Case Detection
Cutaneous leishmaniasis (CL) typically presents as a:
- Painless papule, nodule, plaque, or non-healing ulcer
- Located mostly on exposed body areas such as the face, neck, arms, and legs. Most patients remain asymptomatic, and lesions can persist for weeks to months.
Diagnosis
Clinical Criteria
A suspected case meets at least four of the following features:
- Residence in or travel to endemic areas.
- Painless, non-itchy lesions.
- Lesions persisting for weeks or months.
- Poor response to conventional antibiotics.
- History of similar lesions in the locality.
Confirmatory Tests
Cutaneous Leishmaniasis
- Slit Skin Smear (SSS) – first-line diagnostic method.
- Biopsy and histology for smear-negative cases.
- PCR where available.
- Culture in select settings.
Visceral Leishmaniasis
- rK-39 serology for visceral and mucocutaneous types.
- Bone marrow biopsy.
Treatment
Treatment for CL is offered only in government hospitals by dermatology teams, following nationally approved guidelines.
Indications for Treatment
- All confirmed cases
Treatment regimen will be based on:
- Lesions near vital structures (eye, nose, joints).
- Large, multiple, or progressive lesions.
- Immunocompromised patients.
- Cosmetic concerns.
- Suspected treatment failure or relapse.
Available Treatment Options
First-line Therapies
- Intralesional Sodium Stibogluconate (IL-SSG).
- Cryotherapy.
Second-line Therapies
- Systemic Sodium Stibogluconate.
- Thermotherapy.
- Oral azoles (e.g., fluconazole) in selected cases.
- Amphotericin B for complicated or atypical forms.
- Miltefosine in specific indications.
Follow-Up of Patients
Follow-up is critical for early detection of relapse and monitoring treatment response. Patients with CL are assessed for:
- Lesion healing – complete re-epithelialization expected within 45 days.
- Signs of relapse.
- Treatment failure – lesions worsening within 14 days or failing to heal by day 45.
- Adverse drug reactions.
- Need for additional therapy.
AMC supports follow-up through dermatology clinics and Public Health Inspector (PHI) home visits.