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      Cutaneous Leishmaniasis in an Immigrant Saudi Worker: A Case Report

      case-report

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          ABSTRACT

          Cutaneous leishmaniasis (CL), an uncommon disorder in South-East Asia, including Bangladesh, often presents as granulomatous plaque on the exposed areas, with a high index of suspicion required for diagnosis. Here we report the first imported case of CL caused by Leishmania tropica in a migrant Bangladeshi worker in the Kingdom of Saudi Arabia (KSA). The case, initially suspected as a case of cutaneous tuberculosis, arrived at specimens reception unit (SRU) of diagnostic labs of icddr,b being referred by the physician for ALS testing for tuberculosis. At his arrival in the SRU, one of the health personnel of the unit who used to work in KSA suspected him as a case of CL. The diagnosis was confirmed by smear microscopy which revealed plenty of amastigotes within macrophages. PCR was performed to confirm the species. He was treated with sodium stibogluconate at Shahid Suhrawardy Medical College Hospital, Dhaka.

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          Mucosal leishmaniasis ("espundia" Escomel, 1911).

          S. Marsden (1985)
          One of the more serious clinical forms of leishmaniasis occurs in espundia when the mucosae of the upper respiratory passages are inflamed. This complication is a metastasis from a skin lesion caused by Leishmania braziliensis braziliensis (Lbb) although cases have been described associated with other leishmanial species. Epidemiological data suggest that a detectable mucosal metastasis occurs in fewer than 5% of patients infected with Lbb in our study area. The determinants of this complication are still largely obscure. The granuloma usually commences on the nasal septum. In about two-thirds of our patients the lesion remained restricted to the nose. In the rest the pharynx, palate, larynx and lips were involved, in this order. It is often difficult to isolate the parasite and for routine diagnosis the leishmanin skin reaction and serological tests are helpful. Although a serious condition, with possible mutilation and even death as subsequent complications, treatment is still mainly with pentavalent antimonials, introduced 40 years ago. These are most unsatisfactory for field use, being given parenterally and relatively toxic. In mucosal leishmaniasis, if sufficient antimony can be administered in a regular daily dose, the relapse rate is small (3 of 42 patients followed for a mean of 5 years). Also, antimony treatment of the initial skin ulcer due to Lbb followed for a mean of 4 years of 83 patients resulted in subsequent mucosal metastasis in only 2. Since espundia is relatively rare, specific treatment targeted to this specific problem is the efficient short term solution. At present there is no satisfactory alternative drug to those in current use.
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            Estimation of population at risk of infection and number of cases of Leishmaniasis.

            P Desjeux, P Deraadt, Alfred Ashford (1992)
            In this paper, Dick Ashford, Philippe Desjeux and Peter deRaadt attempt to estimate the total number of people at risk of acquiring disease caused by infection with Leishmania spp. In many areas a very small risk is distributed among large numbers of people so, although the number of people at risk may be large, the number of infections may be very small. An estimate of the global annual incidence of new cases has also been made. This refers to reported clinical disease and probably grossly underestimates the number of infections. The methods by which the estimates have been made are specified so that they, as well as the estimates themselves, may be criticized and modified with some degree of objectivity.
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              A histological classification of cutaneous leishmaniasis and its geographical expression.

              Paul D Ridley (1979)
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Health Popul Nutr
                Journal ID (iso-abbrev): J Health Popul Nutr
                Journal ID (pmc): JHPN
                Title: Journal of Health, Population, and Nutrition
                Publisher: International Centre for Diarrhoeal Disease Research, Bangladesh
                ISSN (Print): 1606-0997
                ISSN (Electronic): 2072-1315
                Publication date (Print): June 2014
                Volume: 32
                Issue: 2
                Pages: 372-376
                Affiliations
                [1] 1Clinical Laboratory Services, Diagnostic Labs, Laboratories, icddr,b, GPO Box 128, Dhaka 1000, Bangladesh
                [2] 2Centre for Nutrition and Food Security, Parasitology Laboratory, Laboratories, icddr,b, GPO Box 128, Dhaka 1000, Bangladesh
                Author notes
                Correspondence and reprint requests: Dr. Hafizur Rahman, Clinical Haematology & Microscopy Lab, Clinical Laboratory Services, Diagnostic Labs, Laboratories, icddr,b, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh, Email: hafizur@ 123456icddrb.org
                Article
                Other ID: jhpn0032-0372
                PMC ID: 4216973
                PubMed ID: 25076674
                SO-VID: 4e810d89-6a43-4b1f-b160-83f2d29193b2
                Copyright © © INTERNATIONAL CENTRE FOR DIARRHOEAL DISEASE RESEARCH, BANGLADESH
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Subject: Case Study

                ScienceOpen disciplines: Nutrition & Dietetics
                Keywords: cutaneous leishmaniasis,ld bodies,leishmania tropica,sodium stibogluconate,bangladesh
                Data availability:
                ScienceOpen disciplines: Nutrition & Dietetics
                Keywords: cutaneous leishmaniasis, ld bodies, leishmania tropica, sodium stibogluconate, bangladesh

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