Typical and atypical cutaneous leishmaniasis in Himachal Pradesh (India)

Abstract

Background Visceral leishmaniasis (VL) is in elimination phase in India while cutaneous leishmaniasis (CL) is being reported from new foci. In Himachal Pradesh (HP), a foci of CL had been reported along Satluj River, but the causative agent poses a dilemma, hence the present study was undertaken in Shimla, Kullu and Kinnaur districts. Methods A total of 28 CL patients from Indira Gandhi Medical College and Hospital Shimla (IGMC) in 2018, were tested by rK39., Twelve fresh cases were subjected to microscopic detection of Leishmania parasite, PCR and sequencing. Skin biopsies of 3–4 mm diameter were cultured, as well as imprints were prepared for the detection of Leishmania amastigotes. Biopsy samples were inoculated into different culture media (M199, RPMI 1640, NNN) and were incubated at 22–24 °C. Polymerase chain reaction (PCR) was performed to characterize Leishmania parasite species. Results Of 28 patients, one was positive by rK39 dipstick test and one imprint was found positive for Leishmania amstigotes. Twelve biopsy DNA samples subjected to PCR for Leishmania kDNA, were found Lesihmania positive. Identification of Leishmania species was confirmed by PCR-RFLP and sequencing method. Of 12 Leishmania positive samples, six were identified as L. donovani , three L. tropica , two L.major and one remained unidentified. Conclusions This study revealed the existence of three species of parasites i.e., L. donovani, L. tropica and L. major indicating the existence of typical and atypical leishmaniasis in Himachal Pradesh. The occurrence of CL cases in HP, Kerala or elsewhere should not be ignored considering them just cases of CL alone. Further studies are warranted to confirm the existence of L.donovani zymodeme MON37 from cases of CL in HP or L.donovani zymodeme MON2 strain causing VL in Bihar. Elimination of CL should also be considered along with goal of Kala -Azar elimination.

Detection of Leishmania donovani in Wild-Caught Phlebotomine Sand Flies in Endemic Focus of Leishmaniasis in Himachal Pradesh, India

“…MN861106.1 and MN861107.1 accession having sequences of L. donovani identified from P. longiductus showed close similarity with the L. donovani sequences from cases of CL in Himachal Pradesh with accession numbers MT423519-21 ( Lata et al 2021 ). Only a single “T” nucleotide deletion was observed at the 265 nt position in both the sequences (MN861106.1 and MN861107.1) in comparison to the L. donovani sequences from the cases of CL in HP (MT423519-21.)…”

“…The present study was undertaken in Rampur, Nirmand, and Nichar subdivisions of Shimla, Kullu, and Kinnaur districts of Himachal Pradesh located along the Sutlej River Valley between 31°05′0″N and 31°42′0″N latitude and 76°52′E and 78°24′0″E latitude. Altogether 16 villages were selected for collection of sand flies ( Lata et al 2021 ) based on accessibility.…”

“…Total DNA was extracted from 52 bloodfed sand flies individually using the Qiagen DNA mini kit (Qiagen), as per manufacturer’s instructions, and eluted in 20 µl buffer. The details of DNA extraction, PCR-RFLP, and DNA sequencing are given in Lata et al (2021) …”

Leishmania donovani persistence and transmission causing cutaneous leishmaniasis in unusual-foci of Nepal

“…The three infected mountain districts which were tagged as doubtful districts of visceral leishmaniasis by the Nepal Government validate the opportunistic nature of the parasites. The infection response also suggests that L donovani has been indigenously circulating even in the cold mountain region with better adoption 34 . At the verge of visceral leishmaniasis elimination as public health problem in Nepal in the 18 endemic districts 35 , the opportunistic tissue tropism of Leishmania species remains an unresolved question.…”

Diagnostic Tools for Cutaneous Leishmaniasis Caused by Leishmania donovani: A Narrative Review

“…Old-World CL is caused by either Leishmania tropica or L. major while VL is caused by L. donovani (in the ISC, China, and Africa) and L. infantum (in the Mediterranean region) [ 2 ]. Post-kala-azar dermal leishmaniasis (PKDL), sometimes considered a fourth entity, is a sequel to VL caused by L. donovani and is reported in both the ISC and Africa [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ]. In addition to the above, atypical “clinical form– Leishmania species” combinations are also reported in different parts of the world ( Table 1 ).…”