Epidemiology and distribution of cutaneous leishmaniasis in District Dera Ismail Khan, Pakistan

Abstract

Background: Leishmaniasis is a parasitic infection that affects people in tropical and temperate regions. It is spread by the biting of sand flies, particularly Phelotomus and Lutzomyia. Sindh, Punjab, Baluchistan, and Khyber Pakhtunkhwa (KP) have higher rates of Cutaneous Leishmania (CL). Environmental variables influencing CL endemic locations in Pakistan are not understood clearly. The current study was aimed to determine the prevalence of cutaneous leishmania and to develop risk map for predicting CL distribution in Khyber Pakhtunkhwa, Pakistan. Material and Methods: A total of 1135 clinically verified subsequent cases of cutaneous leishmaniasis from January 2019 to March 2022 were included in this investigation. Using fine needle aspiration, the diagnosis was validated. Environmental and clinical data from DHQ D.I.K and other local CL centers were collected. By mapping the data using ArcGIS version 10.8 and Google Earth Pro version 7.3.0, the spatiotemporal prevalence of CL infection was examined. Results: Cutaneous leishmaniasis was recorded highest 65% among individuals aged under 30 years. The male cases were high 61.7% than females 38.3%. Early and late lesions were classified from less than two months to more than a year, highest lesion duration between 1-2 months was 57.1%. A total of 1204 lesions, out of these 76.1% individuals fall in category of single lesion while 23.9% fall in multiple lesions. Most of the lesions seen on exposed body areas such as lower extremity was 34.2%, face 30.7%, upper extremity 29.1% and a least number of mixed lesions was 6.1%. Lesions were of nodular and ulcer type. In spatiotemporal analysis, a total of 989 CL cases were recorded in all villages. A choropleth map showed that Tehsil-wise increased incidence of CL at D.I.K with reported cases 63% followed by Paharpur 10%, Paroa 7%, Kulachi 6% and Daraban 2%. An elevation map of the average incidence of CL plotted on DEM, showed that high altitudes have a lower prevalence of CL. The future epidemic threats of CL infection were predicted by IDW map and D.I.K, Kulachi and Paharpur were CL risk areas. The high cluster counties according to the cluster and outliers study were D.I.K and Paharpur ranging from 42750.0 m (z-score= 1.8, P=0.071397) to 51300.0 m (z-score= 1.4, P=0.142513) and Kulachi, Daraban and Paroa ranging from 17100.0 m (z-score= 1.0, P=0.273971), 25650.0 m (z-score= 1.4, P=0.150079) and 34200.0 m (z-score= 0.9, P=0.318580) respectively, were the high and low outlier villages. Conclusion: Leishmaniasis is prevalence was high among the local population, but a temporal increasing pattern was seen in the tehsil D.I.K. and Paharpur, which suggests a potential danger for the spread of CL. For disease prevention and management at the individual and community levels, the area needs to get the right attention.