Cutaneous Leishmaniasis In Pakistan Research Articles

Cutaneous Leishmaniasis in Pakistan: a neglected disease needing one health strategy

BackgroundCutaneous Leishmaniasis (CL) is a neglected tropical disease, which mainly affects poor communities. It is one of the major vector-borne disease and endemic in Pakistan.MethodsA case-control study to evaluate potential risk factors of human-CL was conducted in Khewra region, District Jhelum, Pakistan from January–April 2014. Case data about 90 cases registered during October 2012 to November 2013 was retrieved from Municipal Hospital. Controls were matched (1,1 ratio) on the date of registration with cases from same hospital. Both cases and controls were invited to participate and data was collected in a face-to-face interview. A prospective study of canine leishmaniasis (canine-CL) was also conducted at Civil Veterinary Hospital in the same area. Suspected dogs with skin ulceration signs were included in the study and blood samples were collected. Statistical analyses were conducted to determine association between various parameters and outcome of interest.ResultsThe ages of cases ranged from 1 to 76 years (median = 15 years) and proved to be protective factor i.e. increase in each year in age reduced the likelihood of being infected with human-CL [Odds Ratio (OR) = 0.4, 95% Confidence Interval (CI) = 0.25–0.76]. People sleeping outsides in an open area were more likely to become a case (OR = 8.7, 95% CI = 2.90–26.37) than a control. Poor sanitary condition inside the house (OR = 3.3, 95% CI 1.03–10.56) and presence of other animals in house (livestock, poultry) (OR = 3.6, 95% CI = 1.07–12.12) also identified as risk factors of high significance. The proportion of positive dogs with canine-CL was 21.05% and was significantly associated with human-CL cases in the same area (p < 0.05).ConclusionsWe concluded that adopting self-protections measures against sand-fly, and maintaining good hygiene may lower the risk of human-CL. One-Health Strategy is suggested to control leishmaniasis in human and dog population.

A Brief Review on Infestation of Cutaneous Leishmaniasis in Pakistan

Leishmaniasis is a vector transmitted disease caused by more than 25 obligatory intracellular protozoans belonging to Leishmania; a genus of flagellate protozoa...

Cutaneous leishmaniasis in male schoolchildren in the upper and lower Dir districts of Khyber Pakhtunkhwa, and a review of previous record in Pakistan

Documented reports are limited, showing cutaneous leishmaniasis (CL) as a severe threat to schoolchildren in Pakistan. The present study aimed to investigate the clinico-epidemiology and associated risk factors of CL in local and Afghan male schoolchildren between 6 and 16 years of age. The experimental strategy involved a questionnaire for the collection of information and clinical diagnosis (microscopy and semi-nested PCR) of 113 CL symptomatic schoolchildren out of 8,833 schoolchildren (7,175 local and 1,658 Afghan refugees) studying in nineteen schools of the Upper and Lower Dir Districts, Khyber Pakhtunkhwa, Pakistan. Previous records of CL in Pakistan was studied, and spatial analysis was performed on elevation and agro-ecological maps using Arc-GIS v10.3.1. Active lesions were found predominant (n=113, 1.2%: cutaneous lesions, 97, 86%, and lesions with mucosal involvement, 16, 14%) than scars (20, 0.25%). Active lesions of both local (100, 88%) and Afghan refugees (13, 12%), and infected age groups were found significantly different. Majority of the lesions were dry crusted (98, 86.7%), single (83, 73%), and frequently infecting facial region (59, 52%). Avoiding bed nets, living in mud houses and animal shelters were highly associated with CL infection. Temergara (30, 26.5%) and Rabath (14, 12.3%) were hyperendemic CL foci. Microscopically, 71 (63%) cases were positive, while the PCR assay revealed Leishmania tropica in 110 (97.3%) cases. Previous record revealed that L. tropica is dominant throughout Pakistan, and dry mountains and plateaus of northwestern and southwestern regions are spatially at high-risk. Measures should be taken to reduce CL infection by eliminating the associated risk factors, promoting PCR-based diagnosis and basic medical facilities.

Failure of an innovative low-cost, non-invasive thermotherapy device in treating cutaneous leishmaniasis in Pakistan

This abstract corresponds with the following slides: https://f1000research.com/slides/7-650 presented at Medecins Sans Frontieres UK Scientific Day: Innovation 2018. To watch the presentation click here: https://f1000research.com/videos/7-861 This abstract is part of an an F1000Research gateway that includes posters, slides and videos from the MSF Scientific Day: Innovation 2018. To see more please visit: https://f1000research.com/gateways/MSF/innovation .

Variability of Cutaneous Leishmaniasis Lesions Is Not Associated with Genetic Diversity of Leishmania tropica in Khyber Pakhtunkhwa Province of Pakistan.

Leishmania tropica is the causative agent of cutaneous leishmaniasis in Pakistan. Here, intraspecific diversity of L. tropica from northern Pakistan was investigated using multilocus microsatellite typing. Fourteen polymorphic microsatellite markers were typed in 34 recently collected L. tropica isolates from Pakistan along with 158 archival strains of diverse Afro-Eurasian origins. Previously published profiles for 145 strains of L. tropica originating from different regions of Africa, Central Asia, Iran, and Middle East were included for comparison. Six consistently well-supported genetic groups were resolved: 1) Asia, 2) Morroco A, 3) Namibia and Kenya A, 4) Kenya B/Tunisia and Galilee, 5) Morocco B, and 6) Middle East. Strains from northern Pakistan were assigned to Asian cluster except for three that were placed in a geographically distant genetic group; Morocco A. Lesion variability among these Pakistani strains was not associated with specific L. tropica genetic profile. Pakistani strains showed little genetic differentiation from strains of Iraq, Afghanistan, and Syria (FST = 0.00-0.06); displayed evidence of modest genetic flow with India (FST = 0.14). Furthermore, genetic structuring within these isolates was not geographically defined. Pak-Afghan cluster was in significant linkage disequilibrium (IA = 1.43), had low genetic diversity, and displayed comparatively higher heterozygosity (FIS = -0.62). Patterns of genetic diversity observed suggest dominance of a minimally diverse clonal lineage within northern Pakistan. This is surprising as a wide clinical spectrum was observed in patients, suggesting the importance of host and other factors. Further genotyping studies of L. tropica isolates displaying different clinical phenotypes are required to validate this potentially important observation.

SLC11A1 polymorphisms and host susceptibility to cutaneous leishmaniasis in Pakistan

BackgroundThe vector-borne cutaneous leishmaniasis (CL) is endemic in several regions of Pakistan mainly affecting poor populations. Host genetic factors, particularly SLC11A1 (solute carrier transmembrane protein) within macrophages, play a crucial role in disease pathology and susceptibility. Association of SLC11A1 with cutaneous leishmaniasis, a neglected tropical disease, is not well established. Inconsistencies have been observed within different populations worldwide with respect to genetic susceptibility. This study was designed to investigate genetic variation(s) in SLC11A1 and to assess possible association with cutaneous leishmaniasis in Pakistan.ResultsEight polymorphisms (rs2276631, rs3731864, rs2290708, rs2695342, rs201565523, rs17215556, rs17235409, rs17235416) were genotyped across SLC11A1 in 274 patients and 119 healthy controls. Six polymorphisms were studied by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and sequencing. Two single nucleotide polymorphisms were analyzed with newly designed semi-nested PCR assays. Case-control analysis showed no association between selected polymorphisms in SLC11A1 and cutaneous leishmaniasis. No significant difference was observed in the distribution of alleles between leishmaniasis patients and healthy individuals. Strong pairwise linkage disequilibrium was observed between rs2276631 and rs2290708 (r2 = 64); and rs17235409 and rs17235416 (r2 = 78).ConclusionsThis study shows that genetic variations in the candidate gene SLC11A1 do not affect susceptibility to cutaneous leishmaniasis in the sample population from Pakistan.

Phylogenetic position of Leishmania isolates from Khyber Pakhtunkhwa province of Pakistan

Several species of the genus Leishmania are causative agents of cutaneous leishmaniasis in Pakistan. This study aimed to determine phylogenetic placement of Leishmania species causing cutaneous leishmaniasis in Khyber Pakhtunkhwa province, Pakistan (34 Leishmania tropica, 3 Leishmania infantum), in-relation to species from other geographical areas using gene sequences encoding cytochrome b (cytb) and internal transcribed spacer 2 (its2). Based on cytochrome b sequence analysis, L. tropica strains from Pakistan and other geographical regions were differentiated into two genotype groups, A and B. Within the province, five distinct L. tropica genotypes were recognized; two in group A, three in group B. Two L. infantum isolates from the province were closely associated with both Afro-Eurasian and American species of the Leishmania donovani complex, including Leishmania chagasi, L. infantum and L. donovani from Sudan and Ethiopia; while a third L. infantum isolate could not be differentiated from visceralizing Kenyan and Indian L. donovani. We observed apposite phylogenetic placement of CL-causing L. tropica and L. infantum from Khyber Pakhtunkhwa. Affinities ascribed to Leishmania spp. From the region are valuable in tracing potential importation of leishmaniasis.

New endemic focus of cutaneous leishmaniasis in Pakistan and future epidemics threats

ObjectiveTo get a clear epidemiological picture of cutaneous leishmaniasis in a new endemic focus, in order to address the most probable epidemic threats and its spread to the neighboring regions. MethodsA total of 870 clinically diagnosed patients were included in the study after taking consent and filling questionnaires from each individual. The field Giemsa-stained slides and cultures were examined microscopically. The data was organized in tables and graphs and analyzed using statistical package SPSS V 21. ResultsThe ratio of male was higher than females (499:371), cutaneous and mucocutaneous cases were 96.00% and 4.00%, and only 25.20% patient's used bed nets. A total of 57.10% had dirty places near their homes. Similar cases in the neighborhood and in families were 48.50% and 67.10% respectively. Only 87.35 % of Patients in the age range of 1–20 years received treatment. Up to five lesions per individual were noticed and 72.20% of them had symptomatic secondary infections. The lesions were observed on different sites of the body. ConclusionsLeishmaniasis is neglected in Landi Kotal Khyber Agency, the reasons being prevailing security situations and political sensitivity. North Atlantic Treaty Organization forces in Afghanistan are in contact with Afghanis and with local people of Landi Kotal for logistic purposes. They may act as carriers in co-spreading of the species. There are potential risks of cross border transmission, with the probability of future epidemics in the surrounding regions.

Clinical Manifestations and Distribution of Cutaneous Leishmaniasis in Pakistan

Cutaneous leishmaniasis (CL) is a rising epidemic in Pakistan. It is a major public health problem in the country especially alongside regions bordering the neighboring Afghanistan and cities that have had the maximum influx of refugees. The purpose of our paper is to highlight the diverse clinical manifestations of the disease seen along with the geographic areas affected, where the hosts are particularly susceptible. This would also be helpful in presenting the broad spectrum of the disease for training of health care workers and help in surveillance of CL in the region. The increased clinical diversity and the spectrum of phenotypic manifestations noted underscore the fact that the diagnosis of CL should be not only considered when dealing with common skin lesions, but also highly suspected by dermatologists and even primary care physicians even when encountering uncommon pathologies. Hence, we would strongly advocate that since most of these patients present to local health care centers and hospitals, primary care practitioners and even lady health workers (LHWs) should be trained in identification of at least the common presentations of CL.

Marring Leishmaniasis: The Stigmatization and the Impact of Cutaneous Leishmaniasis in Pakistan and Afghanistan

Cutaneous leishmaniasis or “Kal Dana” (“the year-long sore”), as it is known locally, not only leaves a disfiguring scar on your face, but permanently changes your perception of your own self (Figure 1). “This is not me,” said the woman from Chaman, as she explained her encounter with the disease and the stigmatization associated with it. Figure 1 Marring leishmaniasis with lesions on exposed parts of the face. This 28-year-old woman is a resident of Chaman, a town located near the Pakistan–Afghanistan border, in the southwestern province of Balochistan. For decades, Chaman has been a hub for refugees crossing the Durand line; it also is one of the many regions where poverty and lack of health resources show their true victimization of refugees. One such case is that of this woman. She belonged to a poor family; her father, the sole breadwinner of the family, is a cattle rearer. She acquired her first lesion at the age of 12; from thereon she was socially excluded and not allowed to go to the local madrassah (an Islamic religious school). As she grew older, multiple other lesions appeared on her arms and face (the exposed parts of the body). She described this as a period of grief for her, when her parents started isolating her from the rest of the siblings to prevent further spread. No treatment was acquired, due to the afflicting poverty and lack of resources of the region. But the scar had a deeper impact on this woman, as she is still unmarried in a community where early marriages are common. She describes her fate as, “I will probably get married to a limp or mentally disabled in a year or so; at least that is what happened to all the other girls who had these marks.”

Cutaneous leishmaniasis in Pakistan

Leishmaniasis is a major health problem worldwide. It is also a particular problem in the rural areas of Pakistan. The disease occurs in varying presentations, from the self-limited and even self-healing cutaneous forms to fatal systemic disease. Lesions of cutaneous leishmaniasis may occur anywhere on the body but the most likely sites are the exposed parts. The initial papule rapidly gives rise to an ulcer. Systemic leishmaniasis is rarer in Pakistan and invariably fatal if not treated promptly. It affects the internal body organs, particularly the spleen and the liver. Leishmaniasis is transmitted by an infected female sandfly. Cutaneous lesions are usually single and often self-healing, but a presentation with multiple ulcers resulting from multiple bites from the sandfly is not rare in Pakistan. The disease has a very long history and lesions like leishmaniasis have been described dating back to the ninth century (Balkan sore). Cutaneous leishmaniasis has been given various names in different civilizations such as "Delhi boil" in India, "Baghdad boil" in Iraq, and "saldana" in Afghanistan. The organism responsible for leishmaniasis was discovered 100 years ago but the disease has not been eradicated; rather it is on rise in many parts of the world. If control measures are not taken, it might emerge as a major health problem. Pakistan has a burden of cutaneous and visceral leishmaniasis, the mucocutaneous form being almost nonexistent. The physicians need to know the diagnostic criteria as well as the treatment of the disease. Because of a scarcity of dermatologists in the rural areas, most of these cases present to general practitioners. Control of this disease is further complicated by an inadequate supply of appropriate drugs.

Detection of new endemic areas of cutaneous leishmaniasis in Pakistan: a 6-year study.

Cutaneous leishmaniasis (CL) is endemic in Pakistan and is widely spreading. Recently, an outbreak of the disease was observed in the region. We report some new endemic areas of CL in the country. A total of 1210 cases of CL who visited our department from 1996 to 2001 are reported. Among them, 760 were residents of the Jacobabad, Larkana, and Dadu districts of Sindh province and had never previously traveled to endemic areas. These districts have never been reported/recognized as endemic for CL. Others were residents of endemic areas of Balochistan province. Diagnosis was made on clinical presentation; a giemsa-stained smear test and histopathological results. All the cases were treated with the meglumine antimoniate 600 mg/day (adults) and 15 mg/kg/day (children) intramuscularly for 20 consecutive days. All the patients were aged between 2.5 months and 65 years. Three hundred and ninety-two patients were females and 368 were males. Duration of the disease ranged from 2 to 18 months. Most of the patients had a single lesion on the face and/or extremities. Clinically, the disease was classified as: dry papular type, 407 cases; dry ulcerative type, 335 cases; and wet ulcerative type, 18 cases. No cases of muco-cutaneous or visceral leishmaniasis were found during this period. Smear testing was positive in 845 cases, while 365 cases were histopathologically positive. An ultrastructural study was performed using specimens of a few of the cases. Leishmania parasites were detected in the dermal tissues as well as in the macrophages. We propose that the Jacobabad, Larkana and Dadu districts could be considered endemic for CL. Wet- and dry-type lesions indicate the presence of both Leishmania tropica and L. major in this tropical region.

Cutaneous leishmaniasis in Pakistan

Cutaneous leishmaniasis in Pakistan

Unusual clinical variants of cutaneous leishmaniasis in Pakistan.

Cutaneous leishmaniasis is endemic in the Baluchistan province of Pakistan and poses a great risk to non-immune visitors to the area. The wide spectrum of clinical variants of this common disease is at times a diagnostic challenge. A total of 1709 patients with cutaneous leishmaniasis were recorded over a 1-year period. In 37 (2%) patients the lesions were very unusual, and therefore worth reporting. These included acute paronychial, chancriform, annular, palmoplantar, zosteriform and erysipeloid forms. The zosteriform and erysipeloid forms have rarely been reported previously, but to the best of our knowledge, acute paronychial, chancriform, annular and palmoplantar lesions are being reported for the first time. The morphologically unusual lesions may be attributed to an altered host response or involvement of an atypical strain of parasite in these lesions.