An outbreak of suspected cutaneous leishmaniasis in Ghana: lessons learnt and preparation for future outbreaks

Figures & data

Figure 1.  Map of Ghana showing Ho District Outbreak area.

Table 1. Background characteristics of the patients who volunteered for ulcer biopsies and microscopy report

No	Code	Age	Sex	Occupation	Community	Length of stay in community (years)	Reported duration of lesion at time of diagnosis(weeks)	Location of lesion	LD bodiesseen
1	A.J.	65	F	Farming	Matse	13	3	Left arm	No
2	M.M.	42	F	Farming	Matse	42	3	Right thigh	Yes
3	D.J.	26	F	Hair dressing	Nyive	26	8	Left leg	Yes
4	A.A.	16	M	Student	Akoefe	16	3	Scalp	No
5	D.G.	40	F	Teaching	Taviefe	4	12	Left arm	No
6	K.D.	25	M	Farming	Klefe	23	12	Right arm	Yes
7	K.F.	33	F	Trading	Matse	33	4	Right arm	Yes
8	A.R.	45	M	Farming	Akoefe	45	8	Right arm	No
9	S.B.	12	F	Student	Akoefe	12	3	Right thigh	Yes
10	T.A.	40	F	Farming	Shia	6	6	Back of trunk	Yes
11	K.E.	17	M	Student	Nyive	17	8	Scalp	No
12	B.C.	16	M	Student	Akoefe	6 months	4	Scalp	Yes
13	T.E.	38	F	Trading	Taviefe	36	8	Right arm	Yes
14	B.M.	13	M	Student	Akoefe	13	4	Right calf	Yes
15	K.E.	71	F	Farming	Taviefe	71	8	Right leg	Yes

Table 2. Result of the follow-up to the schools from which initial cases were reported

Village	Number examined	Number of ulcer cases (%)
Akoefe kindergarten and primary	320	39 (12.2)
Akoefe JSS	175	60(34.3)
Nyive JSS	180	25(13.9)
Total	675	124 (18.4)

Table 3. Active case search in three municipalities/districts in the Volta Region

Municipality/district	Number of cases before 2003	Number of cases in 2003	Total
Hohoe municipality	2	174	176
Kpando district	76	91	167
Ho municipality	2,348	6,185	8,533
Total	2,426	6,450	8,876

Table 4. A breakdown of the cumulative results of the active case search for leishmaniasis by November 2003 within the Ho municipality by sub-District

Sub-district	Number of communities with cases	Number of households with cases	Number of cases (before 2003)	Number of cases (in 2003)	Total number of cases by November 2003
Ho/Shia*	49	2,240	1,536	2,854	4,390
Kpedze/Vane*	31	1,493	770	2,725	3,495
Tsito*	17	340	42	556	598
Adaklu	8	18	0	18	18
Kpetoe/Ziope	6	16	0	17	17
Abutia	5	15	0	15	15
Total	116	4,107	2,348	6,185	8,533

*Referred to in the text as ‘endemic communities’.

Figure 2.  Various stages of active lesions (Photographs from M. Kweku).

Figure 3.  Scars and ulcers that are healing (Photographs from H. Akuffo).

Table 5. Summary of cases used for clinical and parasite identification

Year of sample taking	Year of analysis	Sample	Number	Analysis	Results
2002	2002	Biopsy of ulcer	Fifteen ulcer cases	Histology	10/15 LD bodies positive
	2004		Five LD bodies positive	PCR	No Leishmania DNA detected
2003	2003	Ulcer edge scrapings	Two samples from each of four ulcer cases	Smear	4/4 amastigote positive
				Culture	No parasite growth
2004 and 2005	2004 and 2005	Biopsy of ulcer		PCR	L. major identified
2006	2006	Biopsy of ulcer	Nine biopsies from five ulcer cases	PCR	Previously uncharacterised species of Leishmania identified
2007	2007	Biopsy of ulcer	One biopsy from ulcer case

Figure 4.  Smears from lesions of patients with cutaneous lesions showing amastigotes (arrows).