Copyright ©The Author(s) 2023.
World J Clin Infect Dis. May 29, 2023; 13(2): 11-23
Published online May 29, 2023. doi: 10.5495/wjcid.v13.i2.11
Table 1 Findings of published articles on leishmaniasis in southern Himalayas w.r.t. agent-host-environment details
Sample size
Location (if available district, state, country)
Agent factors
Host factors
Vector identified
Environmental factors
River body associated
Authors conclusion
Katakura et al[4]> 1000 Different areas of Pakistan, India, and NepalIn Pakistan Himalayas, Leishmania tropica followed by Leishmania majorCP: Cutaneous leishmaniasis (CL) cases only; No descriptionsIn all Himalayas, P. sergenti followed by P. argentipes and papatasiAltitude is not documentedIndus, GangesMicrosatellite analysis of the parasites will be a powerful tool for population genetic and epidemiological studies of Leishmania species
Rx: Not known
In India, L. donovani followed by L.tropicaOutcome: Not known
In Nepal, L. major
Rab et al[5]239 (1984-1992) and more cases in the past (before 1984)Different areas of Northern areas of Pakistan (Bagh, Abbottabad, Chilas, and Baltistan)LeishmaniaClinical presentation (CP): Not documentedAltitude is not documented IndusThe clinical pattern of VL in north Pakistan is akin to that in north-western China, with a marked predilection for young children, and a male preponderance. The infantile VL has risen 10-fold in the last decade from 0.2 to almost 2 per 100 000 population
Visceral leishmaniasis (VL – all cases); Not described
infantumRx: Not known
Outcome: Not known
Wani et al[6]18Different areas of Uri &Karnah belt, Jammu & Kashmir, IndiaLeishmania, species not identifiedCP: Cutaneous leishmaniasis (CL); mostly nodulo-ulcerative, mostly on the face and single lesionNot documentedAltitude is not documented. The hot and arid climate of these areas(Uri belt) is quite conducive to the growth and development of leishmania and the sand flyNot documented Any patient with nodular/nodulo-ulcerative lesion on exposed parts must be suspected for CL, especially if belonging to the Uri and Karnah region of the Kashmir Valley. The public health authorities should make every effort to contain this new infection in this Valley
Rx: Intravenous sodium
Stibogluconate including two received intra-lesional
Outcome: Survival for all cases
Leherwal et al[7]ThreeUri belt, Jammu & Kashmir, IndiaLeishmania, species not identifiedCP: Cutaneous leishmaniasis (CL); solitary erythematous nodule on the faceNot documentedAltitude is not documented -do-Focuses on the diagnostic part. FNAC may be the method of choice for suspected CL in cases of solitary nodular lesions
Rx: Not documented
Outcome: Not documented
Mahajan et al[8]One Uri in South West Kashmir, Jammu & Kashmir, IndiaLeishmania, species not identifiedCP: Visceral leishmaniasis (VL); 2months fever, weight loss, ascites, anemia, Hepato-splenomegaly,Not documentedAltitude is not documented-do-This advice for further research into the epidemiology, geographic distribution, and inter-species interactions of the parasite
Rx: Intravenous sodium
Outcome: Survived
Sharma et al[9]285Nirmand village,Shimla & Kullu Districts of Himachal Pradesh, IndiaAmong 14 cases, Leishmania tropica (3) and Leishmania donovani (11)CP: CL; mostly nodulo-ulcerative, mostly on extremitiesAmong 41 cases, P. longiductus (29), P. major(8), P. kandelaki (2), and 2 remained unidentified Altitude is not documentedSatluj riverDifferent leishmania species and vectors compared to other parts of India are found in these Himalayas
Tissue smear positivity for amastigotes was 43%Rx: Intra-leisonal sodiumThe climate of the affected areas varies from temperate to subtropical
Outcome: Survival for all cases
Sharma et al[10]161 new localized cases of LCL from May 2001 and December 2003 sub-alpine valley in the mountainous region of the Kinnaur District,Himachal Pradesh, IndiaL. donovani in eight cases and L. tropica in two cases Histopathology showed non-caseating epitheloid cell granuloma in 77% of the cases. Lesions involved mainly the face Phlebotomus longiductus is a possible vectorAltitude, 700-2,900 m above sea levelSatluj RiverIntralesional sodium stibogluconate was effective in all patients
Raina et al[11]18Shimla, Kinnaur & Kullu Districts of Himachal Pradesh, IndiaLeishmania, species not identifiedCP: VL - prolonged fever, weight loss, ascites, pancytopenia, hepato-splenomegaly, lymphadenopathy, diarrhea, and epistaxisNot documentedAltitude, 924 - 2960 m above sea levelSatluj and Beas riverInitial failure to suspect VL in this area might cause a diagnostic delay
Rx: Intravenous sodiumThere is a favorable therapeutic response without recurrence of symptoms during 6 months of follow-up
StibogluconateThe patients had never visited any of the endemic areas
Outcome: 14 Survives and 4 deaths
Thakur et al[46]Cases of CL During 2014–2018 in the study areacase reports came from Districts of Kinnaur, Shimla, and Kullu and the previously nonendemic districts of Mandi and Solan,Himachal Pradesh, India L. donovani variants distinct from the viscerotropic L. donovani strain from northeast IndiaCoexistence of VL and CL Not documentedNot documentedNot documentedThe scenario appears somewhat similar to Sri Lanka and Kerala, where L. donovani parasites cause cutaneous disease, albeit with differences in the region-specific L. donovani variants
Thakur et al[47]Sixty CL patients over the period from 2014 to 2018Satluj river belt in Himachal Pradesh, Khaneri/rampur (location of medical college),Himachal Pradesh, India Presence of L. seymouri co-infection in the unusual CL cases in Himachal Pradesh (HP) caused by L. donovani variantsCoexistence of VL and CL Not documented Not documentedSatluj riverFound the presence of Leptomonas seymouri in 38.5% (22/57) of the patients along with L. donovani detected in all the samples. L. seymouri is a monoxenous insect trypanosoma, generally incapable of infecting humans
Sharma et al[49]NoneShimla, Kinnaur, &Kullu Districts of Himachal Pradesh, IndiaNot applicableNot applicableAmong 62 cases, Phlebotomus longiductus (46), P. major (8), P. kandelaki (8)Our patients reported having been out of the state or district during the three years the preceding onset of symptomsSatluj river Phlebotomus longiductus may be the primary vector for human leishmaniases in this endemic focus, however, it needs another study to prove the vector species corresponding to the type of leishmania species
Table 2 Characteristics of Leishmaniasis in the southern Himalayan region
Sr No.
Geographical area
Causative agent
Clinical picture
1Northern areas of Pakistan[2]LeishmaniaInfantumNot identifiedVisceral leishmaniasis
2Indian states of Jammu & Kashmir[3-5]Not identifiedNot identifiedCutaneous leishmaniasis most common with a single case study of visceral Leishmaniasis
3Himachal Pradesh[6-16]L. donovani & L. tropicaP. longiductus (most common) & P. majorBoth cutaneous & visceral forms ofLeishmaniasis
4Uttarakhand (Garhwal)[17-21]L. donovaniP. argentipesVisceral leishmaniasis
5Uttarakhand (Kumaon)[22-25]Not identifiedP. argentipesVisceral leishmaniasis
6Nepal[26-29]L. donovaniP. argentipesVisceral leishmaniasis
7Bhutan[30,31]L. donovaniP. argentipesVisceral leishmaniasis