Cutaneous leishmaniasis in Dir Lower District, North-West Pakistan: epidemiology and treatment response
Keywords:Cutaneous leishmaniasis, antimonial drugs, chemotherapy, thermotherapy
AbstractObjective To assess the epidemiological and chemotherapeutic aspects of cutaneous leishmaniasis. Methods This study was carried out during September, 2011 to December, 2011 and encompassed a total of 1000 patients of both gender. All patients enrolled in this study were selected at random from four sub-divisions of Dir Lower district. Data regarding different variables were obtained on a designed questionnaire through face-to-face interviews with the patients after approval of their informed consent. Standard protocols were used for confirmation of Leishman-Donovan bodies using slit-skin smears. Results The overall incidence of CL was found to be 21.1%. The prevalence was observed to be significantly higher among Afghans than the local population (32.5% vs. 20.3%, OR: 1.6, p<0.05). The distribution of CL showed significant difference with respect to all studied demographic parameters, except subject’s age and tehsil. More than half of the infected patients (56.8%) had wet lesions and majority of the infected patients (42.3%) had only one lesion. Moreover, face and arms were the most frequently inflicted body parts. It was further observed that among various antimonials used by the patients, sodium stibogluconate demonstrated the highest efficacy followed by glucantime® and stibotim® whereas thermotherapy showed no efficacy. Collectively, the efficacy significantly varied across different antimonials used in this study (p<0.05). Conclusion This study provides detailed information regarding descriptive epidemiological aspects of cutaneous leishmaniasis in Dir Lower District.
Rahim F, Jamal S, Raziq F, Uzair M, Sarwar B, Ali Het al. An outbreak of cutaneous leishmaniasis in a village of district Dir lower. J Pak Med Assoc. 2002;17:343-5.
Svobodova M, Votypka J, Nicolas L, Volf P. Leishmania tropica in the black rat (Rattusrattus): persistence and transmission from asymptomatic host to sand fly vector Phlebotomus sergenti. Microbes Infect. 2003;5:361-4.
Pourmohammadi B, Motazedian MH, Hatam GR, Kalantari M, Habibi P, Sarkari B. Comparison of three methods for diagnosis of cutaneous leishmaniasis. Iran J Parasitol. 2010;5(4):1-8.
Kumar R, Bumb R, Ansari NA, Mehta RD, Salotra P. Cutaneous leishmaniasis caused by Leishmania tropica in Bikaner, India, parasite identification and characterization using molecular and immunologic tools. Am J Trop Med Hyg. 2007;76:896-901.
Brooker S, Mohammed N, Adil K, Agha S, Reithinger R, Rowland Met al. Leishmaniasis in refugee and local Pakistani populations. Emerg Infect Dis. 2004;10:1681-4.
Durrani N, Rowland M, Muniti A, Noyes H, Reyburn H. An outbreak of cutaneous leishmaniasis in an Afghan refugee settlement in north-west Pakistan. Trans R Soc Trop Med Hyg. 1999;93(9):133-6.
Ullah S, Jan AH, Wazir SM, Ali N. Prevalence of cutaneous leishmaniasis in Lower Dir District (N.W.F.P), Pakistan. J Pak Assoc Dermatol. 2009;19:212-5.
Massoom M, Marri S. Current status of leishmaniasis in Pakistan. Bhaduri A, Basu M, Sen A, Kumar S, editors. Current Trends in Leishmaniasis Research. Calcutta, India: Council of Scientific and Industrial Research; 1993. P. 231-6.
Talat H, Attarwala S, Saleem M. Cutaneous leishmaniasis with HIV - Case report. J Coll Physicians Surg Pak. 2014;24(Special Suppl 2):S93-S5.
Kolaczinski J, Brooker S, Reyburn H, Rowland M. Epidemiology of anthroponotic cutaneous leishmaniasis in Afghan refugee camps in northwest Pakistan. Trans R Soc Trop Med Hyg. 2004;98:373-8.
Jamal Q, Shah A, Ali N, Ashraf M, Awan MM, Lee CM. Prevalence and comparative analysis of cutaneous leishmaniasis in Dargai Region in Pakistan. Pak J Zool. 2013;45:537-41.
Pakistan Bureau of Statistics. Pakistan Census Report, 1998. In: Pakistan Bureau of Statistics GoP. Islamabad; 1998.
Mujtaba G, Khalid M. Cutaneous leishmaniasis in Multan, Pakistan. Int J Dermatol. 1998;37:843-5.
Nawaz R, Khan AM, Khan SU, Rauf A. Frequency of cutaneous leishmaniasis in an Afghan refugee camp at Peshawar. Gomal J Med Sci. 2010;8(1):16-9.
Gul B. Incidence of leishmaniasis in District Loralai, Baluchistan. Peshawar: University of Peshawar; 2001.
Fazaeli A, Fouladi B, Sharifi I. Emergence of cutaneous leishmaniasis in a border area at south-east of Iran: an epidemiological survey. J Vector Borne Dis. 2009;46:36-42.
Shirzadi MR, Esfahania SB, Mohebalia M, Ershadia MRY, Gharachorlo F, Razavia MR et al. Epidemiological status of leishmaniasis in the Islamic Republic of Iran, 1983-2012. East Mediterr Health J. 2015;21:736-42.
Rahim F, Rehman F, Ahmad S, Zada B. Visceral leishmaniasis in District Dir, NWFP. J Pak Med Assoc. 1998;48:161-3.
Hanif MM, Akram K, Mustafa G. Intralesional versus oral chloroquine in cutaneous leishmaniasis: comparison of outcome, duration of treatment and total dose of drug. J Coll Physicians Surg Pak. 2016;26:260-2.
Solomon M, Baum S, Barzilai A, Pavlotsky F, Trau H, Schwartz E. Treatment of cutaneous leishmaniasis with intralesional sodium stibogluconate. J Eur Acad Dermatol Venereol. 2009;23:1189-92.