A case of high altitude cutaneous leishmaniasis in a non-endemic region in Nepal

Bastola, Anup; Shrestha, Mitesh; Lamsal, Mahesh; Shrestha, Srijan Lal; Prajapati, Sabita; Adhikari, Anurag; Gupta, Birendra Prasad; Hide, Mallorie; Devkota, Lina; Chalise, Bimal Sharma; Pandey, Kishor; Manandhar, Krishna Das

doi:10.1016/j.parint.2019.101991

Cited by 13 publications

(16 citation statements)

References 15 publications

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“…With substantial insight into the host immune correlates that underline the classical visceral and cutaneous manifestation, scarce reports are available on host immune correlates in L. donovani atypical CL disease emerging in known and newer endemic sites in the Indian subcontinent ( 10 , 30 – 32 , 35 , 36 ). Knowledge on comparative host immune response in LdCL versus typical VL is important to define the key immune checkpoints that can modulate the disease towards atypical phenotype ( 9 – 12 , 37 ). In this regard, no data are available on the systemic cytokine correlates in atypical CL cases with few reports on RT PCR-based lesional cytokine environment in Sri Lankan atypical CL cases.…”

Section: Discussionmentioning

confidence: 99%

“…major as the causative agent in India, Nepal, and Bangladesh (6)(7)(8). More recently, the disease is emerging as an unusual cutaneous manifestation caused by L. donovani in the newer endemic sites in Sri Lanka, Nepal, and India (9)(10)(11). The emergence of such atypical CL poses a newer challenge to the ongoing disease-control program and thus needs to be studied to understand the atypical disease etiology.…”

Section: Introductionmentioning

confidence: 99%

“…The emergence of such atypical CL poses a newer challenge to the ongoing disease-control program and thus needs to be studied to understand the atypical disease etiology. So far, there are few reports on genetic analysis of parasite isolates from atypical CL cases endemic in Sri Lanka, Nepal, and the states of Kerala and Himachal Pradesh (HP) in India, identified as L. donovani genetic variants distinct from the classical VL L. donovani isolates (9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

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An Insight Into Systemic Immune Response in Leishmania donovani Mediated Atypical Cutaneous Leishmaniasis in the New Endemic State of Himachal Pradesh, India

et al. 2022

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Leishmaniasis continues to afflict known and newer endemic sites despite global efforts towards its control and elimination. In this regard, the emergence of newer endemic sites with unusual disease formats is recognized wherein Leishmania donovani complex classically known to cause visceral disease is demonstrated to cause cutaneous manifestation. In this context, atypical cutaneous leishmaniasis (CL) cases caused by L. donovani genetic variants from the newer endemic state of Himachal Pradesh (HP) in India are beginning to be understood in terms of parasite determinants. The atypical CL manifestation further needs to be explored to define host immune correlates with a possible role in driving the unusual disease progression. In the given study, we performed comprehensive systemic-immune profiling of the atypical CL patients from the study area in HP, India, in comparison with the classical visceral leishmaniasis (VL) patients from the northeast region of India. The systemic immune response was studied using ELISA-based assessment of Th1, Th2, Th17, Treg, and Th22 specific plasma cytokine expression pattern and parasite-specific total serum IgG/IgG subclasses. The specified immune correlates are known to exhibit heterogeneous association with the different infecting parasite species, infection load, and co-lateral host immunopathology in classical CL and VL. In the atypical CL patient group, altered expression of IL-10 emerged as the key finding that could potentially fine-tune the Th1/Th17/Th22 effector cytokine axis towards a localized cutaneous manifestation. A reduced expression of IL-10 along with a high IFN-γ/IL-10 ratio as a readout of effective parasite killing defined atypical cutaneous outcome. In contrast, high circulatory IL-10 levels and a depressed IFN-γ/IL-10 ratio were seen in classical VL patients in line with an ineffective parasite-killing cytokine response. Overall, the study highlights new knowledge on host immune correlates in terms of cytokine expression pattern and IgG subclasses that underline atypical disease manifestation such that L. donovani, a generally visceralizing parasite species cause skin localized cutaneous lesions.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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An Insight Into Systemic Immune Response in Leishmania donovani Mediated Atypical Cutaneous Leishmaniasis in the New Endemic State of Himachal Pradesh, India

et al. 2022

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“…Our patient comes from the Okhaldhunga District, which falls within the hilly region of Nepal, with an altitude of approximately 1,500 m. The habitat of leishmania species is typically seen in areas of lower altitude; however, recent reports describe its presence in higher altitude areas. 8,27 In Nepal, 18 districts are considered endemic for visceral leishmaniasis, among which 6 new districts, including this hilly district, were recently added as an endemic region in 2016. 28 The reason for the dissemination of leishmaniasis cases to new areas could include climate change, deforestation, urbanization, frequent travel, immigration from endemic areas, and military operations.…”

Section: Case Reportmentioning

confidence: 99%

“…13 Despite being an endemic country for leishmaniasis, documented cases of CL from Nepal are limited. [7][8][9][14][15][16][17][18][19][20] Only one case report of erysipeloid CL has been published from Nepal. 20 This is the second case of erysipeloid CL from Nepal to be documented in the literature.…”

Section: Introductionmentioning

confidence: 99%

Case Report: An Atypical Erysipeloid Presentation of Cutaneous Leishmaniasis from the Hilly Region of Nepal

Nepal

2021

The American Journal of Tropical Medicine and Hygiene

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Cutaneous leishmaniasis, which is the most common form of leishmaniasis, classically presents as small erythematous papules and nodules that develop into ulcers with indurated, raised outer borders. However, lesions of cutaneous leishmaniasis can have pleomorphic and atypical presentations. The erysipeloid form is one of the rare, atypical presentations of cutaneous leishmaniasis. Reported is a case of a 58-year-old man from the hilly region of Nepal who presented with an atypical erythematous and edematous plaque over the left antecubital fossa. Cutaneous leishmaniasis was not considered as an initial diagnosis because of the atypical appearance of the lesion as well as his residence in the hilly region of Nepal. The diagnosis was made after detection of amastigotes on histopathological examination of a cutaneous biopsy specimen. There was complete regression of the lesion after treatment with oral miltefosine followed by oral fluconazole. Clinicians should be aware of atypical presentations of cutaneous leishmaniasis and it should be considered in the differential diagnosis, regardless of the presentation or geographic location.

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An Insight into Immunopathology of Leishmaniasis

Chauhan¹,

Nikita²,

Madaan³

et al. 2023

Pathobiology of Parasitic Protozoa: Dynamics and Dimensions

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A case of high altitude cutaneous leishmaniasis in a non-endemic region in Nepal

Cited by 13 publications

References 15 publications

An Insight Into Systemic Immune Response in Leishmania donovani Mediated Atypical Cutaneous Leishmaniasis in the New Endemic State of Himachal Pradesh, India

An Insight Into Systemic Immune Response in Leishmania donovani Mediated Atypical Cutaneous Leishmaniasis in the New Endemic State of Himachal Pradesh, India

Case Report: An Atypical Erysipeloid Presentation of Cutaneous Leishmaniasis from the Hilly Region of Nepal

An Insight into Immunopathology of Leishmaniasis

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