Clinical and epidemiological study of cutaneous leishmaniasis in two tertiary care hospitals of Jammu and Kashmir: An emerging disease in North India

摘要

BACKGROUND:Increased number of cases of cutaneous Leishmaniasis (CL) reporting to tertiary care centers of Jammu and Kashmir, a previously non-endemic area for the disease, merits consideration of CL as a major health problem with considerable epidemiological importance.AIMS:1) To describe the clinico-epidemiological profile, therapeutic characteristics and outcome of patients of CL. 2) To highlight our union territory as a new focus of endemicity for CL.METHODOLOGY:A bi-centric hospital based, prospective cohort study was conducted at two tertiary care hospitals of Jammu and Kashmir over a period of 10 years (July 2009 - June 19). All patients presenting to the outpatient department with lesions suggestive of CL were enrolled for the purpose of this study. The demographic data was recorded on preformed questionnaire along with a detailed history and meticulous examination. Patients diagnosed as having CL, based on clinical criteria, were subjected to slit skin smear (SSS) and histopathological examination for confirmation of diagnosis. Intralesional pentavalent antimonial (sodium stibogluconate-SSG) at a dose of 0.5?ml/cm2 (100?mg/ml solution) was administered thrice weekly to the patients with smaller lesions and intravenously or intramuscular, in a dose of 20?mg/kg/day to those with larger lesions. Response to treatment was assessed by total re-epithelialization of lesion with absence of infiltration and erythema, with or without scarring. Treatment was given until complete resolution of lesions or a maximum duration of 10 weeks for intralesional and 3 weeks for systemic therapy. Clinical follow up was initially carried out biweekly for 2 months & monthly thereafter. The final response to treatment was assessed at 6 months.RESULTS:The study included a total of 1300 cases with a mean age of 26.7?±?18.5 years. The mean duration of the disease was 28.52?±?13.5 weeks, ranging from 8 to 64 weeks. Lesions were noted mainly on exposed parts of body, with face being the most commonly affected site (89%). Nodulo-ulcerative plaques were the predominant lesion type observed (73.92%). Presence of Leishman-Donovan (LD) bodies could be demonstrated on SSS and histopathology in 60.69% and 39.54% of patients respectively. Presence of a recognizable histological pattern conforming to CL and response to a therapeutic trial of SSG was considered to be confirmatory in the remaining. Complete cure was achieved in 84.23% cases during the study period. Single lesions were more likely to respond to treatment as compared to multiple lesions. Route of administration did not have any significant impact on the final outcome.CONCLUSION:With the disease showcasing an escalating trend in Jammu & Kashmir, the possibility of a new focus of endemicity and its impact on the public health needs to be contemplated, and appropriate measures should be initiated to contain its spread.Copyright ? 2020. Published by Elsevier Ltd.