Leishmania donovani and Cutaneous Leishmaniasis, Sri Lanka

Abstract

Infection with Leishmania protozoa can result in cutaneous, mucocutaneous, or visceral leishmaniasis (VL), depending on the parasite, host, and environmental factors (1). Globally, the disease results in ≈2 million new cases and 2.4 million disability-adjusted life years each year (2). The leishmaniases have received renewed interest because of an upsurge of cases in traditionally leishmaniasisendemic areas and the emergence of new foci of disease (3,4). One of the most dramatic examples is a new focus of cutaneous leishmaniasis (CL) in Sri Lanka (5), from which >400 cases have been reported since 2001. Previously, multilocus enzyme electrophoresis (MLEE) characterization of a small number of isolates led to the surprising conclusion that CL in Sri Lanka was caused by Leishmania donovani (5). However, L. donovani typically causes VL, a potentially fatal disease and ongoing public health problem in neighboring India, Bangladesh, and Nepal, as well as in East Africa (1,2). No cases of VL have been reported in Sri Lanka. Occasional cases of CL due to L. donovani have been described in other VL-endemic regions (6–9). Karunaweera et al. (5) examined a limited number of isolates and used a single technique, MLEE. Although this technique is usually reliable for characterizing isolates, important exceptions were found in a recent study on L. donovani in East Africa (10). Therefore, we further investigated Sri Lanka CL by examining more isolates and using 2 molecular techniques.