Kathmandu: Deepak Lama, 32, had gone to Dolpa in 2016. After staying there for about three-four months he was back in Kathmandu on October 11, 2016. Upon his return, he noticed blisters on his nose and cheeks. Dismissing it as pimple, he bought a pimple cream from a local pharmacy in Bhaktapur but the cream didn’t work. Rather the size of the blisters increased. In an attempt to treat it, he squeezed making them more reddish, and the shape changed too. So, he visited a hospital in the Capital where he was given medicines for tuberculosis. But that medicine worsened the infection. Later he was referred to Sukraraj Tropical and Infectious Disease Hospital, Teku and its Consultant Tropical Medicine Physician Dr Anup Bastola diagnosed it as ‘cutaneous leishmaniasis’. “It was quite an unusual skin infection. After some tests it was discovered that he was suffering from cutaneous leishmaniasis,” the doctor informed. “Leishmaniasis is caused by the protozoan leishmania parasites. They are transmitted by the bite of an infected female phlebotomine sand flies. And among the three main forms of leishmaniases, Lama was diagnosed with the most common one — cutaneous leishmaniasis. There are about 20 species of leishmania that may cause cutaneous leishmaniasis.” As per Dr Bastola, this is an emerging disease in the country. He informed, “The cases of cutaneous leishmaniasis have been seen in areas like Dharan, Makwanpur, Tanahun, Dhading, Dolpa and Nepalgunj in the country. From 2016 till February 2017, four such cases have been identified in the Teku-based hospital. In addition, eight cases have also been reported from the far western development region while two cases from Dharan.” As an emerging disease, they are still researching about the species of leishmania that is infecting people here. How do people get infected? The infection is transmitted by infected phlebotomine sand flies. “Sand flies become infected by sucking blood from an infected animal or person. As the parasites are found in rodents, these sand flies feed on them and when they bite a healthy person, they transmit the infection,” Dr Bastola shared. Sand flies are basically found in tropical and subtropical regions as the temperature is favourable for its breeding. It is more common in the Middle Eastern countries. As Nepal has a favourable climate for its survival, the sand flies are found here too, which puts people at risk. “Sand flies lay their eggs in damp cattle sheds, poultry farms and in dark rooms. The pupa is found in crevices and in decaying organic matters. People living in huts, involved in outdoor activities are more prone to the bites of sand flies,” explained Dr Bastola adding, “Any one travelling to and living in sand flies prone areas are under the risk of getting infected. People returning from abroad where there are risks of the infection can also be suspected of the disease.” As per him, these sand flies are most active in the evening, and are nocturnal. Although they are less active during the day time, they may bite if they are disturbed. And people might not notice sand flies presence because “they do not make any noise, they are small and their bites even go unnoticed. The bites can be either painful or painless”. Symptoms “When someone is infected with leishmaniases, a red lesion starts as a papule or nodule at the site where the sand fly has bit. It grows slowly and increases in size. In the early stage it seems to be like a pimple,” clarified Dr Bastola. He added, “A crust develops centrally. The patient feels mild itching in the infected area, red juicy plaque-like crusting too are likely to appear. However, at times it can be asymptomatic and can be destructive too. It depends upon the species of leishmania you are infected with.” If left untreated, cutaneous leishmaniasis will lead to secondary infection — mucocutaneous leishmaniasis. He explained, “Skin and mucous membrane are involved with the formation of lesions and are likely to spread in the area. It is likely to damage the face, particularly the region around the nose and mouth. It can completely destroy any part of the skin where it has appeared.” Treatment When Lama was referred to the doctor, his infection was in a poor condition. As such he had to be admitted in the hospital. “I was admitted in the hospital for 12 days in January. Even now I am under medication and am getting better,” Lama shared. With the medicines and diagnostic tools currently available in the country, adequate control of leishmaniasis is possible, Dr Bastola said. However, he insisted that dermatologists must be aware about the infection in advance so that they can diagnose the disease in its early stages. For others, the doctor advised to “keep surroundings clean, try not to come out in the evenings unless necessary, wear full sleeved clothes, not to forget to use mosquito repellents to be safe from the bites of sand flies”.