Cutaneous leishmaniasis among tribals in a Northern district of Kerala

In Kerala, cases of cutaneous leishmaniasis (CL) were seen mainly as imported from Middle-Eastern countries. Recently, many indigenous cases were reported from parts of the Western Ghats. This case series describes cases from routine dermatology surveys in tribal schools and hostels, contact surveys of the index cases, and cases attending the Outpatient Department from August 2022 to July 2023. The index case was detected as part of a school survey and was confirmed using histopathology and polymerase chain reaction (PCR). Following this, surveys were conducted in different tribal colonies in search of contact cases. We studied a total of 16 patients with asymptomatic skin lesions ranging from plaques to nodules without any systemic involvement. All sixteen cases were positive for PCR for leishmaniasis and the species Leishmania donovani (LD) was identified from all of them. Histopathology showed LD bodies in nine cases. Patients were treated with either systemic antifungal alone or with a combination of systemic antifungal with cryotherapy. All the patients responded well to treatment. Patients treated with fluconazole and cryotherapy showed better response. We conclude that active and passive surveillance in endemic areas will help in early detection cases of CL addressing their continued presence in the Western Ghats. Diagnosis can be confirmed with histopathology and PCR analysis.