Clinical and epidemiological studies on the cutaneous leishmaniasis caused byLeishmania(Leishmania)donovaniin Sri Lanka

IntroductionCerebral palsy (CP) describes a heterogeneous group of motor disorders resulting from disturbance in the developing brain. CP occurs in approximately 2.1 per 1000 live births in high-income countries, but in low- and middle-income countries (LMICs) the prevalence and severity of CP may be greater and aetiological risk factors different. In Sri Lanka, a LMIC, there have been no epidemiological studies of CP to date. Systematically collected data are required to identify opportunities for primary and secondary prevention, to plan and establish services to support children and adults with CP and their families and to act as a sampling frame for new research. Here we describe a pilot study protocol for a CP register in Sri Lanka.Methods and analysisThe aim of this study is to establish a CP register in Sri Lanka. We will use different surveillance methodologies in two provinces of Sri Lanka: hospital and community surveillance in the Western Province and community surveillance in the Eastern Province. A common record form will collect demographic, clinical and service data for children with CP <18 years living in these two provinces. Data will be transferred to a secure online data repository and used to describe the epidemiology of CP in these regions. We will describe the strengths and challenges of the surveillance mechanisms and estimate the resources required for ongoing hospital and community based surveillance in the Western and Eastern provinces and to include additional provinces across the country.Ethics and disseminationThis study has ethical clearance from The University of Kelaniya, National Health Research Council, the Institutional Ethics Review Committee of the Lady Ridgeway Hospital, Colombo South Teaching Hospital and the Director of the North Colombo Teaching Hospital. Results from this research will be disseminated through local and international conferences and through publications in peer-reviewed journals.

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Leishmania donovani Induced Cutaneous Leishmaniasis: An Insight into Atypical Clinical Variants in Sri Lanka

Journal of Tropical Medicine ◽

10.1155/2019/4538597 ◽

2019 ◽

Vol 2019 ◽

pp. 1-11 ◽

Cited By ~ 7

Author(s):

Yamuna Siriwardana ◽

Bhagya Deepachandi ◽

Chalukya Gunasekara ◽

Wipula Warnasooriya ◽

Nadira D. Karunaweera

Keyword(s):

Sri Lanka ◽

Head And Neck ◽

Cutaneous Leishmaniasis ◽

Disease Transmission ◽

Leishmania Donovani ◽

Developmental Stages ◽

Clinical Entity ◽

Delayed Treatment ◽

Separate Clinical Entity ◽

Study Laboratory

Sri Lanka is a recent focus having Leishmania donovani induced cutaneous leishmaniasis (CL) as the main clinical entity. A separate clinical entity within profile of CL was described in this study. Laboratory confirmed cases of CL (n= 950, 2002-2014) were analysed. Most lesions showed known classical developmental stages of CL (CCL) observed in other CL endemic settings while few cases (13%, 122/950) showed atypical skin manifestations (ACL). Clinical, geographical, and treatment response patterns of ACL were different from those of CCL. ACL was mainly found among males (68.0%), in 21-40 year age group (51.6%), and reported delayed treatment seeking (23.5% vs 16.3% in CCL), more nonclassical onset (lesions other than acne form <1cm sized papules), (12.1 vs 2.7%, P<0.05.), more head and neck lesions (41.5%. vs 27.2%), more large lesions (>4cm), (18.6 vs 9.9%), and poor laboratory positivity rates (65.6% vs 88.2%) when compared to CCL. When compared to lesions reporting a typical onset, lesions reporting nonclassical onset were more likely to develop ACL later on (50.1% vs 10.7%). As compared to lesions on limbs, those on head and neck and trunk were more likely to be ACL (7.0%, 16.3%, and 22.8%, respectively, P<0.05). ACL features were not age or gender dependent. Highest proportion within ACL category (32.8%) and small proportion of CCL (10.1%) originated from less leishmaniasis prevalent areas (other regions) (P<0.05). North reported more ACL than South (15.9% vs 7.4%). A total of 95 CL cases with a significant travel history were further analyzed. Residents of other regions when acquired infection from North or South developed more ACL than residents in North or South (60.9% vs 15.9% and 42.9% vs 7.4% respectively). Patients in other regions when travelled to North developed more ACL than when they travelled to South (60.9%, 42.9%). ACL and CCL required an average of 18 doses over 16.7 months and 10 doses over 12 weeks, respectively, to achieve a complete clinical cure. Underlying host immunological factors, parasite strain variations and regional variations of both could be underlying etiologies. Established independent transmission within less leishmaniasis prevalent regions combined with an unusual clinical picture leading to poor clinical suspicion and low laboratory confirmation rate will pose potential difficulties in early case detection in these highly populated and commercialized areas. This in turn will further facilitate silent and high disease transmission.

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CKD of Unknown Etiology (CKDu) in Sri Lanka: A Multilevel Clinical Case Definition for Surveillance and Epidemiological Studies

Kidney International Reports ◽

10.1016/j.ekir.2019.03.020 ◽

2019 ◽

Vol 4 (6) ◽

pp. 781-785 ◽

Cited By ~ 9

Author(s):

Eranga S. Wijewickrama ◽

Nalika Gunawardena ◽

Saroj Jayasinghe ◽

Chula Herath

Keyword(s):

Sri Lanka ◽

Clinical Case ◽

Epidemiological Studies ◽

Case Definition ◽

Unknown Etiology ◽

Clinical Case Definition

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PO 8505 LEISHMANIASIS IN ANGOLA – AN EMERGING DISEASE?

BMJ Global Health ◽

10.1136/bmjgh-2019-edc.125 ◽

2019 ◽

Vol 4 (Suppl 3) ◽

pp. A47.3-A48

Author(s):

Sofia Cortes ◽

André Pereira ◽

Jocelyne Vasconcelos ◽

Joana P Paixão ◽

Joltim Quivinja ◽

...

Keyword(s):

Cutaneous Leishmaniasis ◽

Neglected Tropical Diseases ◽

Epidemiological Studies ◽

Sequencing Analysis ◽

Vector Borne Disease ◽

Health Authorities ◽

African Patient ◽

Control Programmes ◽

Vector Borne ◽

The Impact

BackgroundPoverty, lack of resources, inadequate treatments and control programmes exacerbate the impact of infectious diseases in the developing world. Leishmaniasis is a vector-borne disease that is among the ten major neglected tropical diseases. Although endemic in more than 90 countries, the ones most affected, representing over 90% of new cases, are Bangladesh, Brazil, Ethiopia, India, Kenya, Nepal, and Sudan. In Africa south of the equator, the impact of leishmaniasis is much lower. In several countries, like Angola, little is known about this infectious neglected disease. In the 1970s, a group of Portuguese researchers described three cases of cutaneous leishmaniasis in children from Huambo district and in the 1990s visceral leishmaniasis was diagnosed in an African patient. More recently a canine survey in Luanda revealed two Leishmania-infected dogs.After some suspected cases of human cutaneous leishmaniasis in Huambo region in 2017, the Angola health authorities and the Instituto de Higiene e Medicina Tropical (IHMT), Lisbon, Portugal, established a collaboration to analyse samples from some suspected cases.MethodsThree paraffin-embedded human skin samples from dermatological lesions were sent to IHMT for molecular analysis. After DNA extraction, PCR was performed by using four protocols with different molecular markers.ResultsOne PCR protocol using a nested approach was positive in two of the samples. Sequencing analysis confirmed Leishmania sp. DNA.ConclusionThis was the first time that suspected human cutaneous samples were screened for leishmaniasis by molecular methods with detection of Leishmania sp. DNA. These preliminary studies highlight the need for higher awareness of health professionals for leishmaniasis clinical forms, to recognise risk factors and the epidemiological features of leishmaniasis in the Huambo province. It would be relevant to perform further epidemiological studies to confirm if this vector-borne disease could be emergent in this country.

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Histopathology of Cutaneous Leishmaniasis Caused by Leishmania donovani in Sri Lanka

BioMed Research International ◽

10.1155/2020/4926819 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Harshima Wijesinghe ◽

Nayana Gunathilaka ◽

Saveen Semege ◽

Nishantha Pathirana ◽

Nuwani Manamperi ◽

...

Keyword(s):

Sri Lanka ◽

Cutaneous Leishmaniasis ◽

Leishmania Donovani ◽

Clinical Presentation ◽

Cross Sectional Study ◽

Causative Organism ◽

Variable Intensity ◽

Cross Sectional ◽

The North ◽

Parasitic Load

Cutaneous leishmaniasis (CL) is a neglected tropical disease that is gaining importance in Sri Lanka and internationally. The clinical presentation, pathology, and method of parasite elimination in CL vary according to the species. Leishmania donovani is the causative organism for leishmaniasis in Sri Lanka. This collaborative cross-sectional study describes the clinicopathological features of cutaneous leishmaniasis among personnel of the tri-forces serving in the North and East of the country. The histology of fifty cases of CL confirmed by at least two methods (slit skin smear, lesion aspirate, tissue impression, and histology) was reviewed. The parasitic load was assessed semiquantitatively. The histological features were correlated with the clinical presentation and organism load. The majority (89.8%; n=44) presented with a single lesion mostly located in the upper limb (69.4%). The lesion types included papule (34.7%), nodule (32.7%), and an ulcer (30.6%). The evolution time of lesions averaged 31.55 weeks. Epidermal changes were observed in 49 of the biopsies and included hyperkeratosis (90.0%; n=45), acanthosis (44.0%; n=22), atrophy (34.0%; n=17), and interface change (66%; n=33). Dermal changes were seen in all cases and were characterized by a lymphohistioplasmacytic inflammatory infiltrate of variable intensity with ill-formed granuloma in 19 cases (38%) and well-formed epithelioid granulomas in 22 cases (44%). Focal necrosis was present in 20% (n=10). Leishmania amastigote forms were observed in 88% (n=44). Transepidermal elimination (P=0.025), granuloma (P=0.027) formation, and type of lesion (P=0.034) were significantly associated with the organism load. Granuloma formation was associated with a reduction in organism load, indicating that the macrophage activation played an important role in the control of the organism.

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