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Case Report: A Single-Center Case Series on Skin Manifestations of Leishmaniasis from a Non-Endemic State in Southern India
ABSTRACT
Leishmaniasis is endemic in the Indian subcontinent with predominance of visceral leishmaniasis (VL) due to Leishmania donovani. Cutaneous leishmaniasis (CL) is uncommon, and mucocutaneous leishmaniasis (MCL) is rarely reported in this region. Recent reports reveal a changing epidemiology and atypical manifestations. A retrospective study of 52 suspected cases with cutaneous and mucosal involvement seen from January 2008 to December 2018 in a tertiary care setting in a non-endemic state in southern India is reported. Twelve patients were confirmed to have leishmaniasis; seven had MCL, two had CL, and three had post-kala-azar dermal leishmaniasis (PKDL). All cases were male, with a median age of 41.5 years (interquartile range, 30–55.5 years), and the median duration of the disease was 6 years (interquartile range, 1–9.5 years). Patients with MCL had mucosal involvement including destructive ulcero-proliferative lesions due to delayed diagnosis; none had a history of travel to countries endemic for MCL and all were attributable to L. donovani species. On the other hand, Leishmania major which was the causative species in both CL patients was associated with travel to the Middle East. Patients with PKDL presented with multiple plaques and hypopigmented patches; one had concomitant VL and all were from endemic areas. Hitherto uncommon MCL, caused by potentially atypical variants of L. donovani, has emerged as a new manifestation of leishmaniasis in this region. A high index of suspicion based on lesions seen and history of travel combined with PCR-based diagnostics are required to confirm diagnosis for the various skin manifestations of leishmaniasis.
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Author Notes
Authors’ addresses: Santhi John Tharakan, Dincy Peter CV, and Susanne Pulimood, Department of Dermatology, Christian Medical College, Vellore, India, E-mails: shantijohnt15@gmail.com, dincypeter@gmail.com, and sapulimood@cmcvellore.ac.in. Rajiv Karthik and Priscilla Rupali, Infectious Diseases, Christian Medical College, Vellore, India, E-mails: rajiv@cmcvellore.ac.in and prisci@cmcvellore.ac.in. Vedantam Rupa, ENT, Christian Medical College, Vellore, India, E-mail: rupavedantam@cmcvellore.ac.in. Winsley Rose, Pediatric Infectious Diseases, Christian Medical College, Vellore, India, E-mail: winsleyrose@cmcvellore.ac.in. Meera Thomas, Pathology, Christian Medical College, Vellore, India, E-mail: meerathomas@cmcvellore.ac.in. Malathi Manuel and Sitara Swarna Rao Ajjampur, Division of Gastrointestinal Sciences, The Wellcome Trust Research Laboratory, Christian Medical College, Vellore, India, E-mails: malathimanuel25@gmail.com and sitararao@cmcvellore.ac.in.