Simeen Ber Rahman, Bari A U.
Morphological patterns of Cutaneous Leishmaniasis seen in Pakistan.
J Pak Assoc Derma Jan ;12(3):122-9.

A wide spectrum of clinical presentation of Cutaneous leishmaniasis is encountered in various endemic areas of Pakistan. This study was conducted in an attempt to delineate the different morphological patterns of the disease and its geographical distribution. 111 patients of either age or sex with clinical diagnosis of cutaneous leishmaniasis, were included in the study from all four provinces of Pakistan, Northern areas (NA), Azad Kashtnir(AK) and Islamabad. 10 patients were excluded due to various reasons. On the basis of number of the lesions, type of the lesions, site of involvement and gross clinical appearance of the lesions, different morphological patterns were noted and these were correlated with their geographical origin. Predominant clinical form of disease (n=76) seen was wet (rural) type (58 from Baluchistan, 6 from Sind, 5 from NA, 1 from AK and 2 each from NWFP, Punjab and Islamabad). Dry (urban) type (n=19) was seen in Punjab (n=15), Sind (n=2), NWFP (n-I) and AK (n=1). Leishmania recedivans (n=6) was observed in NWFP (n=4), AK (n=1) and NA (n= 1). Sporotrichoid pattern (n= 16) was seen only in wet type of disease and was quite common in patients from Quetta. Other rare variants in wet form were paronychial (n=2), chanceriform (n=1) and whitlow (n=1) while Psoriasiform (n=4), erysipeloid (n=2) and eczematous (n=1) variants were seen in dry form. Wet (rural) type of disease was predominantly seen in Baluchistan, dry (urban) type in Punjab and chronic form in NA & AK. Sporotrichoid patterns was commonly seen from Baluchistan. Since only two species (L.major and L.tropica) have been known to cause cutaneous leishmaniasis in Pakistan, this varied morphological presentation is most likely due to variation in immune response of the host.

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