Mucocutaneous leishmaniasis in Central Punjab and Azad Kashmir regions of Pakistan

Objective: To describe frequency and clinical spectrum of mucocutaneous leishmaniasis in two geographical regions of Pakistan. Patients and methods: This case series was compiled at PAF Hospital Sargodha (January, 2003 to November, 2004) and CMH, Muzaffarabad (January, 2006 to July, 2008). All patients clinically and parasitologically diagnosed as leishmaniasis, having concomitant cutaneous as well as mucosal lesions (contiguous or non-contiguous) were included in the study. Various demographical features (age, sex, geographical origin) and clinical pattern (number, site, morphology) of the lesions were recorded in all cases. Descriptive statistics were used for analysis. Results: Out of 414 cases of tegumentary leishmaniasis, 10 (2.4%) had mucocutaneous disease. In central Punjab (Sargodha) it was 2 out of 148 (1.35%), while it was 8 out of 266 (3.0%) in northern part (Azad Kashmir) of the country. Age range was 2 years to 67 years (mean age = 28.72±4.47 years). There were 3 females and 7 males. 4 of them had solitary contiguous lesions affecting adjacent cutaneous and mucosal surfaces. Rest had more than one discrete lesion and two of them had two mucosal surfaces (nose and lip) involved. Seven patients were treated with weekly intralesional injections (maximum up to 16 weeks) and three received daily intramuscular injections of meglumine antimoniate (for 2 weeks). Most common morphological pattern was psoriasiform plaque. All patients responded well to treatment without any significant side effect. Conclusion: Mucocutaneous leishmaniasis is a rarity but does exist in Pakistan. However, its clinical spectrum is entirely different from that of New World mucocutaneous leishmaniasis. Lesions are characteristically benign and respond well to systemic as well as intralesional antimonials compound. Outcome is even better than what we see in Old World mucocutaneous leishmaniasis.