Is Leishmaniasis in Sri Lanka Benign and Be Ignored?(Report‪)‬

Introduction Leishmaniasis has a wide spectrum of disease manifestations, hence, considered as a group of diseases rather than a single disease entity. The three main clinical forms are visceral, mucocutaneous and cutaneous. According to global estimates the disease results in about two million new cases (1) and 2.4 million disability-adjusted life years annually (2). Until over a decade ago, except for the rare imported case (3), leishmaniasis was not prevalent in or reported from Sri Lanka, although in some parts of neighbouring countries like India, Bangladesh and Nepal it represents a major public health problem, with case burden as high as 21 cases per 10,000 population (4). In Sri Lanka, the first autochthonous case of cutaneous leishmaniasis (CL) was reported in 1992 (5). It is now, however, an established disease in this country (6-8) with a steady increase in numbers and spread of CL cases, affecting almost all provinces within the past five years (7,9). A few cases reported with mucosal involvement (10) and even more alarmingly with fatal visceral disease (11) compound this situation even more. There have been over 2000 cases referred for diagnosis to the Department of Parasitology, Faculty of Medicine, University of Colombo alone, since 2001, from almost all provinces of the country, according to the database maintained in this department with some cases analyzed and published (6,7,9). These numbers undoubtedly portray an under representation and would reflect only a fraction of the true incidence of the disease in this island nation.