Clinical features, risk factors and efficacy of cryotherapy in cutaneous leishmaniasis in Sri Lanka.

ABSTRACT

INTRODUCTION: The first autochthonus case of cutaneous leishmaniasis in Sri Lanka was reported in 1992. Several case reports from different parts of the island have been documented. The case incidence has increased in the recent past. OBJECTIVES: To determine the clinical patterns, risk factors and efficacy of cryotherapy for cutaneous leishmaniasis in Sri Lanka. PATIENTS Sixty-five patients with cutaneous leishmaniasis. DESIGN: Prospective study. SETTING: Department of Parasitology, Faculty of Medicine, Colombo. METHODS: Direct smears prepared from lesion aspirates or punch biopsies were stained and examined for Leishmania sp. All patients with positive smears were included in the study. A pre-designed questionnaire was completed based on clinical evaluation, and the patients were treated and followed up regularly. Investigations were repeated on day 14 and day 90 depending on the response to treatment. RESULTS: Lesions were non-tender, non-itchy papules (early lesions), scaling single nodules or dry crust forming single or multiple ulcers. Young adult males with outdoor behavioural characteristics were mostly affected. Other risk factors were close proximity to jungles, potential reservoir hosts in the environment, lack of awareness and inadequate knowledge and use of preventive measures. Compliance rate for cryotherapy was 40%. The need for frequent hospital visits, the long course of treatment, limited availability and undesirable side effects were identified as reasons for poor compliance. Smear positive rate on day 14 after treatment was 89%. CONCLUSIONS: Cutaneous leishmaniasis is now an established disease in Sri Lanka. Raising public awareness, early diagnosis, definite species identification, availability of proper treatment methods and vector studies are important for its effective control.