Epidemiological and Environmental Determinants of Cutaneous Leishmaniasia with a Focus on Leishmania Parasite Identification

Abstract

Cutaneous leishmaniasis (CL) is a major neglected tropical disease in Pakistan, particularly in the Khyber Pakhtunkhwa province, where environmental, epidemiological, and socioeconomic factors facilitate its transmission. This study aimed to assess the epidemiological trends, environmental determinants, and molecular identification of Leishmania species in the endemic hotspots of the district of . Ramli Rawalkot Islamabad . A total of 167 clinically suspected patients were surveyed between May and September 2024 across seven tehsils. Detailed demographic, housing, behavioral, and clinical data were collected via structured questionnaires, while lesion samples were analyzed through microscopy and PCR for parasite detection. The results revealed a male predominance (65.3%) and a high incidence among children aged 1–15 years (52.7%). CL cases peaked in September (32.3%) and were concentrated in Balambat (28.1%), Timergara (25.7%), and Khall (24.6%). Environmental risk factors included overcrowding (38.3% of households had >15 members), mud-walled houses (79.6%), lack of meshed windows (88.0%), and reliance on wood/dung fuel (68.3%). Behavioral risks such as outdoor sleeping (76.6%) and livestock proximity were also significant, with 91.8% of households keeping animals, predominantly cows.

Clinically, most patients presented with single (67.7%) and ulcerated (85.6%) lesions, primarily on the face and limbs. PCR outperformed microscopy in sensitivity, confirming 78.4% of infections compared to 46.1% by microscopy. The predominant species identified was Leishmania tropica. These findings highlight a complex interplay of environmental, behavioral, and infrastructural vulnerabilities that drive CL transmission. The study advocates for targeted public health interventions, improved housing infrastructure, enhanced diagnostic capacity, and awareness campaigns to mitigate CL in endemic rural communities.

Conclusion: Leishmaniasis remains a major public health issue, particularly in developing nations. The diversity of causative species, vectors, and clinical presentations, coupled with ecological and socioeconomic drivers, complicates control and diagnosis. Cutaneous leishmaniasis, in particular, is rising globally, especially in regions like Pakistan. Improved diagnostic tools and vector control strategies are essential for effective disease management.