Bhutto Abdul Manan, Soomro Rashid A, Nonaka Shigeo, Hashiguchi Yoshihisa
Department of Dermatology, Chandka Medical College/Hospital Larkana, Sindh, Pakistan.
Int J Dermatol. 2003 Jul;42(7):543-8. doi: 10.1046/j.1365-4362.2003.01818.x.
Cutaneous leishmaniasis (CL) is endemic in Pakistan and is widely spreading. Recently, an outbreak of the disease was observed in the region. We report some new endemic areas of CL in the country.
A total of 1210 cases of CL who visited our department from 1996 to 2001 are reported. Among them, 760 were residents of the Jacobabad, Larkana, and Dadu districts of Sindh province and had never previously traveled to endemic areas. These districts have never been reported/recognized as endemic for CL. Others were residents of endemic areas of Balochistan province. Diagnosis was made on clinical presentation; a giemsa-stained smear test and histopathological results. All the cases were treated with the meglumine antimoniate 600 mg/day (adults) and 15 mg/kg/day (children) intramuscularly for 20 consecutive days.
All the patients were aged between 2.5 months and 65 years. Three hundred and ninety-two patients were females and 368 were males. Duration of the disease ranged from 2 to 18 months. Most of the patients had a single lesion on the face and/or extremities. Clinically, the disease was classified as: dry papular type, 407 cases; dry ulcerative type, 335 cases; and wet ulcerative type, 18 cases. No cases of muco-cutaneous or visceral leishmaniasis were found during this period. Smear testing was positive in 845 cases, while 365 cases were histopathologically positive. An ultrastructural study was performed using specimens of a few of the cases. Leishmania parasites were detected in the dermal tissues as well as in the macrophages.
We propose that the Jacobabad, Larkana and Dadu districts could be considered endemic for CL. Wet- and dry-type lesions indicate the presence of both Leishmania tropica and L. major in this tropical region.
皮肤利什曼病（CL）在巴基斯坦呈地方性流行且广泛传播。最近，该地区观察到该病的一次暴发。我们报告该国一些新的CL地方性流行区。
报告了1996年至2001年期间到我们科室就诊的总共1210例CL病例。其中，760例是信德省雅各布阿巴德、拉尔卡纳和达杜地区的居民，且此前从未前往过地方性流行区。这些地区此前从未被报告/认定为CL的地方性流行区。其他病例是俾路支省地方性流行区的居民。根据临床表现、吉姆萨染色涂片检查和组织病理学结果进行诊断。所有病例均连续20天每天肌肉注射葡甲胺锑酸盐，成人剂量为600毫克/天，儿童剂量为15毫克/千克/天。
所有患者年龄在2.5个月至65岁之间。392例为女性，368例为男性。病程为2至18个月。大多数患者在面部和/或四肢有单个病灶。临床上，该病分类为：干性丘疹型407例；干性溃疡型335例；湿性溃疡型18例。在此期间未发现黏膜皮肤型或内脏利什曼病病例。涂片检查845例呈阳性，365例组织病理学检查呈阳性。对部分病例的标本进行了超微结构研究。在真皮组织以及巨噬细胞中检测到利什曼原虫。
我们提议雅各布阿巴德、拉尔卡纳和达杜地区可被视为CL的地方性流行区。湿性和干性病变表明该热带地区同时存在热带利什曼原虫和硕大利什曼原虫。
