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Knowledge, attitude, and practices towards cutaneous leishmaniasis in referral cases with cutaneous lesions: A cross-sectional survey in remote districts of southern Khyber Pakhtunkhwa, Pakistan. PLoS One 2022; 17:e0268801. [PMID: 35617283 PMCID: PMC9135282 DOI: 10.1371/journal.pone.0268801] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/07/2022] [Indexed: 11/29/2022] Open
Abstract
Background Cutaneous leishmaniasis is a neglected tropical disease caused by Leishmania spp. and transmitted by female sandflies. Terrorism and counter-insurgency military operations in Federally Administered Tribal Areas (FATA) lead to a large-scale migration of internally displaced persons (IDPs) in Khyber Pakhtunkhwa and thus, new outbreaks of several infectious diseases such as cutaneous leishmaniasis occurred. This study intended to find the prevalence of cutaneous leishmaniasis in people with cutaneous lesions suspected of having cutaneous leishmaniasis in four remote districts of Khyber Pakhtunkhwa and to assess the participant’s knowledge, attitude, and practices about the infection and its control. Methods A cross-sectional study was carried out in four remote districts of Khyber Pakhtunkhwa including Karak, Lakki Marwat, Tank, and Dera Ismail Khan (D. I. Khan) and a total of 1,674 participants were recruited using a convenience sampling technique. Results The prevalence of cutaneous leishmaniasis among the participants with cutaneous lesions was 50.4% and the infection was comparatively more prevalent in district Karak. Among participants, 56.8% were male and mostly, 53.8% were under the age of 16 years with 52.8% living in kutcha houses and were from rural areas. Multiple skin lesions were more common, and the face was frequently affected body part. The ratio of participants with lesions older than a month was higher and the majority confronted infections with blood protozoan parasites for the first time. Most participants were unaware of the signs/symptoms of the disease, basic knowledge of the vectors, anthroponotic spread, preventive measures, secondary infections, and reservoir hosts. The use of wood/animal dung as fuel, closeness with reservoir animals, and no use of insect repellents were some of the notable risk factors. Conclusion Cutaneous leishmaniasis is highly prevalent in the study area and a very low level of awareness was reported among the participants. This study necessitates the planning and execution of regulations and preventive programs, public health education, awareness campaigns, and disease management practices to overcome future incidence of cutaneous leishmaniasis.
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Ihsanullah M, Yousuf MJ, Ahmad N, Masood Z, Majeed S, Hassan HU, Ibrahim M, Khooharo AR, Khooharo E, Mastoi AH, Zafar N, Shaikh FM. Prevalence of cutaneous leishmaniasis in the largest populated city Karachi, Pakistan. BRAZ J BIOL 2021; 83:e247583. [PMID: 34932616 DOI: 10.1590/1519-6984.247583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 06/04/2021] [Indexed: 11/22/2022] Open
Abstract
The study was undertaken from September 2018 to April 2019 to determine the prevalence of cutaneous leishmaniasis in human beings living in six districts of Karachi. Suspected persons were screened for the disease and positive cases were identified on the basis of skin lesions and blood samples. Samples were observed by mounting their smear. A total of 207 subjects of different ages and sex groups were investigated, however, only 192 (92%) of the suspected cases were found to have the disease 64% of cases were male which were significantly high (p 0.05), than female 36%. The lesion was more frequently detected among the youth ages of 21-30 years (31%) as compared to other groups. In both sexes, legs were found to be more infected (25% male + 20% female) followed by arms (20% male + 0% female) and face (15% male +11% female). The mixed body parts had shown the lowest infections such as (4% in males + 5%) in females. In conclusion, the highest and lowest leishmaniasis infections were observed in District West (23% male + 9% female) followed by District East (15% male + 7% female), District Malir (11% male+ 4% female), District Central (7% male + 5% female), District Korangi (4% male + 7% female) and District South (4% male + 4% female) respectively.
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Affiliation(s)
- M Ihsanullah
- University of Karachi, Department of Zoology, Karachi-75270, Pakistan
| | - M J Yousuf
- University of Karachi, Department of Zoology, Karachi-75270, Pakistan
| | - N Ahmad
- Aquatic Diagnostic e Research Center Bahria University, Karachi-75260, Pakistan
| | - Z Masood
- Department of Zoology, Sardar Bahadur Khan Women's University Quetta Balochistan, Pakistan
| | - S Majeed
- Aquatic Diagnostic e Research Center Bahria University, Karachi-75260, Pakistan
| | - H Ul Hassan
- University of Karachi, Department of Zoology, Karachi-75270, Pakistan
| | - M Ibrahim
- University of Karachi, Department of Zoology, Karachi-75270, Pakistan
| | - A R Khooharo
- Centre of Excellence in Marine Biology University of Karachi, Karachi-75270, Pakistan
| | - E Khooharo
- Regional Training Institute Karachi, Population Welfare Department Government of Sindh, Pakistan
| | - A H Mastoi
- Faculty of Agriculture, Lasbela University of Agriculture, Water and Marine Science, Uthal Balochistan, Pakistan
| | - N Zafar
- Institute of Skin Diseases, Sindh, Karachi, Pakistan
| | - F M Shaikh
- Institute of Skin Diseases, Sindh, Karachi, Pakistan
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Kitano H, Sanjoba C, Goto Y, Iwamoto K, Kitagawa H, Nomura T, Omori K, Shigemoto N, Hide M, Matsumoto Y, Ohge H. Complicated cutaneous leishmaniasis caused by an imported case of Leishmania tropica in Japan: a case report. Trop Med Health 2021; 49:20. [PMID: 33676584 PMCID: PMC7937276 DOI: 10.1186/s41182-021-00312-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 02/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Leishmaniasis is not endemic in Japan, and imported cases are rare. However, there are increasing concerns regarding imported cases of cutaneous leishmaniasis from endemic countries to Japan. This report describes a case of imported cutaneous leishmaniasis that was diagnosed and treated in Japan. CASE PRESENTATION A 53-year-old Pakistani man presented with skin lesions on both malleoli of his right ankle and the dorsum of the left foot. The skin lesions manifested as erythematous nodules surrounding an ulcer in the center of the lesion. The lesions of the malleoli of his right ankle each measured 3 × 3 cm, and the lesion on the top of his left foot measured 5 × 4 cm. He had been living and working in Japan but had a history of a visit to Pakistan for about 2 months in 2018. The skin lesions were biopsied. Giemsa and hematoxylin and eosin staining of biopsy samples showed amastigotes of Leishmania in macrophages, and the presence of Leishmania was confirmed by skin tissue culture. Polymerase chain reaction using biopsy specimens identified Leishmania parasites, and DNA sequence analysis revealed that the species was Leishmania tropica. The patient was treated with intravenous liposomal amphotericin B for 6 days. The erythema disappeared, and the erythematous nodules resolved within 3 weeks. CONCLUSION This is the first report of imported cutaneous leishmaniasis caused by L. tropica from Pakistan, and it is interesting that all three testing modalities showed positive results in this case.
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Affiliation(s)
- Hiroyuki Kitano
- Department of Infectious Diseases, Hiroshima University Hospital, 1-2-3 Minamiku Kasumi, Minamiku, Hiroshima City, Hiroshima, 734-8551, Japan.
| | - Chizu Sanjoba
- Laboratory of Molecular Immunology, Department of Animal Resource Sciences, Graduate School of Agricultural and Life Sciences, Tokyo University, 1-1-1 Yayoi, Bunkyo-Ku, Tokyo, Tokyo, 113-8657, Japan
| | - Yasuyuki Goto
- Laboratory of Molecular Immunology, Department of Animal Resource Sciences, Graduate School of Agricultural and Life Sciences, Tokyo University, 1-1-1 Yayoi, Bunkyo-Ku, Tokyo, Tokyo, 113-8657, Japan
| | - Kazumasa Iwamoto
- Department of Dermatology, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Minamiku Kasumi, Minamiku, Hiroshima City, Hiroshima, 734-8551, Japan
| | - Hiroki Kitagawa
- Department of Infectious Diseases, Hiroshima University Hospital, 1-2-3 Minamiku Kasumi, Minamiku, Hiroshima City, Hiroshima, 734-8551, Japan
| | - Toshihito Nomura
- Department of Infectious Diseases, Hiroshima University Hospital, 1-2-3 Minamiku Kasumi, Minamiku, Hiroshima City, Hiroshima, 734-8551, Japan
| | - Keitaro Omori
- Department of Infectious Diseases, Hiroshima University Hospital, 1-2-3 Minamiku Kasumi, Minamiku, Hiroshima City, Hiroshima, 734-8551, Japan
| | - Norifumi Shigemoto
- Department of Infectious Diseases, Hiroshima University Hospital, 1-2-3 Minamiku Kasumi, Minamiku, Hiroshima City, Hiroshima, 734-8551, Japan
| | - Michihiro Hide
- Department of Dermatology, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Minamiku Kasumi, Minamiku, Hiroshima City, Hiroshima, 734-8551, Japan
| | - Yoshitsugu Matsumoto
- Laboratory of Molecular Immunology, Department of Animal Resource Sciences, Graduate School of Agricultural and Life Sciences, Tokyo University, 1-1-1 Yayoi, Bunkyo-Ku, Tokyo, Tokyo, 113-8657, Japan
| | - Hiroki Ohge
- Department of Infectious Diseases, Hiroshima University Hospital, 1-2-3 Minamiku Kasumi, Minamiku, Hiroshima City, Hiroshima, 734-8551, Japan
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Zeb I, Ali A, Nawab J, Khan MQ, Kamil A, Tsai KH. Cutaneous leishmaniasis in male schoolchildren in the upper and lower Dir districts of Khyber Pakhtunkhwa, and a review of previous record in Pakistan. Acta Trop 2020; 209:105578. [PMID: 32533937 DOI: 10.1016/j.actatropica.2020.105578] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/06/2020] [Accepted: 06/07/2020] [Indexed: 11/27/2022]
Abstract
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.
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Epidemiological features of cutaneous leishmaniasis endemic in hilly areas of district Karak, Khyber-Pakhtunkhwa province of Pakistan. J Parasit Dis 2020; 44:725-729. [PMID: 33184539 DOI: 10.1007/s12639-020-01250-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022] Open
Abstract
Cutaneous leishmaniasis is a vector borne infection caused by flagellated parasitic protozoans of the genus Leishmania. This is an emergent threat and endemic in areas of tropic and sub-tropics and has a wider geographical distribution. This study was aimed to find the epidemiological aspects of cutaneous leishmaniasis during the recent epidemic in district Karak in 2018-2019. The suspected patients of leishmaniasis from different areas of district Karak were examined. We came across 803 cases during six-month period from August 2018 to January 2019. A major portion (> 37%; n = 299) of these patients were in age 11-20 years. The infection rate was higher in female (55.3%; n = 803) compared to males (44.6%; n = 803). Both gender and age showed a significant effect on the occurrence of infection. It is concluded that cutaneous leishmaniasis has appeared as a major health issue in district Karak. The current study report CL outbreak in Karak district which need immediate response from the healthcare authorities. In addition, extensive awareness campaigns are needed for timely prevention of such outbreaks.
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Bashir U, Tahir M, Anwar MI, Manzoor F. Comparison of Intralesional Meglumine Antimonite along with oral Itraconazole to Intralesional Meglumine Antimonite in the treatment of Cutaneous Leishmaniasis. Pak J Med Sci 2019; 35:1669-1673. [PMID: 31777513 PMCID: PMC6861503 DOI: 10.12669/pjms.35.6.363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 02/04/2019] [Accepted: 07/25/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND & OBJECTIVE Cutaneous leishmaniasis (CL) is endemic in developing countries like Pakistan. Pentavalent antimonials are still drug of choice, despite being toxic and intolerable for patients. Second line treatments have been extensively studied but the results of their efficacy are conflicting. This, to our knowledge, will be the first study in this regard. Our objective was to determine if combination of oral itraconazole with intralesional (IL) meglumine antimoniate (MA) reduces the duration of treatment for cutaneous leishmaniasis, as compared to intralesional MA alone. METHODS A randomized controlled trial (single blinded) was carried out from August 2017 till December 2017 on 69 patients who fulfilled inclusion criteria. They were assigned to Group-A or B by lottery method. Group-A patients received IL MA once a week while Group-B received oral itraconazole 200mg, once daily, for six weeks along with similar regimen of IL MA as Group-A. The patients were assessed every three weeks by the blinded assessor till clinical cure was achieved. A follow up visit, two months after clinical cure was done to look for relapse of the disease. RESULTS Thirty patients in Group-A and 35 patients in Group-B completed the study. At 3, 6, 9 and 12 weeks the patients were assessed for: no, partial or complete response and results of the two groups were compared for statistical significance. The p-values of 0.20, 0.57 and 0.11 at 3, 6 and 9 weeks, respectively, depict that there was no significant difference at any step of assessment between the two groups in terms of healing. The p values of each t test was>0.05 refuting the hypothesis. CONCLUSION Combination of oral itraconazole with intralesional MA offered no benefit over intralesional MA alone in the management of cutaneous leishmaniasis in terms of duration of therapy.
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Affiliation(s)
- Uzma Bashir
- Dr. Uzma Bashir, MCPS, FCPS. Department of Dermatology and Otolaryngology, Combined Military Hospital, Quetta, Pakistan
| | - Moizza Tahir
- Dr. Moizza Tahir, MCPS, FCPS, MHPE. Department of Dermatology, Combined Military Hospital, Multan, Pakistan
| | - Muhammad Irfan Anwar
- Dr. Muhammad Irfan Anwar, FCPS. Department of Dermatology, PNS Shifa, Karachi, Pakistan
| | - Faisal Manzoor
- Dr. Faisal Manzoor, MCPS, FCPS. Department of Dermatology and Otolaryngology, Combined Military Hospital, Quetta, Pakistan
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Affiliation(s)
- Alexander J. Blum
- Department of Surgery, Baylor College of Medicine, Houston, Texas, United States of America
| | - M. Farhan Majid
- Center for Health and Biosciences, James A Baker III Institute of Public Policy, Rice University, Houston, Texas, United States of America
| | - Peter J. Hotez
- Center for Health and Biosciences, James A Baker III Institute of Public Policy, Rice University, Houston, Texas, United States of America
- Texas Children’s Center for Vaccine Development, Departments of Pediatrics and Molecular Virology and Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America
- Center for Medical Ethics, and Health Policy, Baylor College of Medicine, Houston, Texas, United States of America
- Department of Biology, Baylor University, Waco, Texas, United States of America
- Scowcroft Institute of International Affairs, Bush School of Government and Public Policy, Texas A&M University, College Station, Texas, United States of America
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