THE FREQUENCY OF OLD WORLD CUTANEOUS LEISHMANIASIS IN SKIN ULCERS IN PESHAWAR

Authors

  • Saeedur Rahman
  • Fatima Humera Abdullah
  • Jamshaid Ali Khan

Abstract

Background: Old World Cutaneous Leishmaniasis (OWCL) is a preventable skin infection that leadsto morbidity and social isolation. It is spreading rapidly. The sore of OWCL may be a non-ulcerativered papule, nodule or a large mutilating ulcer. The ulcer is typically painless and can leave a disfiguringscar. Methods: This was a descriptive study. The diagnosis of OWCL was established by finding LDbodies in skin smear preparation. Results: This study identified 1680 cutaneous leishmaniasis in 1767skin ulcers. Children (n=924) were infected more than other age groups (n=756). There were typicalskin sore of OWCL in 1512 cases while 168 patients had atypical presentation. The ulcers werepainless in 1603 patients. History of insect bite was present in 1366 cases, thorn prick in 156 patients,religious visit to endemic areas in 256 patients, and 4 patients had post surgical non healing wound.Lesions with 4 to 6 months of age had a maximum yield of LD bodies. There were 498 patients fromdifferent areas of Peshawar; 688 cases from leishmania endemic belt of FATA while 89 patients camefrom other urban and rural areas of NWFP. Conclusions: There is a tremendous increase in cases ofOWCL and the disease became endemic in many regions of Pakistan. The bordering areas alongAfghanistan have constituted an endemic belt that had invaded the neighboring urban and rural areas.Several chronic non healing ulcers had been diagnosed as OWCL. Many cases have been detected inPeshawar. People need education about the nature of the diseases and the efficacy of personalprotective measures. Spray with suitable insecticides is required in all residential areas.Keywords: Leishmaniasis, sand flies, amastigote, non-healing ulcers, disfiguring scar

References

aI-Fouzan AS, al-Saleh QA, Najem NM, Rostom AI.

Cutaneous Leishmaniasis in Kuwait: Clinical Experience with

Itraconazole. Int J Dermatol 1991;30:519–21.

Barbosa-de-Deus R, dos Mares-Guia ML, Nunes AZ, Costa

KM, Junqueira RG, Mayrink W, et al. Leishmania major-Like

Antigen for Specific and Sensitive Serodiagnosis of Human

and Canine Visceral Leishmaniasis. Clin Diagn Lab Immunol

;9:1361–6.

Levinson, WE, Jawetz E. (eds). Leishmania. In: Medical

Microbiology & Immunology. (2nd ed). London: Prentice Hall

Int Inc; 1992.p. 356–8.

Hepburn NC. Cutaneous Leishmaniasis. Part II: Historical

Aspects, Epidemiology and Prevention. Proc Royal Coll

Edinb 1993;23(2):140–50.

Herwaldt BL. Leishmaniasis. Lancet 1999;354:1191–9.

Markle WH, Makhoul K. Cutaneous Leishmaniasis: Recognition

and Treatment. Am Fam Physician 2004;69:455–60.

Ashford RW, Desjeux P, de Raadt P. Estimation of population

at risk of infection and number of cases of leshmaniasis.

Parasitology Today 1992;8:104–5).

Bari AU, Rahman SB. Many faces of cutaneous

leishmaniasis. Indian J Dermatol Venereol Leprol

;74(1):23–7.

Bhutto AM, Soomro RA, Nonaka S, Hashiguchi Y. Detection

of new endemic areas of cutaneous leishmaniasis in Pakistan:

a 6-year study. Int J Dermatol 2003;42:543–8.

Leslie T, Saleheen S, Sami M, Mayan I, Mahboob N, Fiekert

K, et al. Visceral leishmaniasis in Afghanistan. CMAJ. 2006

Aug 1;175(3):245–6.

Brooker S, Mohammed N, Adil K, Agha S, Reithinger R,

Rowland M, et al. Leishmaniasis in refugee and local

Pakistani populations. Emerg Infect Dis 2004;10:1681–4.

Rowland M, Munir A, Durrani N, Noyes H, Reyburn H. An

outbreak of cutaneous leishmaniasis in an Afghan refugee

settlement in north-west Pakistan. Trans R Soc Trop Med Hyg

;93:133–6.

Kakakhel, K. Parasitic Infections, Leishmaniasis. In:

Textbook of Dermatology. 2nd Ed. 1992. Peshawar (Pakistan):

Khybermail Press;1992. p.33–4.

Rahman S, Bari A. Laboratory profile in patients of cutaneous

leishmaniasis from various regions of Pakistan. J Coll

Physicians Surg Pak 2003;13:313–6.

Ajdary S, Alimohammadian MH, Eslami MB, Kemp K,

Kharazmi A. Comparison of the Immune Profile of

Nonhealing Cutaneous Leishmaniasis Patients with Those

with Active Lesions and Those Who Have Recovered from

Infection. Infec and Immun 2000;68:1760–4.

Rodrigues EHG, de Brito MEF, Mendonça MG, Werkhäuser

RP, Coutinho EM, Souza WV, et al. Evaluation of PCR for

Diagnosis of American Cutaneous Leishmaniasis in an Area

of Endemicity in Northeastern Brazil. J Clin Microbiol

;40:3572–6.

Levinson W. Blood and Tissue Parasite (Leishmania tropica,

Leishmania maxicana, & Leishmania braziliensis). In:

Medical Microbiology and Immunology (8th ed). Usa. Lange,

McGrawHill Medical; 1998: 349–58.

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Published

2009-09-01