Cutaneous leishmaniasis

Leishmaniasis is an increasingly prevalent, major world health problem caused by infection with a protozoan which is transmitted by sand fly bites. It is endemic in 88 countries on 4 countries. More than 90% of visceral leishmaniasis cases occur in Bangladesh, Brazil, India and Sudan. Although Bangladesh is one of four countries those bearing the most burden of visceral leishmaniasis, cutaneous leishmaniasis is rare in Bangladesh. Cases of cutaneous leishmaniasis (CL) are usually imported to Bangladesh from other endemic countries. A patient from an endemic area of cutaneous leishmaniasis, a non-healing nodulo-ulcerative lesion with "volcanic crater" on exposed part of the body, constant dermal infiltration with lymphocytes, histiocytes and plasma cells and demonstration of intracellular parasites in lesional skin establish the diagnosis of cutaneous leishmaniasis. We here represent a case of cutaneous leishmaniasis in an overseas worker, returned from Saudi Arabia. He presented with multiple asymptomatic nodulo-ulcerative lesions on exposed part of the body. The patient's clinical history, morphology of lesions, laboratory analysis and histopathological examination of lesional skin were consistent with cutaneous leishmaniasis, a rare disease for Bangladesh. Cutaneous leishmaniasis may arise as a health problem among people returned from the Middle-East. Our findings of high titre (>1:64000) direct agglutination test (DAT) in cutaneous leishmaniasis may be an additional point of further study.