Conference Papers

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Clinical and histopathological characteristics of cutaneous leishmaniasis in a group of military personnel in Sri Lanka
(American Society of Tropical Medicine and Hygiene, 2015) Manamperi, N.H.; Fernando, C.S.; Pathirana, A.; Abeyewickreme, W.; de Silva, V.C.; Karunaweera, N.D.
Cutaneous leishmaniasis (CL) is a newly established vector-borne parasitic disease in Sri Lanka. Military personnel have an occupational risk for CL due to being stationed in endemic areas and exposure to vectors outdoors. This study describes the clinical and histopathological features of CL in a group of military personnel. Thirty five patients with smear positive for Leishmania amastigotes were included, their data analyzed for clinical features and skin biopsies processed routinely for histology, examined at a conference microscope and classified into 4 groups using modified Ridley criteria for Leishmaniasis as: I-parasitized macrophages with variable lymphocytes and plasma cells; II-parasitized macrophages with lymphocytes, plasma cells and ill formed histiocytic granulomata; III-a mixture of macrophages (with or without parasites), lymphocytes, plasma cells and epithelioid granulomata; IV-epithelioid granulomatous response with a few lymphocytes and plasma cells but no amastigotes. Lesions were categorized by duration, as acute (< 6 months) or chronic (> 6 months). Study group composed of all males with a mean age of 32.6 years (range 22-47) and lesion duration of 5.6 months (range 1-24). Number of lesions varied from 1 to 6 with majority (71.4%, n= 25) having a single lesion. Nodular (37.1%, n=13) and nodulo-ulcerative (25.7%, n=9) lesions in upper limbs (68.6%, n=24) was the commonest presentation. Twenty nine (82.9%) of the biopsies were positive also by histology. Twenty two (62.9%) were acute and 13 (37.1%) chronic. Group I, II, III and IV patterns were seen in 14 (40%), 12 (34.3%), 5 (14.3%) and 4 (11.4%) respectively and 9 (40.9%), 9 (40.9%), 2 (9.1%) and 2 (9.1%) of acute lesions and 5 (38.5%), 3 (23.1%), 3 (23.1%) and 2 (15.4%) of chronic lesions respectively. Necrosis was not seen in any of the lesions. Majority in this group of military personnel with CL had single lesions affecting the upper limbs and sought treatment within 2 years of appearance of lesions. The histological picture varied from diffuse infiltration of parasitized macrophages admixed with chronic inflammatory cells to ill-formed histiocytic granulomata.
Clinical features of cutaneous leishmaniasis in Sri Lanka and molecular identification of L. donovani as the cause
(Elsevier, 2008) Siriwardana, H.V.Y.D.; Noyes, H.A.; Beeching, N.J.; Wickremasinghe, A.R.; Chance, M.L.; Bates, P.A.; Karunaweera, N.D.
BACKGROUND: Cutaneous leishmaniasis (CL) is a newly established disease in Sri Lanka with over 1500 locally acquired cases reported since year 2001. OBJECTIVES: To study the clinical profile, associated risk factors and genetic analysis of the causative parasite of CL in Sri Lanka. METHODOLOGY: Clinical evaluation was carried out on patients who visited the Department of Parasitology, Faculty of Medicine, Colombo for diagnosis using a pre-tested questionnaire. Light microscopy and/or PCR were performed on lesion material to confirm diagnosis. Formol gel test (FGT) was done on all patients. The causative species was identified by sequencing of the partial 6PGDH gene, followed by microsatellite analysis to study the phylogenetic relationships. RESULTS: There were 401 patients (78.9% males, out of which 57.4% were soldiers) with at least 549 lesions. Most infections were acquired in Northern (55.7%) or Southern (39.3%) Sri Lanka. Several lesion types were noted: papules 23.4%, nodules 25.4%, ulcerating nodules 19.6%, ulcers 23.7%, plaques 6.4% and other 1.7%. Nodules with 5–9 months duration had the highest parasite positivity (n = 100, 75.5%). Sporotrichoid spread (n = 44, 11.9%), satellite lesions (n = 35, 8.9%) and lymphatic spread (n = 109, 27.7%) were commonly observed. No patients had visceral features and the FGT was negative in all subjects. Male sex, 20–40 years of age and over 5 hours/day spent outdoors were identified as risk factors, but not household clustering. The causative species was identified as L. donovani, belonging to a distinct genetic group within that complex. CONCLUSIONS: A dermotrophic variant of L. donovani causes cutaneous leishmaniasis in Sri Lanka. The ability of the local Leishmania parasite to visceralize, self heal or develop drug resistance is yet to be determined. In spite of the generally accepted anthroponotic nature of L donovani, in this study favours zoonotic transmission of the local species. Acknowledgements: Mr. RL Ihalamulla, Mr. S Jayasinghe for technical assistance. Financial support for this study was from Sri Lanka National Science Foundation and the Commonwealth Scholarship Association. © 2008 Elsevier Inc.

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