Abstract
Amidst the ongoing wave of COVID in Pakistan, multiple cities of interior province of Sindh were struck by a new epidemic. This disfiguring disease known as the Desert Boil or Cutaneous Leishmaniasis has affected nearly 4400 people and daily 100–150 cases are being reported in men, women and children of all age. Public health authorities have declared a health emergency in various cities and are trying to curtail this epidemic.
LETTER TO EDITOR,
Amidst the ongoing 5th wave of COVID in Pakistan, presumed to be due to the Omicron variant, multiple cities of interior province of Sindh were struck by a new epidemic. This disfiguring disease known as the Desert Boil or Cutaneous Leishmaniasis, which is usually endemic in these areas, showed a rapid rise in numbers affecting nearly 4400 people in Dadu, Jamshoro and Hyderabad cities over the last few weeks. With a burden of 1500 active cases and 100–150 cases being reported daily in men, women and children of all age, Sindh public health authorities declared a health emergency in various cities. 1
Cutaneous Leishmaniasis caused by the bite of the sand-fly has constantly affected the poor people of different urban and rural areas of Pakistan, with preponderance in the Balochistan province accounting for 60% of total cases. 2 Although cities in interior Sindh, primarily Dadu, reported 30% of total cases of Cutaneous Leishmaniasis, such major outbreaks are extremely rare. The cause of such outbreaks are due to multiple factors including migration of the primary sandfly from other neighboring countries where it is endemic like Iran, Iraq and Afghanistan and also refugee movements, low socio-economic, and poor sanitary conditions in these areas. 3
The challenge of tackling this disease is complicated by the expense and non-availability of the treatment options. The pentavalent antimony derivatives sodium stibogluconate (Pentostam) and meglumine antimoniate (Glucantime) remains the mainstay of systemic treatment, but unfortunately it is not produced locally. 4 Efforts are underway to obtain maximum amount of Glucantime Injection from International Foundations, as treatment is for 21 days continuously and is expensive. 1
The sandfly is known to bite its victim especially at night leading to a wound appearing on skin after 30 days with immediate progression. Major efforts by the Sindh government are under way to implement strategies for vector control so that the spread of this disease can be curbed. The authorities have implemented restrictions on visiting the affected area at night hours, forming health care units and distribution of nets to various residents in the epidemic areas. Multiple sites have been fumigated to eradicate the nests of sandflies in the endemic regions and to control the disease outbreak as well. 1 Hopefully with such measures, the disease can be curtailed in the upcoming weeks otherwise the public health crisis may worsen.
Footnotes
Acknowledgements
There are no acknowledgements.
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
Role of authors
Dr Muhammad Yasir – Conceived and wrote the letter. Dr Fivzia Farooq Herekar – Edited and wrote the letter.