Epidemiological analysis of Leishmaniasis prevalence in Pakistan during 2016-2023

Análise epidemiológica da prevalência da Leishmaniose no Paquistão durante 2016-2023

Abstract

Leishmaniasis, caused by the Leishmania parasite, remains a persistent public health challenge in Pakistan. Despite control efforts, the disease prevalence continues to rise, particularly among pediatric populations. Understanding prevalence patterns and transmission dynamics is critical for effective control strategies. This study aims to analyze leishmaniasis prevalence data from January 2016 to July 2023 in Pakistan. Specific objectives include assessing temporal trends, demographic patterns, and geographical hotspots of transmission, while emphasizing the need for enhanced surveillance and research for targeted interventions. Retrospective analysis was conducted on leishmaniasis prevalence data collected from multiple healthcare facilities across Pakistan. Data included results from diagnostic tests on suspected cases, encompassing both pediatric and adult patients. Descriptive statistical analysis was employed to evaluate prevalence rates, demographic characteristics, and geographical distribution of positive cases. Analysis revealed an increasing trend in leishmaniasis prevalence over the study period. Initially, from 2016 to 2020, a positivity rate of 27% was observed exclusively among pediatric patients in Islamabad, with no adult cases. Subsequently, from 2017 to 2022, the positivity rate increased to 42%, affecting both pediatric and adult populations in Islamabad, Rawalpindi, and Swat. Notably, between July 2022 and July 2023, the positivity rate surged to 56%, primarily impacting adult males in the identified hotspots. The study provides evidence of rising leishmaniasis prevalence in Pakistan, particularly among pediatric patients. Identified hotspots suggest localized transmission, warranting targeted interventions. Enhanced surveillance and research efforts are crucial for understanding disease dynamics and implementing effective control measures. Priority should be given to vulnerable populations and high-burden regions to mitigate leishmaniasis impact in Pakistan.

Keywords:
leishmaniasis; epidemiology; public health; prevalence; Pakistan

Resumo

A leishmaniose, causada pelo parasita Leishmania, continua um desafio persistente de saúde pública no Paquistão. Apesar dos esforços de controle, a prevalência da doença vem aumentando, principalmente entre populações pediátricas. Entender os padrões de prevalência e a dinâmica de transmissão é fundamental para estratégias de controle eficazes. Este estudo tem como objetivo analisar dados de prevalência de leishmaniose de janeiro de 2016 a julho de 2023 no Paquistão. Os objetivos específicos incluem avaliar tendências temporais, padrões demográficos e pontos geográficos de transmissão, enfatizando a necessidade de vigilância e pesquisa aprimoradas para intervenções direcionadas. A análise retrospectiva foi conduzida em dados de prevalência de leishmaniose coletados de várias unidades de saúde em todo o Paquistão. Os dados incluíram resultados de testes diagnósticos em casos suspeitos, abrangendo pacientes pediátricos e adultos. A análise estatística descritiva foi empregada para avaliar taxas de prevalência, características demográficas e distribuição geográfica de casos positivos. A análise revelou uma tendência crescente na prevalência de leishmaniose ao longo do período do estudo. Inicialmente, de 2016 a 2020, uma taxa de positividade de 27% foi observada exclusivamente entre pacientes pediátricos em Islamabad, sem casos adultos. Posteriormente, de 2017 a 2022, a taxa de positividade aumentou para 42%, afetando populações pediátricas e adultas em Islamabad, Rawalpindi e Swat. Entre julho de 2022 e julho de 2023, a taxa de positividade aumentou para 56%, impactando principalmente homens adultos nos pontos críticos identificados. O estudo fornece evidências do aumento da prevalência de leishmaniose no Paquistão, particularmente entre pacientes pediátricos. Os pontos críticos identificados sugerem transmissão localizada, garantindo intervenções direcionadas. O fortalecimento da vigilância e de pesquisa são cruciais para entender a dinâmica da doença e implementar medidas de controle eficazes. Deve-se dar prioridade às populações vulneráveis ​​e regiões de alta carga para mitigar o impacto da leishmaniose no Paquistão.

Palvras-chave: leishmaniose; epidemiologia; saúde pública; prevalência; Paquistão

1. Introduction

Leishmaniasis presents a formidable health challenge across various regions worldwide, particularly in tropical and subtropical areas (Devi, 2024). This disease encompasses several clinical forms, with cutaneous leishmaniasis, affecting the skin, standing as one of the most prevalent manifestations (Khan and Muneeb, 2005). Despite advancements in healthcare, leishmaniasis remains a significant burden on global public health systems, necessitating ongoing research and intervention efforts to mitigate its impact. According to data from the World Health Organization (WHO, 2023), the global incidence of leishmaniasis is considerable, with an estimated 700,000 to 1 million new cases arising each year (Sophie et al., 2017; Khan et al., 2021). However, it's important to acknowledge the inherent variability in leishmaniasis prevalence across different regions. This variability is influenced by a complex interplay of factors including ecological conditions, socio-economic status, healthcare infrastructure, and access to diagnostic and treatment facilities (Rasheed et al., 2024).

The reporting and diagnosis of leishmaniasis cases pose significant challenges due to the disease's diverse clinical presentations and the presence of asymptomatic carriers. Consequently, underreporting and underdiagnosis are prevalent issues in many endemic regions, leading to a gap in our understanding of the true burden of the disease (Bari, 2012). Additionally, limited resources and healthcare infrastructure in some affected areas further exacerbate these challenges, hindering effective disease surveillance and control efforts. Leishmaniasis exhibits diverse prevalence patterns across different continents and regions (Haroon et al., 2024; Rahman et al., 2023). In South America, countries such as Brazil, Colombia, and Peru experience a significant burden of leishmaniasis, with both cutaneous and mucocutaneous forms posing substantial public health challenges. Similarly, in East Africa, nations like Sudan, Ethiopia, and Kenya report notable instances of visceral leishmaniasis, which can lead to severe morbidity and mortality if left untreated (Ullah et al., 2024).

The Indian subcontinent, comprising India, Bangladesh, and Nepal, serves as an endemic region for both cutaneous and visceral leishmaniasis, with India bearing the highest global burden of visceral leishmaniasis. Furthermore, across the Middle East, including Syria, Iraq, Iran, and Saudi Arabia, cutaneous leishmaniasis predominates, adding to the regional disease burden (Rasheed et al., 2024). Additionally, certain countries in the Mediterranean Basin, such as Turkey, Greece, and Spain, grapple with a mix of both cutaneous and visceral leishmaniasis cases. While leishmaniasis cases are relatively rare in North America, specific regions in Mexico and the southern United States have reported occurrences (Sophie et al., 2017; Bashir et al., 2023; Saeed et al., 2021a, 2021b, 2021c). However, it's important to note that leishmaniasis prevalence can be dynamic, influenced by factors such as environmental changes, population movements, and socio-economic conditions. Therefore, continuous monitoring and surveillance efforts are essential to track changes in disease prevalence and inform targeted intervention strategies (Khan et al., 2024).

2. Material and Methods

2.1. Study design

This retrospective study aimed to analyze leishmaniasis prevalence data collected from multiple healthcare facilities across Pakistan over an extended period from January 2016 to July 2023. The study design adhered to ethical guidelines and obtained necessary approvals from relevant institutional review boards or ethics committees.

2.2. Data collection

Leishmaniasis prevalence data were sourced from medical records and laboratory databases of participating healthcare facilities. The data included results from diagnostic tests conducted on suspected leishmaniasis cases, encompassing both pediatric and adult patients. Information regarding patient demographics and test results (positive/negative) was extracted for analysis.

2.3. Data analysis

Descriptive statistical analysis was performed to evaluate prevalence rates, demographic characteristics, and geographical distribution of positive leishmaniasis cases. Prevalence rates were calculated as the proportion of positive cases relative to the total number of tests conducted within specific time intervals. Temporal trends in prevalence rates were assessed to identify any patterns or changes over the study period.

2.4. Quality control

Data quality assurance measures were implemented to ensure the accuracy and reliability of the collected information. This involved data validation checks, verification of patient identifiers, and resolution of any discrepancies or inconsistencies encountered during data compilation. Additionally, periodic audits were conducted to verify the integrity of the dataset.

2.5. Ethical considerations

The study adhered to ethical principles outlined in the Declaration of Helsinki and obtained necessary approvals from relevant ethics committees or institutional review boards. Patient confidentiality and privacy were strictly maintained throughout the study, with data anonymization procedures implemented to protect sensitive information.

2.6. Limitations

Several limitations were acknowledged in this study, including potential biases inherent in retrospective data collection, reliance on secondary data sources, and variations in diagnostic practices across healthcare facilities. Additionally, underreporting or misclassification of leishmaniasis cases could have influenced prevalence estimates. Despite these limitations, efforts were made to minimize bias and ensure the validity of study findings.

2.7. Statistical analysis

Statistical software packages such as SPSS (Statistical Package for the Social Sciences) or R were utilized for data analysis. Descriptive statistics, including frequencies, percentages, and measures of central tendency, were calculated to summarize the demographic and clinical characteristics of the study population. Comparative analyses, such as chi-square tests or t-tests, were conducted to assess differences in prevalence rates between subgroups or time periods, where applicable. A significance level of p < 0.05 was considered statistically significant for all analyses.

3. Results

Between January 2016 and December 2020, a total of 11 tests for Leishmania antibodies were conducted, revealing a prevalence of approximately 27%. Among these tests, 3 yielded positive results, indicating the presence of Leishmania infection, while the remaining 8 tests were negative. Strikingly, all positive cases were found exclusively in pediatric patients, with one case in a pediatric male and two cases in pediatric females. Notably, no positive cases were detected among adult males or females during this period. The positive cases were predominantly concentrated in the city of Islamabad, suggesting a localized focus of infection among pediatric populations.

From March 2017 to July 2022, a larger cohort of 29 tests were performed, demonstrating an increased prevalence rate of approximately 42% compared to the previous period. Pediatric cases continued to dominate the positive results, with 2 cases identified in pediatric males and 1 case in a pediatric female. Additionally, positive cases were detected in adult populations, with 6 cases in adult males and 3 in adult females. Geographically, positive cases were reported in three distinct locations: 9 in Islamabad, 1 in Rawalpindi, and 2 in Swat, indicating a broader distribution of the infection across different regions.

In the most recent period, from July 2022 to July 2023, a notable increase in testing was observed, with a total of 100 tests conducted. Among these tests, 56 yielded positive results, signifying a prevalence rate of approximately 56%, which is substantially higher compared to the preceding periods. The age and gender distribution of positive cases remained consistent, with a higher number of positive cases observed in adult males (28) compared to adult females (13) and pediatric cases (3 in males and 2 in females). Moreover, the infection appeared to be spreading to additional locations, with 39 positive cases reported in Islamabad, 35 in Rawalpindi, and 26 in Swat.

Overall, the data reveals a concerning upward trend in leishmaniasis prevalence in Pakistan, with a notable proportion of positive cases observed in pediatric patients. The concentration of positive cases in specific regions, particularly Islamabad, Rawalpindi, and Swat, suggests the presence of potential hotspots for leishmaniasis transmission. Further research and comprehensive surveillance efforts are imperative to elucidate the disease's epidemiology, identify associated risk factors, and implement targeted preventive measures and control strategies in affected areas.

4. Discussion

The prevalence data of leishmaniasis in Pakistan provides valuable insights into the epidemiology and burden of this neglected tropical disease. Leishmaniasis, caused by the Leishmania parasite and transmitted through the bite of infected sandflies, poses significant challenges to public health systems, particularly in regions with favorable ecological conditions for its transmission (Memon et al., 2023). The observed prevalence rates, ranging from approximately 27% to 56% across different time periods, underscore the fluctuating nature of leishmaniasis burden within Pakistan. This variability reflects the dynamic interplay of factors such as environmental conditions, human behavior, and healthcare access, which influence disease transmission and detection. The higher prevalence rates observed in recent years suggest a concerning trend of increasing disease burden, highlighting the urgency of effective control measures. Of particular concern is the predominance of pediatric cases among positive outcomes throughout the study periods. Pediatric populations are especially vulnerable to severe forms of leishmaniasis, and early detection and treatment are crucial to prevent morbidity and mortality (Rasheed et al., 2024; Memon et al., 2023). The concentration of positive cases in children underscores the need for targeted interventions aimed at this demographic, including improved access to healthcare services and educational initiatives to raise awareness among caregivers. Geospatial analysis reveals notable hotspots of leishmaniasis transmission in urban centers such as Islamabad, Rawalpindi, and Swat. These findings align with previous research highlighting the role of urbanization and environmental factors in driving disease transmission. The concentration of cases in specific regions underscores the importance of localized control efforts, including vector control measures and targeted surveillance, to curb disease spread and reduce community transmission (Naz et al., 2023). In a global context, leishmaniasis remains a significant public health challenge in endemic regions across Latin America, East Africa, the Indian Subcontinent, the Middle East, and Central Asia. The varying prevalence rates and epidemiological patterns observed within Pakistan are reflective of the broader global diversity in leishmaniasis transmission dynamics. Cross-border collaboration and knowledge sharing are essential for developing effective control strategies that address the unique challenges posed by the disease in different regions.

Advanced technologies, including artificial intelligence and molecular diagnostics, hold promise for enhancing disease surveillance and control efforts. The predictive models can help anticipate disease outbreaks and guide resource allocation for targeted interventions. Molecular diagnostics enable rapid and accurate diagnosis, facilitating early treatment initiation and preventing disease progression. These technological advancements represent valuable tools in the fight against leishmaniasis and underscore the importance of innovation in addressing complex public health challenges (Ullah et al., 2023). Vector control remains a cornerstone of leishmaniasis prevention, with strategies targeting sandfly populations and breeding sites playing a critical role in interrupting disease transmission. The integration of recent approaches into vector control efforts offers opportunities for optimizing interventions and reducing disease burden effectively. The prevalence data of leishmaniasis in Pakistan provide valuable insights into the epidemiology and burden of this neglected tropical disease. Addressing the challenges posed by leishmaniasis requires a multifaceted approach, encompassing targeted interventions, advanced technologies, and cross-sectoral collaboration. By prioritizing surveillance, research, and control efforts, stakeholders can work towards reducing the burden of leishmaniasis and improving the health outcomes of affected populations (Saeed et al., 2023a, b; 2024a, b; Saeed and Piracha, 2023; Piracha et al 2023, 2024; Uppal et al., 2024).

5. Conclusion

The retrospective study conducted from 2016 to 2023 provides valuable insights into the prevalence and epidemiological trends of leishmaniasis in Pakistan. The findings underscore a concerning increase in the disease burden over the study period, with a notable impact on pediatric populations. The prevalence rates have shown variability across different time periods, highlighting the dynamic nature of leishmaniasis transmission within the country. The identification of geographical hotspots, particularly in urban centers like Islamabad, Rawalpindi, and Swat, emphasizes the need for targeted interventions and localized control efforts. These efforts should focus on vector control measures, enhanced surveillance, and community-based interventions to effectively curb disease transmission. The study also underscores the importance of advanced technologies, such as artificial intelligence and molecular diagnostics, in improving disease surveillance and control strategies. Leveraging these tools can aid in early detection, prompt treatment initiation, and the development of targeted preventive measures. In light of the findings, there is a critical need for continued research, surveillance, and collaboration among healthcare stakeholders to mitigate the growing burden of leishmaniasis in Pakistan. By implementing evidence-based interventions and fostering cross-sectoral cooperation, it is possible to reduce the impact of leishmaniasis and improve the health outcomes of affected populations.

Acknowledgements

We would like to acknowledge the efforts of Muhammad Ahmad from Nishtar Medical College, Multan Pakistan.

• #Principal Investigator
  ^Equal Contribution

References

• BARI, A.U., 2012. Clinical spectrum of cutaneous leishmaniasis: an overview from Pakistan. Dermatology Online Journal, vol. 18, no. 2, pp. 4. http://doi.org/10.5070/D38K3992KR PMid:22398225.
  » http://doi.org/10.5070/D38K3992KR
• BASHIR, S., SHABBIR, K., DIN, F.U., KHAN, S.U., ALI, Z., KHAN, B.A., KIM, D.W. and KHAN, G.M., 2023. Nitazoxanide and quercetin co-loaded nanotransfersomal gel for topical treatment of cutaneous leishmaniasis with macrophage targeting and enhanced anti-leishmanial effect. Heliyon, vol. 9, no. 11, e21939. http://doi.org/10.1016/j.heliyon.2023.e21939 PMid:38027656.
  » http://doi.org/10.1016/j.heliyon.2023.e21939
• DEVI, S., 2024. Surge of cutaneous leishmaniasis in Pakistan. The Lancet. Infectious Diseases, vol. 24, no. 4, e222. http://doi.org/10.1016/S1473-3099(24)00146-4 PMid:38402889.
  » http://doi.org/10.1016/S1473-3099(24)00146-4
• HAROON, M., AKHTAR, T., MEHMOOD, H., SILVA SANTOS, A.C., DA CONCEIÇÃO, J.M., BRONDANI, G.L., SILVA TIBÚRCIO, R.D., GALINDO BEDOR, D.C., VITURINO DA SILVA, J.W., SALES JUNIOR, P.A., ALVES PEREIRA, V.R. and LIMA LEITE, A.C., 2024. Synthesis of hydrazinyl-thiazole ester derivatives, in vitro trypanocidal and leishmanicidal activities. Future Medicinal Chemistry, vol. 16, no. 3, pp. 221-238. http://doi.org/10.4155/fmc-2023-0255 PMid:38269432.
  » http://doi.org/10.4155/fmc-2023-0255
• KHAN, H., WAQAS, M., KHURSHID, B., ULLAH, N., KHALID, A., ABDALLA, A.N., ALAMRI, M.A. and WADOOD, A., 2024. Investigating the role of sterol C24-methyl transferase mutation on drug resistance in leishmaniasis and identifying potential inhibitors. Journal of Biomolecular Structure & Dynamics, vol. 42, no. 19, pp. 10374. http://doi.org/10.1080/07391102.2023.2256879 PMid:37723868.
  » http://doi.org/10.1080/07391102.2023.2256879
• KHAN, K., KHAN, N.H. and WAHID, S., 2021. Systematic review of Leishmaniasis in Pakistan: evaluating spatial distribution and risk factors. The Journal of Parasitology, vol. 107, no. 4, pp. 630-638. http://doi.org/10.1645/19-191 PMid:34358311.
  » http://doi.org/10.1645/19-191
• KHAN, S.J. and MUNEEB, S., 2005. Cutaneous leishmaniasis in Pakistan. Dermatology Online Journal, vol. 11, no. 1, pp. 4. http://doi.org/10.5070/D325B5X6B4 PMid:15748545.
  » http://doi.org/10.5070/D325B5X6B4
• MEMON, S., AHMED, N., SHAH, S.A., BARI, A.U., RAHIM, M., FAROOQ, O. and NASIR MEMON, M., 2023. Comparing dermatoscopic features with slit skin smear and histopathology in diagnosis of cutaneous leishmaniasis. Cureus, vol. 15, no. 2, e35336. http://doi.org/10.7759/cureus.35336 PMid:36974240.
  » http://doi.org/10.7759/cureus.35336
• NAZ, S., AROOSH, A., CANER, A., ŞAHAR, E.A., TOZ, S., OZBEL, Y. and ABBASI, S.W., 2023. Immunoinformatics approach to design a multi-epitope vaccine against cutaneous leishmaniasis. Vaccines, vol. 11, no. 2, pp. 339. http://doi.org/10.3390/vaccines11020339 PMid:36851219.
  » http://doi.org/10.3390/vaccines11020339
• PIRACHA, Z.Z., SAEED, U., AHMED, R.A., KHAN, F.N. and NASIR, M.I., 2023. Global emergence of Langya virus: A serious public health concern. Journal of Global Health, vol. 13, pp. 03034. http://doi.org/10.7189/jogh-13-03034
  » http://doi.org/10.7189/jogh-13-03034
• PIRACHA, Z.Z., SAEED, U., PIRACHA, I.E., NOOR, S. and NOOR, E., 2024. Decoding the multifaceted interventions between human sirtuin 2 and dynamic hepatitis B viral proteins to confirm their roles in HBV replication. Frontiers in Cellular and Infection Microbiology, vol. 13, pp. 1234903. http://doi.org/10.3389/fcimb.2023.1234903
  » http://doi.org/10.3389/fcimb.2023.1234903
• RAHMAN, A., TAHIR, M., NAVEED, T., ABDULLAH, M., QAYYUM, N., MALIK, D.H. and AMIN, B., 2023. Comparison of meglumine antimoniate and miltefosine in cutaneous leishmaniasis. Journal of the College of Physicians and Surgeons--Pakistan, vol. 33, no. 12, pp. 1367-1371. PMid:38062590.
• RASHEED, S.B., SHAH, M.Z. and JAMAL, Q., 2024. Molecular identification of Leishmania tropica in mammals occurring in human-inhabited areas of a cutaneous leishmaniasis endemic focus in North-West Pakistan. Parasitology Research, vol. 123, no. 1, pp. 5. http://doi.org/10.1007/s00436-023-08025-9 PMid:38052938.
  » http://doi.org/10.1007/s00436-023-08025-9
• SAEED, U. and PIRACHA, Z.Z., 2023. PIN1 and PIN4 inhibition via parvulin impeders Juglone, PiB, ATRA, 6,7,4′-THIF, KPT6566, and EGCG thwarted hepatitis B virus replication. Frontiers in Microbiology, vol. 14, pp. 921653. http://doi.org/10.3389/fmicb.2023.921653 PMid:36760500.
  » http://doi.org/10.3389/fmicb.2023.921653
• SAEED, U., INSAF, R.A., PIRACHA, Z.Z., TARIQ, M.N., SOHAIL, A., ABBASI, U.A., FIDA RANA, M.S., GILANI, S.S., NOOR, S., NOOR, E., WAHEED, Y., WAHID, M., NAJMI, M.H. and FAZAL, I., 2023b. Crisis averted: a world united against the menace of multiple drug-resistant superbugs -pioneering anti-AMR vaccines, RNA interference, nanomedicine, CRISPR-based antimicrobials, bacteriophage therapies, and clinical artificial intelligence strategies to safeguard global antimicrobial arsenal. Frontiers in Microbiology, vol. 14, pp. 1270018. http://doi.org/10.3389/fmicb.2023.1270018 PMid:38098671.
  » http://doi.org/10.3389/fmicb.2023.1270018
• SAEED, U., PIRACHA, Z.Z., ALROKAYAN, S., HUSSAIN, T., ALMAJHDI, F.N. and WAHEED, Y., 2023a. Immunoinformatics and evaluation of peptide vaccines derived from global hepatitis B viral hbx and hbc proteins critical for covalently closed circular DNA integrity. Microorganisms, vol. 11, no. 12, pp. 2826. http://doi.org/10.3390/microorganisms11122826 PMid:38137971.
  » http://doi.org/10.3390/microorganisms11122826
• SAEED, U., UPPAL, M.R., UPPAL, M.S., UPPAL, R., KHAN, A.A., HASSAN, A. and PIRACHA, Z.Z., 2024a. Hepatitis C virus associated ALT, AST, GGT, Bili T, HB, HBA1C, CREAT, PT, aPPT, AFP, CEA, CA 125, CA 19-9, iPTH biomarkers, computed tomography and HCV burden of disease during pre COVID-19 era (2018-2019) and post COVID-19 era (2020-2022) in Pakistan. Brazilian Journal of Biology = Revista Brasileira de Biologia, vol. 84, e271451. http://doi.org/10.1590/1519-6984.271451 PMid:37341223.
  » http://doi.org/10.1590/1519-6984.271451
• SAEED, U., UPPAL, R., KHAN, A.A., UPPAL, M.R., PIRACHA, Z.Z. and UPPAL, S.R., 2024b. nalytical assessment of clinical sensitivity and specificities of pharmaceutical rapid SARS-CoV-2 detection nasopharyngeal swab testing kits in Pakistan. Brazilian Journal of Biology = Revista Brasileira de Biologia, vol. 84, e265550. http://doi.org/10.1590/1519-6984.265550 PMid:38451627.
  » http://doi.org/10.1590/1519-6984.265550
• SAEED, U., UPPAL, S.R., PIRACHA, Z.Z. and UPPAL, R., 2021a. Azithromycin treatment for SARS-CoV-2-related COVID-19 pandemic could worsen extensively drug resistant (XDR) typhoid: a risk of losing the last bullet against Salmonella enterica serovar typhi. Jundishapur Journal of Microbiology, vol. 14, no. 1, e113874. http://doi.org/10.5812/jjm.113874.
• SAEED, U., UPPAL, S.R., PIRACHA, Z.Z. and UPPAL, R., 2021b. COVID-19 transmission via fomites at low temperature: a potential silent SARS-CoV-2 propagation route. American Journal of Biomedical Science & Research, vol. 12, no. 1, pp. 80-82.
• SAEED, U., UPPAL, S.R., PIRACHA, Z.Z., RASHEED, A., AFTAB, Z., ZAHEER, H. and UPPAL, R., 2021c. Evaluation of SARS-CoV-2 antigen-based rapid diagnostic kits in Pakistan: formulation of COVID-19 national testing strategy. Virology Journal, vol. 18, no. 1, pp. 34. http://doi.org/10.1186/s12985-021-01505-3 PMid:33581714.
  » http://doi.org/10.1186/s12985-021-01505-3
• SOPHIE, M., HAMEED, A., MUNEER, A., SAMDANI, A.J., SALEEM, S. and AZHAR, A., 2017. SLC11A1 polymorphisms and host susceptibility to cutaneous leishmaniasis in Pakistan. Parasites & Vectors, vol. 10, no. 1, pp. 12. http://doi.org/10.1186/s13071-016-1934-2 PMid:28061874.
  » http://doi.org/10.1186/s13071-016-1934-2
• ULLAH, W., KHAN, A., NIAZ, S., AL-GARADI, M.A., NASREEN, N., SWELUM, A.A. and BEN SAID, M., 2024. Epidemiological survey, molecular profiling, and phylogenetic analysis of cutaneous leishmaniasis in Khyber Pakhtunkhwa, Pakistan. Transactions of the Royal Society of Tropical Medicine and Hygiene, vol. 118, no. 4, pp. 273-286. http://doi.org/10.1093/trstmh/trad086 PMid:38055843.
  » http://doi.org/10.1093/trstmh/trad086
• ULLAH, W., YEN, T.Y., NIAZ, S., NASREEN, N., TSAI, Y.F., RODRIGUEZ-VIVAS, R.I., KHAN, A. and TSAI, K.H., 2023. Distribution and risk of cutaneous Leishmaniasis in Khyber Pakhtunkhwa, Pakistan. Tropical Medicine and Infectious Disease, vol. 8, no. 2, pp. 128. http://doi.org/10.3390/tropicalmed8020128 PMid:36828544.
  » http://doi.org/10.3390/tropicalmed8020128
• UPPAL, R., SAEED, U., UPPAL, M.R., KHAN, A.A., AHMAD, M. and PIRACHA, Z.Z., 2024. SARS-CoV-2 clearance in term of Cycle Threshold (Ct) during first two waves of COVID-19 in Pakistan: a phenomenon of delayed viral clearance post-corticosteroid treatment. Brazilian Journal of Biology = Revista Brasileira de Biologia, vol. 84, e271452. http://doi.org/10.1590/1519-6984.271452 PMid:38985057.
  » http://doi.org/10.1590/1519-6984.271452
• WORLD HEALTH ORGANIZATION – WHO, 2023. Leishmaniasis. Geneva: WHO.

Publication Dates

• Publication in this collection
  27 Jan 2025
• Date of issue
  2024

History

• Received
  20 Mar 2024
• Accepted
  01 Aug 2024