A Clinico-Epidemiological Study of Cutaneous Leishmaniasis in a Non-Endemic Region of South Rajasthan

Abstract

Introduction: Cutaneous leishmaniasis (CL) is a vector-borne protozoal infection of the skin with variable clinical manifestations. In Rajasthan, western Thar desert is endemic for this disease. Aim: The present study was aimed to describe clinico-epidemiological features of cutaneous leishmaniasis cases from a non-endemic area of South Rajasthan. Materials and Methods: A hospital-based prospective study was carried out during a period of 3 years (2017-2019). Data regarding clinical profile and treatment outcome were recorded in a predesigned proforma for analysis. Diagnosis of CL was made clinically and confirmed by demonstration of amastigotes in microscopic examination of Giemsa stained tissue smear of lesions. Results: Out of 24 patients, 16 (67%) were females and 8 (33%) were males. The age ranged from 3 months to 68 years (median-25). Face (67%) and extremities (29%) were the common sites affected. The most common morphological form was crusted plaques (54%) followed by nodular lesions (38%). Slit skin smear for Leishmania donovani bodies was positive in all patients (100%). Conclusion: This study highlights a focus of CL in non-endemic areas of South Rajasthan. Of late leishmaniasis is breaking out of its classical boundaries and is increasingly being reported from new geographic locations with a possibility of a novel parasite variant. Therefore, a high clinical suspicion of CL should be kept in non-endemic area.

Clinicoepidemiological Study of Cutaneous Leishmaniasis: A Hospital Based Study

“…o of 0.70:1. This is consistent with earlier studies done by Sharma NL et al 7 , Yemisen M et al 8 , Gurel MS et al 9 and Virath R et al 13 In contrast, higher incidence of CL was found in males. 3,6,[10][11][12]14 In Nepal, males are mostly indulged to outdoor works and females to household works.…”

“…The single lesion of CL was mostly seen in 73.91% of the cases in our study, which is consistent with the fi ndings of Pandey K et al 3 , Aara N et al 6 , Sharma NL et al 7 , Yemisen M et al 8 , Gurel MS et al 9 , Gunathilaka N et al 10 , Ghimire PG et al 11 , Galgamuwa LS et al 12 , and Virathet al 13 In contrast, mul" ple lesions were mostly seen in the study by AlSamaraiet al 14 Face was the most common loca" on of single lesion in our study. Similar fi ndings were reported by Pandey K et al 3 , Sharma NL et al 7 , Yemisen M et al 8 , Gurel MS et al 9 , Ghimire PGet al 11 , and Virath R et al 13 In contrast, Aara N et al 6 , Gunathilakaet al 10 , Galgamuwa LS et al 12 , and AlSamarai AM et al 14 reported most common lesions in upper limbs. Lesions presented mainly on exposed parts of the body suggests vectors and sandfl ies could easily access those areas with short sleeved upper clothing items as their vestment and due to the high popula" on density of sandfl ies in those areas.…”

“…Thus, they were the most commonly involved sites, and the ulcerated form was the most common form in our study. 8 Our study mostly presented with the ulcera" ve papulonodular type of CL lesion consistent with the study by Sharma NL et al 7 , Gurel MS et al 9 , and Galgamuwa LS et al 12 Ulcera" ve plaque was commonly seen in the study by Aara N et al 6 , Ghimire PG et al 11 , and AlSamarai AM et al 14 Crusted plaque variant was presented in a study by Virath R et al 13 Most commonly presented ulcerated lesions were reported by Yemisen M et al 8 and Gunathilaka N et al 10 Among the various morphologic form of CL ulcera" ve-nodular form (oriental sore) is the most commonly described lesion which is consistent to our study. 16 Majority number of new CL cases, 5(10.87%) in each month of February, March, April, August, November, and December was observed in our study.…”

“…c concern in females may have led to female preponderance in our study. 13 The ca# le kept close to the residen! al houses by people in rural areas are also known to a# ract both anthropophilic and zoophilic vectors.…”

“…on ranging from 15 days to 1 year was 11.25 months. 13 Due to the misdiagnosis, lack of laboratory facili! es and transport infrastructure in the remote areas like Karnali province of Nepal to seek medical advice may be the cause for the delay in the presenta!…”