Prevalence of cutaneous leishmaniasis in suspected population of District Peshawar Khyber Pakhtunkhwa Pakistan

The present study was performed for the purpose of exposing the prevalence of Cutaneous Leishmaniasis across district Peshawar. The study was fulfilled by a collection of 1023 prepared smear slides for seeking Leishmania parasite in the lesions containing population. Microscopic examination was carried out and 370 (36.17%) cases were confirmed positive and in the remaining 653 (63.83%) cases no evidence of parasite was observed. The study was analyzed through different angles of prevalence such as gender wise which concluded; male=18.48%, female=17.69%, age wise where maximum witness of parasite was observed in pre-school aged (14.56%) and school going aged individuals (6-15%). Whereas, month-wise statistics showed 9.38% cases in March and 8.70% in April however, the least number of infections occurred in June (2.93%) followed by July (2.34%). Further molecular study is needed to analyze the genotypes of the Leishmania parasites in the studied area.


Introduction
Leishmania is a protozoan parasite, causes complex diseases called Leishmaniasis. After malaria and filariasis, it is the third most prevalent parasite-borne disease in the world [1]. Leishmaniasis can be presented as a model for other parasitic diseases [2]. To understand the developmental processes, mice and rats are being used for experiments [3]. Leishmaniasis can be; Cutaneous leishmaniasis (CL), Mucocutaneous leishmaniasis (MCL) and visceral Leishmaniasis (VL) [4]. It is further divided into Old World Leishmaniasis and New World Leishmaniasis. Old World leishmaniasis consists of CL which is confined to skin and VL which includes bloodstream and inner organs. But the New World Leishmaniasis includes both CL and MCL with the involvement of mucous membrane along with skin [5]. In Pakistan anthroponotic Cutaneous leishmaniasis is caused by Leishmania tropica whereas zoonotic Cutaneous leishmaniasis is caused by Leishmania major. Leishmania major is common in rural areas while Leishmania tropica is commonly present in urban area [6]. Leishmania parasites are transmitted by the sand fly [7]. The Phlebotomine sand-flies transmit the infection not only in tropical regions but also in subtropical and temperate regions of round about hundred countries [8]. Studies showed that nearly 15,000 cases of CL arise annually in Iran. But the actual cases are 4-5 times more than the reported [9]. Around 1,500,000 cases of Cutaneous Leishmaniasis are reported annually [10]. This parasite is mostly found in tropical region of developing countries [11]. Rodents serves as reservoir host for the parasite of Leishmaniasis, they become infected while vector feeding blood [12]. The (Table 1)

Materials and Methods
The current study was based on the collection of prepared slides for cutaneous Leishmaniasis. The slides and tests results were collected from different localities of district Peshawar.

Study area
The present study work was carried out in district Peshawar (Fig. 1).

Laboratory analysis
The bite of sand fly may not be painful. At the beginning of infection, there are no symptoms but after a week the sore enlargement starts and also the number of sores (lesions) increases. After ten to fifteen days the sore appears as volcano shaped structure i.e. the raised margins of ulcer and central crater. It is then confirmed by laboratory analysis whether the lesion is leishmanoid or not.

Instruments utilized
The diagnostic methods available at present f or Leishmaniasis are based on clinical and ep idemiological features, parasitological detecti on (stained smears, culture and histopatholog y) and immunological methods. The result of current study was obtained by smear formation of slides. Parasites visibility was checked through the binocular microscopes (KYIWA-BIOLUX-12 and OLYMPUS-C-12) with the power of x100 oil immersion Results Overall prevalence of Cutaneous Leishmaniasis in Peshawar region A total of 1023 slides were taken from suspected population of different regions located in district Peshawar. Out of the suspected population 370 (36.17%) individuals were effected with cutaneous leishmaniasis (Positive) and the rest 653 (63.83%) indicated no parasite of Leishmania (Negative). The (Fig. 2)

Age wise prevalence of cutaneous leishmaniasis in Peshawar region
The occurrence of cutaneous leishmaniasis in different age groups is given in (Table 3). The data shows that highest percentage of cutaneous leishmaniasis i.e. 14.56% was found in people of age ranged between 6-15 year of age.