Risk Factor Analysis of Cutaneous Leishmaniasis in Sri Lanka through a Nationwide Survey

Rajika Dewasurendra Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka;

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Nilakshi Samaranayake Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka;

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Hermali Silva Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka;

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Nuwani Manamperi Department of Parasitology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka;

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Upul Senerath Department of Community Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka;

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Sanath Senanayake Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka;

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Nissanka de Silva Department of Zoology, Faculty of Applied Sciences, University of Sri Jayawardenapura, Nugegoda, Sri Lanka;

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Panduka Karunanayake Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka;

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Guofa Zhou Department of Population Health and Disease Prevention, University of California, Irvine, California

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Nadira Karunaweera Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka;

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Leishmaniasis in Sri Lanka was first reported in the early 1990s. Cutaneous leishmaniasis (CL) cases have markedly increased in recent years, demanding due attention from health authorities. The spatial distribution of CL is not homogeneous. This case-control study investigated factors that may contribute to this heterogeneous distribution through a nationwide study. Information on sociodemographic, economic, and environmental characteristics was collected from study participants (cases, n = 303; controls, n = 2,762). All individuals were followed up for 3 years, and signs of CL or associated complications were recorded. Differences in possible risk factors between cases and controls were analyzed. Individuals <18 years old, electricity supply, spending >2 hours outdoors, visiting jungles/water bodies, and living near CL patients were identified as risk factors. Household members of 1.3% of cases, 2.3% of controls residing within a perimeter of 500 m from a patient, and 0.8% of controls living beyond 2 km from a case developed CL. Thus, CL in Sri Lanka appears intertwined with living environment and host behavior. Common environmental factors may be responsible for the higher risk of CL in individuals living in close proximity to CL patients. This may at least partly explain the clustering of CL cases in selected areas of the country.

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Author Notes

Financial support: Research reported in this publication was supported by the National Institute of Allergy and Infectious Diseases of the NIH (https://www.niaid.nih.gov/) under Award Number U01AI136033 to N. Karunaweera. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The American Society of Tropical Medicine and Hygiene (ASTMH) assisted with publication expenses.

Disclosure: Ethics approval for this study was granted by the Ethics Review Committee of the Faculty of Medicine, University of Colombo, Sri Lanka (EC – 17-062). Relevant approvals to conduct the health survey were obtained from the Director General of Health Services, Ministry of Health, Sri Lanka, and from the prospective provincial directors of Health Services and regional directors of Health Services. Written informed consent was obtained from all study participants before recruitment to the study. Informed consent was obtained from all participants of this study.

Data availability: The data presented in this study are available from the corresponding author on request. The data are not publicly available owing to the fact that the dataset contains personal identifiers.

Authors’ addresses: Rajika Dewasurendra, Nilakshi Samaranayake, Hermali Silva, Sanath Senanayake, and Nadira Karunaweera, Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka, E-mails: rajika@parasit.cmb.ac.lk, nilakshi@parasit.cmb.ac.lk, hermali@parasit.cmb.ac.lk, sanath@parasit.cmb.ac.lk, and nadira@parasit.cmb.ac.lk. Nuwani Manamperi, Department of Parasitology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka, E-mail: nuwani_harsh@kln.ac.lk. Upul Senerath, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka, E-mail: upul@commed.cmb.ac.lk. Nissanka de Silva, Department of Zoology, Faculty of Applied Sciences, University of Sri Jayawardenapura, Nugegoda, Sri Lanka, E-mail: nissanka@sjp.ac.lk. Panduka Karunanayake, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka, E-mail: panduka@clinmed.cmb.ac.lk. Guofa Zhou, Department of Population Health and Disease Prevention, University of California, Irvine, CA, E-mail: zhoug@hs.uci.edu.

Address correspondence to Nadira Karunaweera, Department of Parasitology, Faculty of Medicine, University of Colombo, 25, Kynsey Rd., Colombo 08, Sri Lanka. E-mail: nadira@parasit.cmb.ac.lk
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