First Evidence for Two Independent and Different Leishmaniasis Transmission Foci in Sri Lanka: Recent Introduction or Long-Term Existence?

Autor: Siriwardana Y; Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo 00800, Sri Lanka., Deepachandi B; Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo 00800, Sri Lanka., Weliange SS; Department of Community Medicine, Faculty of Medicine, University of Colombo, Colombo 00800, Sri Lanka., Udagedara C; Teaching Hospital, Kandy 20000, Sri Lanka., Wickremarathne C; National Hospital, Colombo 00800, Sri Lanka., Warnasuriya W; Teaching Hospital, Kurunegala 60000, Sri Lanka., Ranawaka RR; Teaching Hospital, Kalutara 12000, Sri Lanka., Kahawita I; Base Hospital, Homagama 10200, Sri Lanka., Chandrawansa PH; 332/4, Anagarika Dharmapala Mawatha, Nupe, Matara 81000, Sri Lanka., Karunaweera ND; Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo 00800, Sri Lanka.
Jazyk: angličtina
Zdroj: Journal of tropical medicine [J Trop Med] 2019 Jul 25; Vol. 2019, pp. 6475939. Date of Electronic Publication: 2019 Jul 25 (Print Publication: 2019).
DOI: 10.1155/2019/6475939
Abstrakt: Cutaneous leishmaniasis caused by a genetic variant of L. donovani is being reported from Sri Lanka since year 2001. Patients presented from different geographical locations (600 patients from North or South and a minority of cases from other foci, 2001-2013) were studied. Analysis revealed two different sociodemographic and clinical profiles of leishmaniasis in Northern and Southern Sri Lanka. Also, the same different profiles were present in these foci since the onset of the recent outbreak and had independently propagated within each focus over the time. A profile of 14 parameters identified in the Northern focus was further examined with regard to other locations. Northwestern (10/14) and Central parts (9/14) of the island were more similar to Northern focus (14/14). Infection would have originated in one focus and spread to other 2 in Northern Sri Lanka. Southern focus was different from and appeared older than all others (2/14). Western focus that accommodates a large transient population had a mixed picture of North and South features (4/14). Lesions in North showed a slow progression and a nonulcerative nature (128/185, 69.2%), while those in South showed a rapid progression and less nonulcerative lesions (193/415, 46.5%). Clinical analysis favoured a parasite aetiology (considerable strain differences) rather than a host aetiology (age, gender, or genetics). Both foci demonstrated a biannual seasonal variation since the onset of the epidemic. Two peaks were observed during the early and latter parts of the year. Furthermore, long-term existence and recent spatiotemporal expansion and detection of leishmaniasis in this country rather than a recent introduction and establishment were indicated by these findings. Vigorous antimalarial activities that existed in Sri Lanka until few decades ago, lack of professional awareness, and more recent military activities that brought human population in close contact with a sylvatic cycle would have played a role in silent propagation of Leishmania parasites and subsequent increment in human cases, respectively, in this country.
Competing Interests: The authors declare that there are no conflicts of interest.
Databáze: MEDLINE
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