Clinico-epidemiological pattern of cutaneous leishmaniasis in armed forces personnel fighting war against terrorism in Khyber Pakhtunkhwa Province and FATA regions

ABSTRACT

Cutaneous leishmaniasis [CL] is endemic in various regions of Khyber Pakhtunkhwa [KPK] province and Federally Administered Areas [FATA]. Troops deployed in these regions are at an increased risk of acquiring the disease as compared to the native population. To determine clinical and epidemiological pattern of CL in armed forces personnel serving in endemic areas of CL in KPK and FATA. This observational/descriptive study was conducted at CMH, Peshawar from January, 2010 to June, 2010. All patients of any age reporting in skin outdoor with clinical diagnosis of CL were enrolled in the study and all were subjected to skin slit smears for Leishman-Donovan [LD] bodies and skin biopsies were also taken in all cases to observe histopathological features. Patients in whom clinical diagnosis was not supported by laboratory diagnosis, were excluded. Clinical and epidemiological data was recorded and finally analyzed by using descriptive statistics. Out of 172 initially enrolled cases, 2 were excluded from the study as their clinical diagnosis was not supported by laboratory findings. All patients were young males [deployed armed forces personnel]. Their ages ranged from 18 to 43 [mean age 27.4 years]. Number of lesions ranged from 1-11. Multiple lesions were seen in 41.2% cases only. Size of lesions ranged from 1-13 cm. 70.6% of lesions were seen on upper and lower limbs followed by head and neck region 27.6%, and trunk and abdomen 1.8%. Morphological patterns seen were crusted plaques, psoriasiform plaques, nonhealing ulcers, erythematous infiltrated nodules and papules. Majority of the cases were from the regular army units deployed in the areas in recent past [71.8%] as compared to 28.2% of native troops of Frontier Corps [FC] 3% deployment of regular troops against 0.5% of FC troops. CL is common in soldiers serving in KPK province and FATA regions of Pakistan. Armed forces personnel who moved from central Punjab and deployed in these areas for operations against terrorists are at much higher risk of acquiring the disease as compared to the native troops. This risk can be decreased by implementing effective precautionary measures and education of the soldiers