Searching for cutaneous leishmaniasis in tribals from Kerala, India

Abstract

Background:In India, indigenous cases of cutaneous leishmaniasis (CL) are mainly confined to the northwestern region. But now, more and more case reports are coming in from other parts of India. In January 2009, a 26-year-old lady residing in a forest area in Thiruvananthapuram district of Kerala State presented with bluish red nodules on her upper extremities, of six months duration, which was clinically more in favor of cutaneous leishmaniasis. She had never gone out of the district of Thiruvananthapuram in her life.Aim:To investigate whether the patient hails from a new endemic focus of cutaneous leishmaniasis.Setting and Design:An epidemiological investigation in the form of a survey was carried out in March 2009 by a multidisciplinary team among 63 persons residing in the Mele Aamala and Aayiramkala forest tribal settlements in Kuttichal Panchayat of Thiruvananthapuram district.Material and Methods:History taking and clinical examination of 38 persons in the area with special consideration to skin lesions was undertaken. Microbiological and histopathological examination of the skin lesions was done. Breeding places of sand fly and possible reservoirs of Leishmania were also simultaneously investigated.Statistical analysis used:The data obtained was tabulated as frequency and percentage. Chi-square test was done to find out the statistical significance of differences in distributions.Results:Out of the 38 persons examined, active lesions were found in 12 persons and six had healed lesions. Tissue samples were obtained from seven out of the 12 suspected cases. Four of them showed Leishman Donovan (LD) bodies in tissue smears. Out of the cultures taken from three patients, one showed promastigote forms in Novy McNeal Nicolle (NNN) medium. Histopathological study was done in five patients and two patients had LD bodies, one had epithelioid cell granuloma and the other two had mixed infiltrate with predominantly macrophages. All the three investigations were carried out in three patients and out of them one showed positivity in all the three investigations and the rest two were positive in tissue smear and histopathological examination. Sandflies collected from the area gave an indirect evidence of its role in the disease transmission in the area.Conclusion:The clinical, microbiological and histopathological evaluation of the skin lesions was consistent with cutaneous leishmaniasis. But none of the patients gave history of travel outside the district before the onset of the disease and no one had newly moved into this area within the last two years. So this may be considered as probably a new focus of cutaneous leishmaniasis

Multilocus microsatellite typing reveals a genetic relationship but, also, genetic differences between Indian strains of Leishmania tropica causing cutaneous leishmaniasis and those causing visceral leishmaniasis

“…Human CL has also been reported from different parts of India, e. g. Rajasthan State, north-west India [8], Himachal Pradesh, northern India [9], and Kerala State, south-west India [10]. Three species of Leishmania have been found to cause CL in India: L. major , L. tropica and L. donovani [1].…”

Emergence of visceral leishmaniasis in Kollam district, Kerala, southern India

“…1 Kala azar was not a major public health problem in Kerala, the southern Indian state except a few isolated cases being reported in the last decade. [2][3][4][5][6][7][8] Kollam, a district with a population of 2.6 million typically represents cross section of Kerala's natural attributes. 81,438 hectares of land are under forest cover, in the eastern portion of the district.…”

Visceral Leishmaniasis in a Non-Endemic Region of India- Investigation of an Outbreak

“…1 Cutaneous forms of the disease are now being detected increasingly in the southern part of the country. 2 Newer species of Phlebotomus and natural infection of Phlebotomus with Leishmania parasites have been demonstrated in the tribal belts of western ghats in south India in recent years. 6,7 Cutaneous and visceral forms of the disease have been detected in individuals with no history of travel to endemic areas and in whom no definite routes of transmission could be postulated.…”

“…6,7 Cutaneous and visceral forms of the disease have been detected in individuals with no history of travel to endemic areas and in whom no definite routes of transmission could be postulated. 2,7 Also, the clinical management of VL is undergoing rapid changes with the use of liposomal forms of Amphotericin B and also due to the use of various combinations of miltefosine, amphotericin B, paromomycin etc. 8 But the healthcare professionals are facing newer challenges due to the emergence of miltefosine resistant forms of VL.…”

“…It is transmitted by the bite of an infected female Phlebotomus (sand fly) and is seen mostly in developing countries. 1,2 It can manifest as cutaneous, mucosal or visceral forms, which result from infection of macrophages in the dermis, in the naso-oropharyngeal mucosa and throughout the reticuloendothelial system, respectively. Cutaneous and mucosal leishmaniasis causes substantial morbidity, whereas visceral leishmaniasis (VL) can be life threatening.…”