Islamabad : The cases of Leishmaniasis, a parasitic infection that has high mortality rate is continuously on the rise in the country particularly in border areas of the Sindh and Baluchistan provinces while the disease has been taking endemic nature in a number of districts in Khyber Pakhtunkhwah and AJK.
The rare skin disease that damages the immune system severely is caused by the bite of infected Phlebotomine sand fly. It is fatal if not managed properly and treated well in time.
In Pakistan, the reported cases of one of the three types of Leishmaniasis, visceral Leishmaniasis have been reported from Dera Ismail Khan, Quetta, Tank, Hazara Division, Northern areas and Azad Jammu and Kashmir. These hilly areas provide favorable environment for growth and development of vector sand-fly while for cutaneous Leishmaniasis, statistics revealed that the cases were reported from all the provinces of Pakistan.
The cutaneous Leishmaniasis was found endemic in Mansehra, Swat, Dir, Chitral, Dera Ghazi Khan, Skardu, Gilgit, Abbottabad, Chilas, Azad Kashmir, Dera Bughti, Quetta Rawalpindi, Khuzdar, Lasbela, Qila Saifullah, Jacobabad, Rajanpur, Dera Ismail Khan, Qila Abdullah, Pishin, Larkana and Dadu. Besides the health care facilities, awareness regarding the specific disease is deficient in the said community, said Associate Professor of Pathology and Consultant Microbiologist at Al-Nafees Medical College Islamabad Dr Humaira Zafar while talking to ‘The News’ on Tuesday.
She added the disease is considered to affect the lower socioeconomic communities and countries and in Pakistan too, about 66 per cent of the population is resident of rural areas, which lack good health care facilities and bearing the cost of treatment for leishmaniasis is beyond the capacity of majority of people living in areas from where the cases are being reported.
The global statistics for the year 2018 showed its endemic nature in 98 countries. It was also identified that 350 million people are susceptible to this disease annually. It is ranked as the second most common disease after malaria, which is harboring high mortality rate. The commonest reason for this state of affairs is the subclinical state and prolonged incubation period, she said.
She added the cure rate is highly dependent upon the early diagnosis and prompt management with the help of anti parasitic drugs, sodium stibogluconate and amphotericin B. The hospitalization should be a preferred choice for amphotericin B management. Regarding preventive options the specific vaccine availability is yet a debatable issue. Therefore complete eradication is a challenge for health care providers, said Dr. Humaira.
She explained the disease can occur in three common forms including cutaneous, visceral, and mucocutaneous Lesihmaniasis. Mucocutaneous Leishmaniasis is most severe form due to chronic course. The clinical manifestations can be fever, anemia, muscle wasting, immune-suppression, superficial skin ulcers, and hepatosplenomegaly.
For cutaneous Leishmaniasis, the ulcerative skin lesions begin to develop even after many weeks or even months after the bite of sand-fly. The lesions usually take longer course for healing leaving behind a scar.
Visceral Leishmaniasis is also known as kala-azar. The involvement of skin, liver, spleen and bone marrow are seen in this form. The management options for patients with visceral Leishmaniasis having involvement of liver and spleen becomes limited. The available drugs are highly costly with severe side effects, said Dr. Humaira.
Moreover, she said nowadays the emergence of resistance pattern results in multiple relapses. The clinical features of Mucocutaneous Leishmaniasis appears even after years of initial skin lesions. The infection spreads to the nose, mouth, and throat triggering sores and bleeding. This form is usually seen when initial Cutaneous Leishmaniasis infection has not been treated, she said.
Studies reveal that treatment may reduce severity of the disease and medication can cure the disease. However, treatment is most effective when started before extensive damage to your immune system. Visceral leishmaniasis is often fatal within two years if it is not treated properly. Leishmaniasis damages the immune system so that it cannot fight off infections causing death ultimately. Dr. Humaira said the awareness regarding early diagnosis and hence prompt management is the only preventive option available. The gold standard for diagnosis is either by histopathological examination of affected tissue or by fine needle aspiration and cytology. Besides that serological diagnostic modalities like Direct agglutination test (DAT) and rk39 dipstick assays, Enzyme-linked Immunosorbent Assay (ELISA), Indirect Immunofluorescence Antibody Test (IFAT), antigen-based latex agglutination test (KAtex) have proven to be helpful.
Talking of remedy, she said in the absence of vaccine and till the time of its availability in Pakistan, prevention from disease can be the only way out to combat this disease. Using repellants like 20-30 per cent DEET or 20 per cent Picaridin or N-diethyl-meta-toluamide on exposed skin, spraying outer layer clothing and gear with permethrin, use of permethrin treated bed net, all will be helpful to reduce the spread of the disease, ultimately reducing the chances of frequent epidemics, said Dr. Humaira.