Demographic characteristics and clinical features of patients presenting with different forms of cutaneous leishmaniasis, in Lay Gayint, Northern Ethiopia

Abstract

Cutaneous leishmaniasis (CL) is a neglected tropical disease caused by Leishmania parasites, that can cause long-term chronic disabilities. The clinical presentation of CL varies in both type and severity. CL presents as three main clinical forms: localised lesions (localised cutaneous leishmaniasis, LCL); mucocutaneous leishmaniasis (MCL) that affects the mucosa of the nose or the mouth; or as disseminated not ulcerating nodules (diffuse cutaneous leishmaniasis, DCL). Here we recruited a cohort of CL patients in a newly established leishmaniasis treatment centre (LTC) in Lay Gayint, Northwest Ethiopia, and collected detailed demographic and clinical data. The results of our study show that more males than females present to the LTC to seek diagnosis and treatment. 70.2% of CL patients presented with LCL and 20.8% with MCL. A small number of patients presented with DCL, recidivans CL (a rare form of CL where new lesions appear on the edges of CL scars) or with a combination of different clinical presentations. The duration of illness varied from 1 month to 180 months. Over a third of CL patients had additional suspected CL cases in their household. Despite the majority of CL patients having heard about CL, only a minority knew about its transmission or that it could be treated. Most CL patients lived in areas where environmental factors known to be associated with the transmission of CL were present. This work highlights that CL is an important public health problem in Lay Gayint and emphasises the urgent need for more CL awareness campaigns, better health education and better disease management practices.

Fig 1. Ages of CL patients.

(A) Ages of adult female (n = 72) and male (n = 135) CL patients. B. Ages of child female (n = 57) and male (n = 82) CL patients. Statistical differences were determined using a Mann-Whitney test. The straight line represents the median. The differences were not significant.

Fig 2. Map of the permanent places of residence of the recruited CL patients in Northern Ethiopia.

Red dots represent adult CL patients, green dots child CL patients; and dot size represents the number of CL patients coming from each place of residence. Black lines show roads, grey lines show state boundaries. Map created in R v4.0.5 [35] using a base map of the region from Open Street Map [36] https://www.openstreetmap.org/#map=8/11.084/38.200.

Fig 3. Examples of contained and spreading LCL lesions.

A. Contained lesion, with a distinct border around the lesion (contained LCL, C LCL). B. Spreading lesion, without clear edges (spreading LCL, S LCL).

Fig 4. Duration of illness and number of lesions.

A. Duration of illness in months for each clinical presentation in adult CL patients (LCL: n = 144, MCL: n = 49, DCL: n = 4, recidivans: n = 1, multiple CL: n = 8); this information was missing for 1 LCL patient. B. Duration of illness in months for each clinical presentation in child CL patients (LCL: n = 94, MCL: n = 21, DCL: n = 1, recidivans: n = 5, multiple CL: n = 12); this information was missing for 4 LCL and 2 MCL patients. C. Number of lesions for each clinical presentation in adult CL patients (LCL: n = 145, MCL: n = 49, DCL: n = 4, recidivans: n = 1, multiple CL: n = 8). D. Number of lesions for each clinical presentation in child CL patients (LCL: n = 98, MCL: n = 23, DCL: n = 1, recidivans: n = 5, multiple CL: n = 12). E. Number of lesions in adult S (n = 105) and S (n = 40) LCL patients. In Fig 4A, 4B, 4C and 4D, statistical differences between the five different clinical presentations of CL were measured by Kruskal-Wallis test and the multiple comparison between each clinical presentation using Dunn’s multiple comparison test. In Fig 4E, statistical difference between S and C LCL was determined using a Mann-Whitney test. The straight line represents the median. Only significant differences were annotated, in the absence of *, the differences were not significant.