Descriptive Epidemiological Profile of Cutaneous Leishmaniasis: A Hospital-Based Cross-Sectional Study in a Border District of Khyber Pakhtunkhwa, Pakistan
DOI:
https://doi.org/10.66344/jpad.v36i2.3331Keywords:
Epidemiology, Cutaneous leishmaniasis, Infection, Prevalence, DeterminantsAbstract
Background Cutaneous Leishmaniasis is a neglected tropical disease endemic in Pakistan, particularly along the Afghanistan border. District Dir Lower in Khyber Pakhtunkhwa faces significant disease burden due to cross-border migration, refugee settlements, and suitable sandfly vector ecology.
Objective This study aimed to describe the epidemiological and clinical characteristics of Cutaneous Leishmaniasis (CL) among suspected patients presenting to healthcare facilities in District Dir Lower, Khyber Pakhtunkhwa, Pakistan.
Methods Three hundred (300) patients with suspected CL lesions were enrolled in the study. Confirmed cases were identified via microscopic examination of Giemsa-stained slit-skin smears for Leishmania amastigotes. A structured questionnaire was administered to collect data. Data were analyzed using descriptive statistics (frequencies, percentages). Associations were explored using the Chi-square test (P<.05).
Results Infection frequency was significantly higher among Afghan refugees (57.37%, 35/61) compared to Pakistani locals (42.62%, 26/61) (P<.001). The highest proportion of cases was in the 1-10 years age group (32.78%, 20/61). Samarbagh subdivision accounted for the highest proportion (22.95%, 14/61). A seasonal peak was observed in July (36.06%, 22/61), with a gradual decline thereafter. Wet lesions (59.01%, 36/61) and single lesions (63.93%, 39/61) were more frequent. Shepherds constituted the highest occupational group (34.42%, 21/61).
Conclusion CL in District Dir Lower exhibits a heterogeneous descriptive profile influenced by age, ethnicity, occupation, season, and geography. Findings represent hospital-based frequency and not population prevalence. Integrated control strategies targeting high-risk groups are warranted.
References
1. Mandell GL, Bennett JE, Dolin R. Principles and Practice of Infectious Diseases. 6th ed. Philadelphia: Elsevier Churchill Livingstone; 2005. p. 1864–1890.
2. Malani PN. Mandell, Douglas, and Bennett’s principles and practice of infectious diseases. JAMA. 2010;304(18):2067-71.
3. Burza S, Croft SL, Boelaert M. Leishmaniasis. Lancet. 2018;392(10151):951-70.
4. McGwire BS, Satoskar AR. Leishmaniasis: clinical syndromes and treatment. QJM. 2014;107(1):7-14.
5. Shirazi MK, Razmi G, Naghibi A. Cutaneous leishmaniasis in the patients referred to medical laboratories in Mashhad, Iran. J Res Health. 2015;5(1); 121-4.
6. World Health Organization. Leishmaniasis: fact sheet. 2023. Available from: https://www.who.int/news-room/fact-sheets/detail/leishmaniasis
7. Ullah W, Yen TY, Niaz S, et al. Distribution and risk of cutaneous leishmaniasis in Khyber Pakhtunkhwa, Pakistan. Trop Med Infect Dis. 2023;8(2):128.
8. Saifullah M, Shishir MR, Ferdowsi R, Tanweer S, van der Meeren P, Khan MI, et al. Micro and nano encapsulation, retention and controlled release of flavor and aroma compounds: a critical review. Trends Food Sci Technol. 2019;86:230-51.
9. Khan SA, Zia-ul-haq HM, Umar M, Yu Z. Digital technology and circular economy practices: a strategy to improve organizational performance. Bus Strategy Dev. 2021;4(4):482-90.
10. Hussain A, Ali S, Rizwan M, Zia Ur Rehman M, Javed MR, Imran M, et al. Zinc oxide nanoparticles alter the wheat physiological response and reduce the cadmium uptake by plants. Environ Pollut. 2018 Nov;242(Pt B):1518-1526.
11. Kassi M, Tareen I, Kasi PM. Cross-border movement and infectious diseases: a case study of leishmaniasis in the Pakistan-Afghanistan region. Front Public Health. 2022;10:873125.
12. Ullah W, Nasir A, Ahmad SI, Sajid M, Rehman A, Shafi M, et al. Epidemiological and clinical determinants of cutaneous leishmaniasis in District Dir Upper Khyber Pakhtunkhwa, Pakistan: a case-based analysis of 336 confirmed infections. Indus J Biosci Res. 2025;3(5):245-50.
13. Brooker S, Kolaczinski J, Reyburn H, Rowland M. Epidemiology of anthroponotic cutaneous leishmaniasis in Afghan refugee camps in northwest Pakistan. Trans R Soc Trop Med Hyg. 2004;98(6):373-8.
14. Zeb I, Qureshi NA, Shaheen N, Zafar MI, Ali A, Hamid A, et al. Spatiotemporal patterns of cutaneous leishmaniasis in the district upper and lower Dir, Khyber Pakhtunkhwa, Pakistan: A GIS-based spatial approaches. Acta Trop. 2021 May;217:105861.
15. Akhtar S, Saleem M, Iqbal J. Epidemiology and clinical features of cutaneous leishmaniasis in Khyber Pakhtunkhwa, Pakistan. J Infect Public Health. 2022;15(2):245-51.
16. Kariminia A, Sharifi I, Aflatoonian MR, Mohammadi MA, Salarkia E. A comprehensive review of cutaneous leishmaniasis in Kerman Province, southeastern Iran (1997-2017). J Parasit Dis. 2019;43(4):507-15.
17. Ullah W, Khan A, Niaz S, Al-Garadi MA, Nasreen N, Swelum AA, et al. Epidemiological survey, molecular profiling and phylogenetic analysis of cutaneous leishmaniasis in Khyber Pakhtunkhwa, Pakistan. Trans R Soc Trop Med Hyg. 2024;118(4):273-86.
18. Gonzalez K, Calzada JE, Saldaña A, Rigg C, Alvarado A, Chaves LF, et al. Clinical diagnosis of cutaneous leishmaniasis: a systematic review and meta-analysis. PLoS Negl Trop Dis. 2020;14(10):e0008769.
19. Qureshi NA, Alia A, Rashid U, Ur-Rehman T, Alida N. Prevalence of Leishmania tropica in school boys of Khyber Agency, FATA near Pak-Afghan border. Acta Trop. 2016;164:90-94.
20. Chowdhury R, Kumar V, Mondal D, Das ML, Das P, Roy L. Implication of vector characteristics of Phlebotomus argentipes in the kala-azar elimination program in the Indian subcontinent. Pathog Glob Health. 2018;112(3):99-108.
21. Jamal F, Fletcher A, Harden A, Wells H, Thomas J, Bonell C. The school environment and student health: a systematic review and meta-ethnography of qualitative research. BMC Public Health. 2013;13:1.
22. Mann S, Frasca K, Scherrer S, et al. A review of leishmaniasis: current knowledge and future directions. Curr Trop Med Rep. 2021;8(2):121-32.
23. Yasmin H, Adhikari A, Koirala S. Psychosocial impact of cutaneous leishmaniasis: a systematic review. PLoS Negl Trop Dis. 2020;14(11):e0008842.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Journal of Pakistan Association of Dermatologists
This work is licensed under a Creative Commons Attribution 4.0 International License.
Submission declaration
Authors retain the copyright to their work and grant the 'Journal of Pakistan Association of Dermatologists (JPAD)' the right of first publication under a Creative Commons Attribution 4.0 International (CC BY 4.0) license. This license allows others to share, adapt, and reuse the work for any purpose, including commercial use, as long as appropriate credit is given to the original authors and the journal.
By submitting a manuscript, authors confirm that the work has not been published previously (except as an abstract, lecture, or academic thesis), is not under review elsewhere, and has been approved by all authors and relevant authorities. Once accepted, the article will be openly accessible under the CC BY 4.0 license, ensuring wide dissemination and reuse with proper attribution.
