Body location of “New World” cutaneous leishmaniasis lesions and its impact on the quality of life of patients in Suriname

Ricardo V P F Hu,Ria Reis,Henry J C De Vries,Henk D F H Schallig,Pythia Nieuwkerk,Rudy F M Lai A Fat,Sahienshadebie Ramdas,Johan Van Weyenbergh

doi:10.1371/journal.pntd.0008759

Abstract

Cutaneous leishmaniasis (CL) is a chronic skin infection caused by Leishmania parasites, causing single or multiple skin nodules and ulcers on the exposed body locations. Healing of lesions is followed by scar formation. Active and healed CL lesions may affect patient’s health related quality of life (HRQL). The aim of this study was to determine whether the body location of the leishmaniasis lesions affects the HRQL of localized CL patients in Suriname. The HRQL of 163 patients with CL was assessed by Skindex-29 and EQ-5D/VAS questionnaires. Forty-six patients out of the total study population also participated in a qualitative anthropological study involving in depth interviews. All patients were allocated in 4 groups in the following hierarchy: head and face, upper limbs, lower limbs and trunk. Patients with lesions on the lower limbs had significantly higher Skindex-29 scores, indicating worse HRQL, in the symptom scale compared to lesions on head/face and trunk. The lower limb group was more likely to report problems in the dimensions self-care, mobility, daily activities and pain/discomfort of the EQ-5D. Little to no social stigma was reported in the in-depth interviews. The findings of this study indicate that Surinamese patients with CL lesions located on the lower limbs had more impairment in HRQL than on other body locations. Stigma related to CL seems to be virtually absent in Suriname.

Highlights

Leishmaniasis is a poverty-related disease with an estimated 0.7 to 1 million new cases reported per year from nearly 100 endemiccountries [1]
Cutaneous leishmaniasis (CL) is a chronic infection with a spectrum of clinical presentations; most frequent is skin ulceration, which can lead to disfiguring scar formation
The present study is conducted in the framework of the PELESU project (Clinical, Parasitological and Pharmaco-Economic evaluation of 3 days versus 7 days pentamidine isethionate regimen for cutaneous leishmaniasis in Suriname, Trial ID: NTR 2076; reviewed and approved by the Ethics Committee of the Ministry of Health in Suriname, file number VG006–2009) as part of the Leishmania Research Program in Suriname, an integrated research program comprising 3 different study scopes: clinical, biological, and medical-anthropological

Summary

Introduction

Leishmaniasis is a poverty-related disease with an estimated 0.7 to 1 million new cases reported per year from nearly 100 endemiccountries [1]. Leishmaniasis is caused by different species of the genus Leishmania, which are transmitted through the bite of an infected female sand fly of the genus Phlebotomus or Lutzomyia. CL is a chronic infection with a spectrum of clinical presentations; most frequent is (extensive) skin ulceration, which can lead to disfiguring scar formation. CL is endemic in Suriname at an annual rate of 6/1000, with around 250 cases officially reported each year, and mainly presents as localized cutaneous leishmaniasis, (LCL). (V.) guyanensis, and the disease mainly affects young males involved in mining, logging and tourism operations; leishmaniasis is considered to be an increasing public health problem [3,4] The majority of cases is caused by L. (V.) guyanensis, and the disease mainly affects young males involved in mining, logging and tourism operations; leishmaniasis is considered to be an increasing public health problem [3,4]

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Conclusion