghanistan, Iran, Iraq, Algeria, Saudi Arabia, Peru, and Pakistan.

Cutaneous Leishmaniasis in

Pakistan Cutaneous leishmaniasis is also known as

Oriental sore, Aeppo button, Jericho boil, Dehli boil

Cutaneous Leishmaniasis (CL) is a rising epidemic in Pakistan.

Cutaneous leishmaniasis is found in all the four provinces of Pakistan including KPK, Baluchistan, Sindh and Punjab.

Cutaneous Leishmaniasis in

Pakistan Percentage of patients found in these

provinces in descending order are, Baluchistan,KPK, Sindh and Punjab

It is a major public health problem in regions bordering the neighboring Afghanistan and Iran.

L. tropica is mostly seen in urban areas whereas L. major is more common in rural areas of the country

Clinical Manifestations

CL is usually noted on exposed parts of the body, mainly arms, face, and legs.

However, the clinical manifestations are extremely diverse including unusual sites and atypical morphologies.

A typical lesion is a painless ulcer with a raised, indurated margin and a necrotic base.

Their sizes also vary from 0.5 cm to 3 cm in diameter. Secondary bacterial infection is common

Women and children are particularly affected.

Studies In Pakistan

Rawalpindi, Sargodha, and Muzaffarabad (Bari and Rahman, 2002–2006)

Muzaffarabad, Azad Jammu and Kashmir (Ul Bari and Raza, 2006–2008)

Punjab and Khyber Pakhtunkhwa (Ul Bari and Rahman, 2004–2006)

Sindh and Balochistan (Myint et al., 2008)

Peshawar, KPK (Ul Bari, 2009)

Cutaneous Leishmaniasis

Cutaneous Leishmaniasis

Cutaneous Leishmaniasis

Cutaneous Leishmaniasis

Cutaneous Leishmaniasis

Cutaneous Leishmaniasis

Cutaneous Leishmaniasis

Diagnosis

The diagnosis is made by the trained eye of a careful physician based on the typical lesion, history of exposure, usually in an endemic area.

A full thickness biopsy taken from margin of the lesion: prepare an impression smear, for histological examination, and for culture.

Alternatively, needle aspirates and slit skin smears may be useful.

Serology is unhelpful for cutaneous disease.

Methods using PCR for confirming the diagnosis and are more

sensitive than microscopy and culture.

Treatment

There is no single optimal treatment for all forms of cutaneous leishmaniasis.

The pentavalent antimony derivative sodium stibogluconate and meglumine antimoniate.

Rifampicin may be efficacious.

Alternative systemic agents include aminosidine (paromomycin), pentamidine, and ketoconazole.

The most promising oral drug today is miltefosine.