Placing Leishmaniasis in the Limelight through the Communicable Disease Surveillance System: An Experience from Sri Lanka (original) (raw)
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Potential challenges of controlling leishmaniasis in Sri Lanka at a disease outbreak
BioMed Research International, 2017
The present works reviewed the existing information on leishmaniasis in Sri Lanka and in other countries, focusing on challenges of controlling leishmaniasis in the country, in an outbreak. Evidence from recent studies suggests that there is a possibility of a leishmaniasis outbreak in Sri Lanka in the near future. Difficulty of early diagnosis due to lack of awareness and unavailability or inadequacy of sensitive tests are two of the main challenges for effective case management. Furthermore, the absence of a proper drug for treatment and lack of knowledge about vector biology, distribution, taxonomy and bionomics, and reservoir hosts make the problem serious. The evident potential for visceralization in the cutaneous variant of L. donovani in Sri Lanka may also complicate the issue. Lack of knowledge among local communities also reduces the effectiveness of vector and reservoir host control programs. Immediate actions need to be taken in order to increase scientific knowledge about the disease and a higher effectiveness of the patient management and control programs must be achieved through increased awareness about the disease among general public and active participation of local community in control activities.
Spatial Epidemiologic Trends and Hotspots of Leishmaniasis, Sri Lanka, 2001–2018
Emerging Infectious Diseases
L eishmaniases are diseases caused by Leishmania spp. parasites transmitted through the bites of infected female phlebotomine sand flies. A neglected tropical disease that mainly affects the tropics and subtropics, leishmaniasis has 3 forms: cutaneous, visceral, and mucocutaneous (1). Cutaneous leishmaniasis (CL) is the most common form, causing skin lesions that can leave scars and cause lifelong disability (1). Visceral leishmaniasis (VL) is the most serious form and has a case-fatality rate >95% in untreated cases; globally, 50,000-90,000 new cases and 20,000-40,000 deaths occur annually, making VL one of the largest killers among neglected tropical diseases (1-3). Approximately 0.7-1 million new CL cases and a few thousand mucocutaneous leishmaniasis cases occur worldwide each year (1-3). South Asia has the highest incidence of VL; India, Nepal, and Bangladesh are predominantly affected. Leishmaniasis in this region is caused by Leishmania donovani transmitted by Phlebotomus argentipes sand flies (2-4). Driven by the goal to eliminate VL in South Asia by 2020, the 3 countries once highly endemic for VL have made remarkable progress, bringing down reported cases from 50,898 in 2007 to 6,174 in 2017; Nepal had an 84% case reduction, India an 87% reduction, and Bangladesh a 96% reduction (2,4). Such efforts have contributed greatly to the ≈80% reduction in global VL incidence during 2007-2017 (2,4,5). Local and international health policy makers do not view leishmaniasis as an urgent health issue in Sri Lanka, possibly because of the perceived nonserious nature of CL and relatively small numbers of reported cases (1,2,4). Locally acquired CL was not reported in Sri Lanka before 1992 (6), and only a few sporadic cases were reported before incidence rates began to escalate in 2001 (7). Since then, locally acquired VL and mucocutaneous forms also have been reported, although most leishmaniasis cases in the country are cutaneous (7-11). Typical symptoms of CL are single, nontender, nonitchy lesions in the form of nodules, papules, or ulcers (Figure 1, panels A-C) that affect exposed body parts (7,10). Occasional atypical symptoms include dermal plaques (Figure 1, panel D), erythematous ulcerative patches (12,13), and mucosal tissue involvement (14). In Sri Lanka, initial treatment for CL is weekly intralesional inoculations of sodium stibogluconate administered through dermatology units of the government health sector at a physician's discretion.
Is leishmaniasis in Sri Lanka benign and be ignored?
Journal of vector borne diseases, 2009
Cutaneous leishmaniasis is now an endemic disease in Sri Lanka. Many studies have focussed on various aspects of this disease but the knowledge, particularly on epidemiological and vector aspects is still poor and the awareness among the general public and even medical/paramedical personnel regarding this disease remains grossly inadequate. The steady increase in the numbers and spread of cutaneous leishmaniasis cases in Sri Lanka and the very close similarity (genotypic and phenotypic) between the local parasite Leishmania donovani MON-37 and the parasite causing visceral leishmaniasis in India (L. donovani MON-2), considered together with the more recent case reports of autochthonous cases of visceral disease in this country, calls for urgent action for setting up of a surveillance programme to estimate the true disease burden and to implement an organized control strategy, combined with operational and epidemiological research to aid control efforts to avert a potentially major c...
Cross-Sectional Study to Assess Risk Factors for Leishmaniasis in an Endemic Region in Sri Lanka
American Journal of Tropical Medicine and Hygiene, 2013
Sri Lanka reports significantly more cutaneous leishmaniasis (CL) cases than visceral leishmaniasis (VL) cases, both of which are caused by Leishmania donovani MON-37. A cross-sectional study conducted in an area with a high prevalence of CL prevalent included 954 participants of an estimated population of 61,674 to estimate the number of CL cases, ascertain whether there is a pool of asymptomatic VL cases, and identify risk factors for transmission. A total of 31 cases of CL were identified, of whom 21 were previously diagnosed and 10 were new cases. Using rK39 rapid diagnostic test to detect antibodies against Leishmania spp., we found that only one person was seropositive but did not have clinical symptoms of CL or VL, which indicated low transmission of VL in this area. χ 2 test, independent sample t-test, and multivariate analysis of sociodemographic and spatial distribution of environmental risk factors showed that living near paddy fields is associated with increased risk for transmission of CL (P 0.01).
Emergence of visceral leishmaniasis in Sri Lanka: a newly established health threat
Pathogens and Global Health, 2017
Background: Sri Lanka is a new focus of human cutaneous leishmaniasis caused by a genetic variant of usually visceralizing parasite Leishmania donovani. Over 3000 cases have been reported to our institution alone, during the past two decades. Recent emergence of visceral leishmaniasis is of concern. Methods: Patients suspected of having visceral leishmaniasis (n = 120) fulfilling at least two of six criteria (fever > 2 weeks, weight loss, tiredness affecting daily functions, splenomegaly, hepatomegaly and anemia) were studied using clinic-epidemiological, immunological and haematological parameters. Seven cases (four progressive, treated (group A) and 3 nonprogressive, potentially asymptomatic and observed (group B) were identified. Clinical cases were treated with systemic sodium stibogluconate or amphotericin B and all were followed up at the leishmaniasis clinic of University of Colombo for 3 years with one case followed up for 9 years. Results: All treated cases responded well to anti leishmanial treatment. Relapses were not noticed. Clinical features subsided in all non-progressive cases and did not develop suggestive clinical features or change of laboratory parameters. Visceral leishmaniasis cases have been originated from different districts within the country. Majority had a travel history to identified local foci of cutaneous leishmaniasis. Conclusion: Visceral leishmaniasis is recognized as an emerging health threat in Sri Lanka. At least a proportion of locally identified strains of L. donovani possess the ability to visceralize. Apparent anti leishmanial sensitivity is encouraging. Timely efforts in disease containment will be important in which accurate understanding of transmission characteristics, increased professional and community awareness, improved diagnostics and availability of appropriate treatment regimens.
Journal of Tropical Medicine, 2019
Cutaneous leishmaniasis caused by a genetic variant of L. donovani is being reported from Sri Lanka since year 2001. Patients presented from different geographical locations (600 patients from North or South and a minority of cases from other foci, 2001-2013) were studied. Analysis revealed two different sociodemographic and clinical profiles of leishmaniasis in Northern and Southern Sri Lanka. Also, the same different profiles were present in these foci since the onset of the recent outbreak and had independently propagated within each focus over the time. A profile of 14 parameters identified in the Northern focus was further examined with regard to other locations. Northwestern (10/14) and Central parts (9/14) of the island were more similar to Northern focus (14/14). Infection would have originated in one focus and spread to other 2 in Northern Sri Lanka. Southern focus was different from and appeared older than all others (2/14). Western focus that accommodates a large transien...
2020
Background Cutaneous leishmaniasis (CL) appears to be spreading to previously non-endemic regions of Sri Lanka. The aim of this study was to describe a newly emerging focus of CL in the district of Gampaha, in Western Sri Lanka. Methods A case based descriptive study was carried out from January 2018 to April 2019 in the Mirigama Medical Officer of Health (MOH) area, which reported the highest number of CL cases in Gampaha District. Laboratory confirmed cases were traced and socio-demographic and clinical data were collected via a validated questionnaire and clinic records respectively. The quality of life (QOL) of study participants was measured using the Dermatology Life Quality Index (DLQI). Global Positioning System (GPS) coordinates of patient residences were recorded using handheld GPS receivers. Sand-flies were collected from four selected sites, using Indoor Hand Collection (IHC) (162 units) and Cattle Baited Net Traps (CBNT) (n=3) and a battery-operated aspirator. Results O...
Asymptomatic Leishmania infections in northern India: a threat for the elimination programme?
Transactions of the Royal Society of Tropical Medicine and Hygiene, 2014
Visceral leishmaniasis (VL) continues to embody as a mammoth public health problem and hurdle to the socioeconomic development of Bihar, India. Interestingly, all leishmanial infections do not lead to overt clinical disease and may stay asymptomatic for a period of time. Asymptomatic cases of VL are considered as probable potential reservoirs of VL, and thus can play a major role in transmission of the disease in highly endemic areas of Bihar, India. They outnumber the exact disease burden in endemic areas of this region, thus jeopardizing the goal of the elimination program that is due by 2015. This article discusses the potential risk factors, epidemiological markers of transmission and requirement of highly sensitive diagnostic tools for efficient recognition of the high risk groups of conversion to symptomatic for proper designing of strategies for implementation of the control programs.
Assessment of knowledge and perceptions on leishmaniasis: An island-wide study in Sri Lanka
PLOS Neglected Tropical Diseases, 2022
Cutaneous leishmaniasis (CL) is a notifiable disease in Sri Lanka with increasing case numbers reported from every part of the country. In addition to disease treatment and vector control measures, knowledge and perceptions in a community are key contributors to a successful intervention program. An island-wide survey was carried out to assess the knowledge and perceptions regarding CL across the island, with 252 confirmed CL cases and 2,608 controls. Data was collected by trained personnel, using a pre-tested Case Reporting Form (CRF). Although the percentage who referred to CL by its correct name was low (1.4%), majority stated that it is a fly induced skin disease (79.1%). Knowledge on the symptoms, curability and the name of the vector was high in these communities, but specific knowledge on vector breeding places, biting times and preventive methods were poor. The patients were more knowledgeable when compared to the controls. Differences in the level of knowledge could be identified according to the level of education of the participants as well as across the different areas of the country. The main source of information was through the healthcare system, but the involvement of media in educating the communities on the disease was minimal. While this study population was unaccustomed to the use of repellants or sprays, the use of bed nets was high (77.7% of the participants) in this study population. Although misconceptions and incorrect practices are rare in Sri Lankan communities, promoting health education programs which may improve disease awareness and knowledge on vector and its control will further strengthen the control and prevention strategies.