Screening for Leishmaniasis
Early identification of leishmaniasis is essential to prevent complications, reduce transmission, and ensure timely treatment. Because many patients first seek care at outpatient clinics, strengthening screening is a national priority.
Who Should Be Screened?
Screening is recommended for individuals living in or frequently visiting endemic areas. Priority groups include:
- Outdoor workers such as farmers, military personnel, and construction workers.
- Residents living near scrub jungles, paddy fields, cattle sheds, or dense vegetation.
- People with chronic, painless skin lesions unresponsive to routine antibiotics (suspected cutaneous leishmaniasis).
- Patients presenting with prolonged fever, weight loss, and splenomegaly (suspected visceral leishmaniasis).
Why Screening Matters
- Guides patients quickly to definitive diagnosis and treatment.
- Limits parasite reservoirs, reducing community transmission.
- Prevents severe morbidity and disability from advanced disease.
- Feeds surveillance to monitor hotspots and mobilize targeted responses.
How Screening Is Conducted
Leishmaniasis is diagnosed by detecting Leishmania parasites (or DNA) in tissue specimens using microscopy, molecular methods, or specialized culture techniques.
Cutaneous Leishmaniasis
- Clinical assessment of suspected skin lesions.
- Slit-skin smear (SSS) performed at hospitals by trained Public Health Laboratory Technicians (PHLTs). SSS is over 70% sensitive and 100% specific for cutaneous leishmaniasis.
- Biopsy and histopathology for smear-negative cases.
- PCR and culture (select tertiary centres) for confirmation.
Visceral Leishmaniasis
- Clinical review focused on fever duration, weight loss, anaemia, and splenomegaly.
- rK-39 rapid diagnostic test for quick bedside screening.
- Bone marrow biopsy and specialist referral for definitive diagnosis.
Integration with National Surveillance
Leishmaniasis is a notifiable disease in Sri Lanka. According to national guidelines:
- Suspected cases must be notified to the Regional Malaria Officer / Anti Malaria Campaign and the MOH via H544.
- Both passive (facility-based) and active case detection are conducted in high-risk areas as outlined in the National Strategic Plan.
AMC strengthens screening by organizing community clinics, mobile dermatology services, and enhanced surveillance in endemic districts.