Epidemiological, Clinical and Treatment Profile of Leishmaniasis in Birao, Central African Republic

Abbreviations

CL: Cutaneous Leishmaniasis; WHO: World Health Organisation.

Introduction

Cutaneous leishmaniasis is a parasitic infection transmitted to humans by the bite of the sandfly, the vector of the disease. Depending on the parasite species responsible and the immune defense system set up by the host, the disease can take the form of a skin or visceral. Cutaneous leishmaniasis (CL) is a global public health problem; it is endemic in more than 70 countries with an estimated annual incidence of 1,500,000 cases [1]. According to WHO, it ranks ninth among the 13 most important tropical diseases [2]. In Africa, cutaneous leishmaniasis is endemic, particularly in the north, east and south. In addition, the number of cases of cutaneous leishmaniasis that are neither reported nor diagnosed is probably higher, so much so that official data hardly allow us to know the real number of patients. It is noted that affected populations do not always consult a doctor for this condition [3].

In the Central African Republic, little work has been done on this subject, hence the interest of this present study on the epidemiological, clinical and therapeutic profile of leishmaniasis in the provincial town of Birao. This study contributes to the epidemiological surveillance of neglected tropical diseases [4, 5, 6].

Patients and Methods

This was a prospective descriptive study, from August to September 2024, which made it possible to record demographic, clinical and therapeutic data on leishmaniasis among the population of the city of Birao, as well as surrounding villages (Table 1).

A survey was therefore carried out in the neighborhoods, looking for suspected cases of cutaneous leishmaniasis. After raising awareness among health and administrative authorities, the survey team was placed at fixed points in the neighborhoods and villages to receive all those who presented with skin lesions similar to leishmaniasis. These were vegetative papular lesions or vegetative or crusted or ulcerated papulonodules (Table 2).

Sociodemographic and clinical data were collected after questioning and examination. The cases were put on treatment with metronidazole. Skin scrapings from the edges of the lesions were taken in some cases and were stained with Giemsa and interpreted at the National Laboratory (Table 3). Questionnaires consisting of different variables were used to obtain data entered and analyzed on Epi info version 7 (Figures 1 & 2).

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Discussion

More than half of the patients (56%) had lesions that had been developing for more than 2 years. As for Koureissi T [7] in Mali, he reported in his study an average duration of development of 5 months. This difference could be explained by the higher level of knowledge among the Malian population than that of the Central African Republic [8]. This level of knowledge of leishmaniasis allows the patient to go to the hospital more quickly in the event of the appearance of skin lesions and reduces traditional treatments. All the slides sent showed amastigote forms without genotyping and all the cases had evolved favorably under metronidazole. Kelembho E, et al. [9] in 2003 described a proven case of leishmaniasis imported from Chad, bordering Birao, due to leishmania major which had been cured under the same molecule [10, 11].

Conclusion

This study has shown that this pathology does exist in the population of Birao with a prevalence of 0.17%. Children are the most affected with a male predominance; the crusty and nodulo-ulcerative forms evolve favorably under methronidazole. Despite this low prevalence, it constitutes a public health problem, being a disabling neglected tropical disease, hence the need for staff training and the availability of drugs, including metronidazole and antimony derivatives.

Acknowledgment

We thank the health professionals of Birao Hospital for their help throughout the work. Ethical considerations Authorization was obtained from the Director of Birao Hospital, the ethical authority of the health facility. The data were used in the strictest confidentiality and stored according to the standards.