Imported Cutaneous Leishmaniasis in India: Diagnosis and Treatment with Implications for Kala Azar Elimination.

Cutaneous leishmaniasis (CL) is an emerging infection in Kerala state. Recent reports showed that Leishmania donovani is causing the dual manifestations, CL and visceral leishmaniasis (VL). In addition, the influx of migrants and returnees from other countries has introduced CL caused by non-endemic variants of Leishmania. A 46-year-old migrant worker from Nepal presented with a single erythematous nodule with crusting and erosions. It was diagnosed as CL through molecular diagnosis, and L. donovani was proven as the parasite by ITS-1 RFLP and sequencing. Additionally, the strain was identified as zymodeme MON-37 by sequence analysis of the 6-PGDH gene. Simultaneously, the phylogenetic analysis revealed the genetic relatedness of the current L. donovani isolate to those previously reported from Nepal. In contrast to the indigenous cases recorded in Kerala, this patient's serum samples showed an unusual rK-39 positivity, and Leishmania DNA was detected in circulation. The patient was successfully treated with intravenous amphotericin B. In the context of the nation attaining VL elimination, the differential tropism of Leishmania species, increasing migrations, and the detection and proper treatment of suspected cases are of high public health significance, as unnoticed cases can create new transmission pockets compromising the elimination efforts. This study signifies the importance of monitoring skin lesions among migrants and returnees from other countries to enhance the National Leishmaniasis Elimination strategies.