Clinico-demographic characterization of Cutaneous leishmaniasis in patients reporting to two hospitals in Matara and Hambantota districts, Sri Lanka

Abstract

Background: Cutaneous leishmaniasis (CL) is an established disease in Sri Lanka.
Objectives: This study aimed to characterize clinico-demographic pattern of CL, in patients reported to District General Hospital (DGH) Matara and Base Hospital (BH) Tangalle, which report about 100 new cases monthly.

Methods: Clinico-demographic findings of 47 CL confirmed patients (>18 years; Slit skin smears (SSS) and/or PCR positive) from preliminary data of a cross sectional study carried out at DGH Matara and BH Tangalle from August/2018 to January /2019 were analysed. Interviewer administered questionnaire was used to gather the demographic data.
Results: Median age was 43 years. Out of the 13 cases from DGH Matara, four reported from Urugamuwa and one each from other areas of the district. Of the 34 cases from BH

Tangalle, 12 were from Beliaththa. Eight SSS negatives became PCR positive and one PCR negative was SSS positive. Majority of the lesions were single (n=40, 85.1%), non-tender (n=38, 80.8%), non-itchy (n=34, 72.3%) and small (< 2cm, n=36, 76.6%) ulcerated nodules (n=14, 29.8%) in upper limbs (n=25, 53.1%) with parasitic grading of 1+ (n=20, 42.5%). Nine patients reported persistent itching without any evidence of secondary pathology. Clinical evidence of secondary bacterial infection presented in four patients and out of them, two had painful lesions. Thirty two lesions were <4 months duration. In addition to ulcerated nodules and plaques, three out of nine papules were ulcerated within 4 months’ by history. Two patients had a family member with CL.
Conclusions: Ulceration of papules is a novel observation. Urugamuwa is a possible emerging focus of CL in Matara where Dickwella is the known hot spot. Beliathta could be a main disease focus in Hambantota. This preliminary study based on a smaller sample size needs to be validated with a bigger sample size.