Cutaneous leishmaniasis in nonendemic geographic areas: Unraveling the itinerant cases

Abstract

Background: Cutaneous leishmaniasis endemic in 70 countries worldwide and in certain regions of India is otherwise an uncommon presentation in non-endemic zones, leading to their missed diagnosis. Movement of people between these regions further exposes them to the risk of this infection. The aim of this study was to analyze the presentation of these missed cases, basis of their final diagnosis, management and follow up with the objective of highlighting cutaneous leishmaniasis as an important differential diagnosis in these cases. Methods: A prospective 4-year cohort of patients who were diagnosed as cutaneous leishmaniasis (CL) and post kala azar dermal leishmaniasis (PKDL) between 2012 and 2016 were studied. Their presentation, basis of diagnosis, treatment response to different agents and follow up was studied. Results: Of a total of 380547 patients seen in the four-year period, 15 CL and 2 PKDL symptomatic from 6 months to 7 years were diagnosed at our centre. Leishmania amastigotes were seen in smears in 10 and 4 in skin biopsy. Four were diagnosed based on polymerase chain reaction for Leishmania. Ten were managed with iv Sodium Stibogluconate (SSG), five with intralesional SSG and one with liposomal amphotericin B. All responded to treatment and were followed up for one year thereafter. Conclusion: Although CL and PKDL are rare outside their endemic zones, travelers and population exposed to newer endemic zones may result in atypical presentations which clinicians are not experienced with. This study highlights this possibility and our experience in diagnosing and treating such cases.