Is leishmaniasis in Sri Lanka benign and be ignored? (original) (raw)
Related papers
Leishmania donovani causing cutaneous leishmaniasis in Sri Lanka: a wolf in sheep's clothing?
Trends in Parasitology, 2009
Research involving leishmaniasis, a newly established disease in Sri Lanka, has focused mostly on parasitological and clinical factors, with inadequate understanding of other aspects, including its epidemiology and vector. The escalation in the spread of cutaneous leishmaniasis cases within Sri Lanka and the close resemblance (genotypic and phenotypic) between the local parasite Leishmania donovani MON-37 and the parasite causing visceral leishmaniasis in India (L. donovani MON-2), underscored by the more recent case reports of autochthonous cases of visceral and mucocutaneous-like disease, are clear warnings to the health authorities, scientists and policy makers. An effective control strategy is needed to contain further spread of cutaneous disease and avert a more-virulent form of leishmaniasis becoming endemic in Sri Lanka.
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.
BioMed Research International, 2019
Sri Lanka reports a large epidemic of cutaneous leishmaniasis (CL) caused by an atypical L. donovani while regional leishmaniasis elimination drive aims at achieving its targets in 2020. Visceralization, mucotrophism, and CL associated poor treatment response were recently reported. Long-term clinico-epidemiological trends (2001-2013) in this focus were examined for the first time. Both constant and changing features were observed. Sociodemographic patient characteristics that differ significantly from those of country profile, microchanges within CL profile, spatial expansion, constant biannual seasonal variation, and nondependency of clinical profile on age or gender were evident. Classical CL remains the main clinical entity without clinical evidence for subsequent visceralization indicating presence of parasite strain variation. These observations make a scientific platform for disease control preferably timed based on seasonal variation and highlights the importance of periodic...
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...
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.
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.
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...
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).
Journal of Tropical Medicine, 2019
Sri Lanka is a recent focus havingLeishmania donovaniinduced cutaneous leishmaniasis (CL) as the main clinical entity. A separate clinical entity within profile of CL was described in this study. Laboratory confirmed cases of CL (n= 950, 2002-2014) were analysed. Most lesions showed known classical developmental stages of CL (CCL) observed in other CL endemic settings while few cases (13%, 122/950) showed atypical skin manifestations (ACL). Clinical, geographical, and treatment response patterns of ACL were different from those of CCL. ACL was mainly found among males (68.0%), in 21-40 year age group (51.6%), and reported delayed treatment seeking (23.5% vs 16.3% in CCL), more nonclassical onset (lesions other than acne form <1cm sized papules), (12.1 vs 2.7%, P<0.05.), more head and neck lesions (41.5%. vs 27.2%), more large lesions (>4cm), (18.6 vs 9.9%), and poor laboratory positivity rates (65.6% vs 88.2%) when compared to CCL. When compared to lesions reporting a typic...