Emergence of cutaneous leishmaniasis in Nepal

Abstract

Background Cutaneous leishmaniasis (CL) is endemic in 70 countries worldwide. Nepal is considered non-endemic for CL and hence the control program is targeted to visceral leishmaniasis (VL) only. Here, we report the emergence of CL cases in different parts of Nepal. Methods We analyzed the CL and VL cases reported to Epidemiology and Diseases Control Division (EDCD), Ministry of Health and Population, Nepal through District Health Information System 2 (DHIS-2) and Early Warning and Reporting System (EWRS) during the past 4 years (2016–2019). Any laboratory-confirmed case was included in the study. Demographic and clinical details of each patient were transcribed into Excel sheets, verified with the case report forms and analyzed. Results VL has been reported in Nepal since 1980, but CL was reported very recently. From 2016 to 2019, 42 CL cases were reported from 26 different hospitals to EDCD which had been diagnosed on the basis of clinical presentation, and laboratory findings (demonstration of amastigotes in Giemsa-stained smears and rK39 test results). Majority of the patients (31.0%, 13/42) visited to the hospital within 1–6 months of onset of lesions. Facial region (38.1%, 16/42) was the common place where lesions were found ompared to other exposed parts of the body. CL was successfully treated with miltefosine for 28 days. The majority of CL patients did not have history of travel outside the endemic areas and there was no report of sandfly from these areas. Conclusion These evidences highlight that the Government of Nepal need to pay more efforts on CL and include it in differential diagnosis by clinicians, and plan for an active surveillance when the country is targeting leishmaniasis elimination by the year 2025 with the decreasing number of VL cases.

Leishmania donovani persistence and transmission causing cutaneous leishmaniasis in unusual-foci of Nepal

“…The Infectious and Viral Disease Research Laboratory (IVDRL) of Tribhuvan University of Nepal, which successfully adopted the molecular PCR-based test for diagnosis of cutaneous leishmaniasis in Nepal for the rst time, could be exploited for diagnosis as well as for surveillance of cutaneous leishmaniasis all over the country using all the PCR laboratory set-ups during the Covid-19 pandemics. Country may develop centers for both the visceral and cutaneous leishmaniasis surveillance and control program in every district or province since, L. donovani is endemic in 18 districts and 50 districts listed in doubtful endemic ones 11 , and cutaneous leishmaniasis is seen in 16 districts of all provinces.…”

“…Nepal, a South Asian Country, is in the very interesting geographical location of the world having the plain tropical in the South to the highest Mount Everest Himalaya in the North. Visceral leishmaniasis is endemic in Nepal since 1950s, primarily in the southeastern region of the Terai plain, along India 10 , 11 .…”

“…Biological diagnosis of cutaneous leishmaniasis is based on microscopic examination by ne needle aspiration cytology 13 , histopathology 14 and serological rK39 diagnostic tests 11 . The rst PCR-based molecular diagnosis to diagnose leishmaniasis in Nepal was performed in 2017 by Prof.…”

“…In 2006, a patient from Nepal visited to Safdarjung Hospital of New Delhi (India) for the treatment of skin disease was initially suspected as a case of basal cell carcinoma, but with skin clinical manifestations similar to a cutaneous leishmaniasis, a molecular diagnostic test (kDNA PCR) made it possible to diagnose cutaneous leishmaniasis caused by Leishmania (L.) major followed by the most appropriate treatment 12 . Increasing trends of cutaneous leishmaniasis have been reported in different parts of Nepal 13 , 11 . From 2016 to 2019, Pandey et al reported 42 cutaneous leishmaniasis cases referring to Epidemiology and Diseases Control Division (EDCD), Ministry of Health and Population, Nepal as diagnosed on the basis of clinical presentation and laboratory ndings 11 .…”

“…Increasing trends of cutaneous leishmaniasis have been reported in different parts of Nepal 13 , 11 . From 2016 to 2019, Pandey et al reported 42 cutaneous leishmaniasis cases referring to Epidemiology and Diseases Control Division (EDCD), Ministry of Health and Population, Nepal as diagnosed on the basis of clinical presentation and laboratory ndings 11 . Among these data, a very clear increment was observed between 2017 (2 cases) and 2018 (18 cases), and 21 new cutaneous leishmaniasis cases were reported in 2019 alone 11 .…”