Clinical Manifestations and Distribution of Cutaneous Leishmaniasis in Pakistan

Cutaneous leishmaniasis (CL) is a rising epidemic in Pakistan. It is a major public health problem in the country especially alongside regions bordering the neighboring Afghanistan and cities that have had the maximum influx of refugees. The purpose of our paper is to highlight the diverse clinical manifestations of the disease seen along with the geographic areas affected, where the hosts are particularly susceptible. This would also be helpful in presenting the broad spectrum of the disease for training of health care workers and help in surveillance of CL in the region. The increased clinical diversity and the spectrum of phenotypic manifestations noted underscore the fact that the diagnosis of CL should be not only considered when dealing with common skin lesions, but also highly suspected by dermatologists and even primary care physicians even when encountering uncommon pathologies. Hence, we would strongly advocate that since most of these patients present to local health care centers and hospitals, primary care practitioners and even lady health workers (LHWs) should be trained in identification of at least the common presentations of CL. 1. Background Cutaneous leishmaniasis (CL) is a rising epidemic in Pakistan [1]. It is a major public health problem in the country especially alongside regions bordering the neighboring Afghanistan and cities that have had the maximum influx of refugees [2]. Pakistan in particular, as highlighted by Postigo, has been a focus of both anthroponotic cutaneous leishmaniasis caused by Leishmania tropica (L. tropica) and zoonotic CL caused by Leishmania major (L. major) with epidemics occurring in various parts of the country [3]. L. tropica is mostly seen in urban areas whereas L. major is more common in rural areas of the country [4]. The purpose of our paper is to highlight the diverse clinical manifestations of the disease seen along with the geographic areas affected where the hosts are particularly susceptible. This would also be helpful in presenting the broad spectrum of the disease for training of health care workers and help in surveillance of CL in the region [3]. 2. Methodology for Our Review We searched the terms “cutaneous”, “leishmaniasis,” and “Pakistan,” in Pubmed which retrieved a total of 67 articles. These articles were then systematically reviewed with focus on the number of people affected in different areas of the country and the clinical manifestations of the disease documented by the authors. A summary of the studies selected is outlined in Table 1. References citing other studies done in the