Cutaneous Leishmaniasis of the Lid: A Report of Nine Cases

Leishmaniasis is a parasitic disease caused by Leishmania species and is classified into three forms; cutaneous, mucocutaneous, and visceral. The eyelid is a rare site involved by leishmaniasis and only makes up 2.5% of cases with cutaneous leishmaniasis (CL). Although CL can affect both upper and lower lids on either their outer or inner aspects, the lateral canthus is most often affected. The most common aspect of lid leishmaniasis is chalazion-like lesions but ulcerous, phagedenic, cancer-like forms, and unilateral chronic granulomatous blepharitis may be observed. When the lid is involved, the disease is usually self-limiting; healing usually takes up to one year, hence early diagnosis and treatment are important. The diagnosis is based on a high index of suspicion regarding the endemicity of the disease in the region. Response to treatment in lid CL cases is quite satisfactory. In this article, we report nine cases of lid leishmaniasis with satisfactory responses to intralesional meglumine antimoniate

Cutaneous Leishmaniasis in Khyber Pakhtunkhwa Province of Pakistan: Clinical Diversity and Species-Level Diagnosis.

This study primarily aimed to identify the causative species of cutaneous leishmaniasis (CL) in the Khyber Pakhtunkhwa Province of Pakistan and to distinguish any species-specific variation in clinical manifestation of CL. Diagnostic performance of different techniques for identifying CL was assessed. Isolates of Leishmania spp. were detected by in vitro culture, polymerase chain reaction (PCR) on DNA extracted from dried filter papers and microscopic examination of direct lesion smears from patients visiting three major primary care hospitals in Peshawar. A total of 125 CL patients were evaluated. Many acquired the disease from Peshawar and the neighboring tribal area of Khyber Agency. Military personnel acquired CL while deployed in north and south Waziristan. Leishmania tropica was identified as the predominant infecting organism in this study (89.2%) followed by Leishmania major (6.8%) and, unexpectedly, Leishmania infantum (4.1%). These were the first reported cases of CL caused by L. infantum in Pakistan. PCR diagnosis targeting kinetoplast DNA was the most sensitive diagnostic method, identifying 86.5% of all samples found positive by any other method. Other methods were as follows: ribosomal DNA PCR (78.4%), internal transcribed spacer 2 region PCR (70.3%), culture (67.1%), and microscopy (60.5%). Clinical examination reported 14 atypical forms of CL. Atypical lesions were not significantly associated with the infecting Leishmania species, nor with "dry" or "wet" appearance of lesions. Findings from this study provide a platform for species typing of CL patients in Pakistan, utilizing a combination of in vitro culture and molecular diagnostics. Moreover, the clinical diversity described herein can benefit clinicians in devising differential diagnosis of the disease

Pattern of skin infections in black Africans of Sierra Leone (West Africa)

<b>Background:</b> Physical differences among human populations may lead to variable prevalence of skin disorders in different ethnicities. Skin infections are one of the important curable and largely preventable categories of skin disorders in the communities. <b> Aim:</b> The purpose of the study was to see the patterns of skin infections in black Africans of Sierra Leone and to compare with other ethnic populations. <b> Materials and Methods:</b> Local blacks of all age groups presenting in Dermatology out patient department of Pak Field Hospital (established as a part of UN peacekeeping mission in Sierra Leone) were included (from Nov 2004 to Oct 2005). Relevant clinical history and physical examination was done. Laboratory investigations were carried out when indicated. Skin diseases were broadly classified into two major categories i.e., infective and noninfective. Among infective, sexually transmitted infections were again separated. Nonblack settlers in the area and UN troops were not included in the study. Data was recorded and analyzed by Microsoft Excel program. <b> Results:</b> 3011 patients belonging to different local tribes having a variety of skin disorders were seen. Patients were of all ages and both sexes ranging from one month to 73 years of age. The Infective skin disorders were seen in 61.7&#x0025; patients and most prevalent were superficial fungal infections (41.2&#x0025;) followed by, sexually transmitted infections (9.9&#x0025;) and parasitic infections (6.5&#x0025;). Bacterial and viral infections were rare and so was the scabies. More than 90&#x0025; parasitic infections were onchocerciasis with full spectrum of cutaneous manifestations. <b> Conclusion:</b> Pattern of skin infections in blacks varies considerably from other ethnic races. Environmental factors, geographical location and free existence of vector for onchocerciasis in West African region, possibly have a significant influence in this variable prevalence

Carotenemia in an African lady

Carotenemia is characterized by an abnormal yellowish orange pigmentation of the skin, predominantly seen on the palms and soles. Although it may be associated with several diseases such as diabetes, hypothyroidism and anorexia nervosa, it is caused by excessive intake of carotene-rich food such as oranges and carrots in most cases. The condition is harmless, but it can lead to a mistaken diagnosis of jaundice. Herein, an interesting case of carotenemia is described in a 32-year-old female secondary to increased ingestion of oral sweet potatoes and oranges