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CASE REPORT
Year : 1990  |  Volume : 56  |  Issue : 3  |  Page : 228-229

Indigenous cutaneous leishmaniasis




Correspondence Address:
K Muhammed


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  Abstract 

A 20 year old male from Nilambur of Malappuram district of Kerala developed an asymptomatic , single, well circumscribed erythomatous indurated plaque about 3x 2.5 cm in size with central crusting, on the left forearm just about the wrist on the lateral aspect, of six months duration. He had never gone out of his native place at any time in his life, Slit smear examination and staining with Giemsa stain showed plenty of extracelluar and intracellular Leishman, Donovan bodies, ,Histopathology of the lesion was consistent with diagnosis of cutaneous Leishmaniasis. He was treated with rifampicin'600 mg and the lesion showed signs of regression within one month.


Keywords: Cutaneous leishmaniasis


How to cite this article:
Muhammed K, Narayani K, Aravindan K P. Indigenous cutaneous leishmaniasis. Indian J Dermatol Venereol Leprol 1990;56:228-9

How to cite this URL:
Muhammed K, Narayani K, Aravindan K P. Indigenous cutaneous leishmaniasis. Indian J Dermatol Venereol Leprol [serial online] 1990 [cited 2019 May 26];56:228-9. Available from: http://www.ijdvl.com/text.asp?1990/56/3/228/3533


Cutaneous leishmaniasis in Kerala is supposed to be an imported disease. Most of the cases are seen in those who return from the Middle East countries. Two cases reported recently from Trivandrum also acquired it from Saudi Arabia[1]. Indigeneous cases are reported only from the north-western parts of the country[2]. We report an indigenous case in a man from Nilambur, Malappuram district of Kerala state.


  Case Report Top


A 20 year old male who had not gone out of his native place, Nilambur of Malappuram district of Kerala, at any time in his life, developed an asymptomatic, single, well-circumscribed, erythematous, indurated plaque of about 3 x 2.5 cm size, with central crusting, on the left forearm just above the wrist on the lateral aspect, of six months duration. It had started as a small erythematous papule, at the site of an insect bite in the forest where he was working as a manual labourer. The lesion had gradually increased the present size. The central crusting was noticed about one month ago. There was no sensory impairment and no thickening or tenderness of the cutaneous nerves in the vicinity of the lesion or elsewhere. Regional lymph nodes were not enlarged. Systemic examination did not reveal any abnormality.

Slit-smear examination and staining with Giemsa stain revealed plenty of extracellular and intracellular Lei shman-Donovan (LD) bodies. Smear examination for AFB was negative. Biopsy from the lesion showed granulomatous infiltrates in the upper dermis composed of epithelioid cells, giant cells, lymphocytes and macrophages, consistent with the diagnosis of cutaneous leishmaniasis. He was treated with rifampicin 600 mg daily after evaluating the hepatic and renal functions. The lesion showed signs of regression in the form of smear negativity, reduction in crusting, erythema and induration at the end of one month.


  Comments Top


There are three types of the Old World cutaneous leishmaniasis caused by the following

(1) L. tropica minor, causing urban or anthroponotic cutaneous leishmaniasis,

(2) L. tropica major, causing rural or zoonotic cutaneous leishmaniasis, and

(3) L. aethiopica, causing diffuse cutaneous leishmaniasis[3]. Rodents are the main reservoir in the second type whereas hyrax is the reservoir in the third type. Sandfly (Phlebotomus) is the vector . The clinical form taken by the infection depends on the response of the host's cell mediated immunity[4].

The vector and the infecting agents are supposed to be not present in. Kerala. Our case probably belongs to the rural zoonotic cutaneous variety. About 90% of such lesions heal spontaneously in a few weeks or months, but usually leave ugly scars.

The various therapeutic modalities used for the treatment of cutaneous leishmaniasis include physical agents, chemotherapy and surgery but still there is no single treatment tha, is uniformly effective in all the cases. Among drugs, pentavalent antimonials (sodium stibogluconate and N-methylglucamine antimonte) are the drugs of choice131. Though used widely all over the world, they are not totally satisfactory and the toxic effects on various organs limit their use. Rifampicin alone and in combination with isoniazid and sodium stibogluconate has been tried by various workers with varying resuIts[5],[6],[7],[8],[9],[10],[11].

In our case, the lesion showed signs of regression with 600 mg of rifampicin daily for a month. Since cutaneous leishmaniasis heals spontaneously within a few weeks or months, we do not know whether the response seen in our case was the natural course of the disease or the effect of our treatment.

Our patient had never gone out of his native place in Nilambur, which is a forest area on the western ghats adjacent to the tropical rain-forest of Silent Valley. We do not know whether the infective agent and the vector are the same as in the other types of cutaneous leishmaniasis. An epidemiological study in this remote forest area may throw more light on this problem.

 
  References Top

1.Lohidakshan Unnithan M, Shanmugham Pillai SM, Vijayadharan M et al : Two cases of cutaneous leishmaniasis seen in Trivandrum, Ind J Dermatol Venereal Leprol, 1988, 54 : 161-162.  Back to cited text no. 1    
2.WHO Geneva, The Leishmaniases, Technical Report Series 701, 1984; p 57.  Back to cited text no. 2    
3.Chong H : Oriental sore, A look at trends in and approaches to the treatment of leishmaniasis, Internal: J Dermatol, 1986; 25 : 615-622.  Back to cited text no. 3    
4.Bryceson A : Immunological aspects of clinical leishmaniasis, Proc R Soc Med, 1970; 63 : 1056-1060.  Back to cited text no. 4    
5.Selim S : Cutaneous leishmaniasis, J Kuwait Med Assoc, 1972; 6 : 159..  Back to cited text no. 5    
6.I skandar I : Rifampicin in cutaneous leishmaniasis, J Int Med Res, 1978; 6 : 280-285.  Back to cited text no. 6    
7.Even-Paz Z, Weinrauch L, Livshin R et al: Rifampicin treatment of cutaneous leishmaniasis, Internat J Dermatol, 1982; 21 : 110-112.  Back to cited text no. 7    
8.Livshin R, El-On J, Weinrauch L et al : Therapeutic effect of rifampicin and isoniazid against leishmania tropica major, Internat J Dermatol, 1983; 22 : 61.  Back to cited text no. 8    
9.White S, Hendricks L and Chulay J : Leishmaniasis, a case history and treatment failure with rifampicin, Arch Dermatol, 1980; 116 : 620.  Back to cited text no. 9    
10.Vander Meulen.J, Mock B, Fekete E et al : Limited therapeutic action of rifampicin/isoniazid against Leishmania mexicana amazonensis, Lancet, 1981, 1 : 1122-1123.  Back to cited text no. 10    
11.Pereek S : Combination therapy of sodium stibogluconate and rifampicin in cutaneous leishmaniasis, Internat J Dermatol, 1984; 23 : 70-71.  Back to cited text no. 11    



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