Clinical challenges in cutaneous leishmaniasis: A cohort from Southern Province, Sri Lanka

Abstract

Southern Province of Sri Lanka is endemic to cutaneous leishmaniasis (CL). This study aims to describe the clinico-demographic profile of a cohort of CL patients (n=115, CL confirmed by PCR), reported at two main hospitals in the Matara and Hambantota districts of the Southern Province, highlighting the novel clinical presentations and possible challenges and/or favourable findings in the elimination of CL from the Province, along with a comparison with the provincial literature (Quality-checked publications of similar data) to identify possible disease trends, which could be useful in planning control programmes. We have found that CL is common in young males, and typically appears as single nodules in the upper limb. These nodules often contain high parasite loads. Our observations show that ulceration of papules and plaques is a new development in the province. This could have significant implications for differential diagnosis and chronicity. One positive trend we have observed is the early seeking of treatment, which had improved diagnostic rates. Additionally, there has been an increase in reporting of papules, which were silent reservoirs of CL. This indicates an increased awareness of the disease among patients in this cohort. However, several negative trends were identified as well. The Tangalle divisional secretariat division has emerged as a possible new disease focus. Furthermore, the high number of nodules and lesions with high parasite loads, which are likely to be less responsive to treatment, could pose challenges for CL elimination. It is important to note that these findings are based on a limited sample size and should be further investigated with a larger sample to gain more comprehensive understanding of the situation.

KEYWORDS: Cutaneous leishmaniasis, Southern Province, Sri Lanka, clinical, demographic, Leishmania donovani