Dr. Mehak Jonjua: In recent years, Jammu and Kashmir has emerged as a significant focus area for cutaneous leishmaniasis (CL), a parasitic disease caused by the Leishmania species. The regions most affected include the Chenab Valley, Poonch, and Rajouri districts in the Jammu division, as well as Kupwara and Baramulla districts in the Kashmir division. This disease, primarily spread by sandflies, presents unique challenges in diagnosis, treatment, and public health management, especially in resource-limited settings.
Zeeshan Khan, a ten-year-old boy from Kishtwar, Kashmir, represents the typical journey of many CL patients in the region. Two years ago, Zeeshan developed sores on his nose. His parents, Mian Khan, a laborer, and Abida Bano, a homemaker, initially tried home remedies, which worsened the condition. The sores became crusty and infected with pus, and a new sore appeared on his left leg. It was only after two years, when the condition became unbearable, that they sought medical help. At the hospital, Zeeshan was diagnosed with cutaneous leishmaniasis and began receiving appropriate treatment.
The first documented cases of CL in the Kashmir Valley were reported in 2009 from the Tangdhar area of Kupwara district. Initially, these patients were misdiagnosed and treated unsuccessfully for skin tuberculosis until microscopic examination in a tertiary care hospital in Srinagar revealed the true cause. According to Dr. Promod Mehta ‘The region’s climate plays a significant role in the disease’s epidemiology. Climate change is a significant driver, as alterations in temperature, rainfall, and humidity affect the population size, distribution, and survival of sandflies, which are the primary vectors for the disease. Population mobility also plays a role, as the movement of non-immune individuals into areas with established transmission cycles can lead to outbreaks. Additionally, deforestation and the establishment of human settlements near forested areas have created environments conducive to sandfly habitation’.
The disease burden disproportionately affects children, who account for 60%-70% of cases due to their early exposure to the parasite when their immune systems are still developing. Several factors contribute to the rising incidence of CL in Jammu and Kashmir.
Jammu and Kashmir’s climate, characterized by hot summers and cold winters, provides an ideal environment for the Leishmania species. Over the past decade, there has been a noticeable increase in CL cases in Jammu and Kashmir. In 2009, Srinagar hospital reported only six to seven cases annually, but this number has since risen to 60 patients, with around 100 cases reported yearly in Jammu.
One of the main challenges in diagnosing CL is its initial presentation. Unlike bacterial infections, which often show severe symptoms early on, CL lesions or boils on exposed body parts like the face, hands, and feet develop slowly. These lesions often go unnoticed until they become larger or more painful, particularly when they involve sensitive areas like the eyelids. The disease’s underreporting is further exacerbated by the fact that it predominantly affects impoverished individuals in remote areas who lack access to specialized dermatological care.
Historically, the drug of choice for CL was sodium stibogluconate, known for its high efficacy and minimal side effects. However, this drug is no longer readily available in North India due to low profitability for pharmaceutical companies.
Addressing the CL epidemic in Jammu and Kashmir requires a multifaceted approach. Enhancing public health infrastructure, improving access to effective treatments, and conducting extensive research to understand the disease’s epidemiology are crucial steps. Public awareness campaigns to educate communities about prevention and early symptoms, combined with government and international support to ensure the availability of essential medications, are vital to controlling and eventually eradicating cutaneous leishmaniasis in the region.
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