Sudan Medical Specialization Board

Council of Dermatology and Venereology

Assessment of Knowledge, Attitude and Practice Toward

Cutaneous Leishmaniosis among Senior General Surgery
Registrars in Sudan, 2023

By

Dr. Afag Eltuhami Abdalrahman Mohamed

A research proposal submitted as partial fulfillment for the Medical Doctorate in

dermatology and venereology

Supervisor

Dr. Ibrahim Mohamed Sayed Ahmed

Consultant Dermatologist

SMSB 2023
 TABLE OF CONTENTS

Contents Page

Introduction/ background 3

Literature review 5

Problem statement 9

Rationale / Justification 10

Objectives 11

Materials and Methods 12

References 17

Appendix 1: Arabic version of data collection form 20

Appendix 2 Questionnaire 21

ABBREVIATIONS

CL Cutaneous Leishmaniasis

KAP Knowledge, Attitude And Practice

KPP Knowledge, Perceptions, And Practices

PCR Polymerase Chain Reaction

SPSS Statistical Package For Social Sciences

WHO World Health Organization

2
 1. INTRODUCTION/ BACKGROUND

Cutaneous leishmaniasis refers to a group of parasitic diseases caused by

various species of Leishmania. It primarily affects the skin, resulting in
localized, ulcerative lesions [1]. The disease is prevalent in tropical and
subtropical regions worldwide, including Sudan. Cutaneous
leishmaniasis can have profound socioeconomic impacts and
significantly affect the quality of life of affected individuals. [1, 2]

Globally, cutaneous leishmaniasis affects around 1.5 million individuals

annually, with the majority of cases occurring in the Americas, the
Middle East, and Africa [2]. In Sudan, the disease is endemic,
particularly in rural areas with poor living conditions [3]. It is estimated
that thousands of cases are reported each year, although the actual
number may be significantly higher due to underreporting and limited
access to healthcare.

Cutaneous leishmaniasis is caused by various species of Leishmania

parasites, including L. major and L. tropica. The transmission occurs
through the bite of infected female sandflies. Risk factors for contracting
the disease include residing in endemic areas, exposure to sandfly bites,
poor housing conditions, poverty, and lack of knowledge regarding
preventive measures [4].

Once transmitted, the Leishmania parasites invade macrophages, leading

to inflammation and immune response. The parasite's ability to
manipulate the immune system contributes to the persistence of the
infection and the subsequent development of cutaneous lesions [4].

Cutaneous leishmaniasis manifests as unique clinical presentations.

Initially, a small papule or nodule appears at the site of the sandfly bite,
which eventually ulcerates [5]. The lesions are often painless and can

3
vary in size, shape, and appearance, resulting in significant scarring if
not promptly treated. Multiple lesions can develop in some cases [2].

Diagnosing cutaneous leishmaniasis relies on clinical examination,

history of exposure, and laboratory confirmation. Various laboratory
tests, including microscopic examination, cultures, polymerase chain
reaction (PCR), and serological assays, may be employed to identify the
causative Leishmania parasite [4].

Managing cutaneous leishmaniasis involves a multi-faceted approach.

Treatment options include local interventions (topical anti-leishmanial
drugs), systemic medications (such as antimonials, miltefosine, or
amphotericin B), and physical interventions (cryotherapy, heat therapy,
or surgical excision). Appropriate management can significantly reduce
disease duration, prevent complications, and minimize scarring [5, 6].

Senior general surgery registrars play a crucial role in the diagnosis and
management of cutaneous leishmaniasis. However, limited knowledge
and incorrect attitudes among these healthcare professionals can lead to
misdiagnosis, inappropriate management, and potential complications.
For instance, mistaking cutaneous leishmaniasis for cellulitis or abscess
may result in unnecessary debridement procedures, leading to scarring.
Therefore, assessing the knowledge, attitude, and practice of senior
general surgery registrars regarding cutaneous leishmaniasis is essential
to ensure accurate diagnosis, appropriate treatment, and improved
patient outcomes.

Cutaneous leishmaniasis is a significant public health concern globally

and particularly in endemic areas like Sudan. Assessing the knowledge,
attitude, and practice of senior general surgery registrars regarding this
disease is crucial to prevent misdiagnosis, improper management, and
potential complications. Enhancing their understanding of the unique
4
dermatological presentations, proper diagnostic approaches, and
appropriate management strategies, then, healthcare professionals can
contribute to better outcomes for patients affected by cutaneous
leishmaniasis.

Accordingly, our research aimed to conduct an assessment of

knowledge, attitude and practice toward cutaneous leishmaniosis among
senior general surgery registrars in Sudan, 2023.

5
 2. LITERATURE REVIEW

Cutaneous Leishmaniosis (CL) is a prevalent vector-borne disease

caused by the protozoan parasite Leishmania. Sudan, located in the
Eastern Africa region, is known to have a high burden of cutaneous
leishmaniosis cases [3]. Despite its significance, there is limited research
addressing the knowledge, attitude, and practice of CL specifically
among senior general surgery registrars in Sudan.

Searching for relevant literature on this topic proves to be a challenging

task. The existing studies primarily focus on patients' perspectives, while
literature investigating the knowledge, attitude, and practice of medical
students is relatively rare. Furthermore, even in cases where studies
involve doctors, they often fail to differentiate between visceral and
cutaneous leishmaniosis, which are distinct disease entities requiring
different management approaches.

This scarcity of comprehensive studies highlights the need for further

research in this area. After targeting senior general surgery registrars
specifically, this study aims to bridge the existing gaps in knowledge,
attitude, and practice assessment related to cutaneous leishmaniosis.
Moreover, it is important to note that to the best of our knowledge, no
previous research has addressed this specific issue in Sudan or within
the region.

After exploring the perspectives of senior general surgery registrars, this

study hopes to shed light on their level of knowledge regarding CL,
assess their attitudes towards the disease, and evaluate their practices in
diagnosing and managing cutaneous leishmaniosis cases. The insights
gained from this research will aid in identifying potential areas where
improvements can be made in medical education and training programs,

6
ultimately contributing to better patient care and public health outcomes
in Sudan.

In a study conducted in Portugal, Rocha et al. surveyed 486 health

students and professionals to assess their knowledge, perceptions, and
practices (KPP) regarding cutaneous leishmaniasis. The majority of
participants (75%) were familiar with cutaneous leishmaniasis, and over
80% had been exposed to the disease during their training. However,
only 69% correctly identified cutaneous leishmaniasis as endemic in
Portugal. This finding underscores the importance of adopting a One
Health approach to raise awareness and effectively manage cutaneous
leishmaniasis [7].

In a study conducted in Morocco's ELHajeb province, El-Mouhdi et al.

investigated the knowledge and experiences of healthcare professionals
involved in cutaneous leishmaniasis management. While most
participants demonstrated a good understanding of clinical signs,
misconceptions regarding the disease's vector, reservoirs, and
transmission mode were prevalent. Only 17% had received continuing
education on leishmaniasis, and 85% focused primarily on treatment
rather than prevention. Additionally, 47% reported patient non-
adherence to antileishmaniasis treatment, and 25% observed the use of
the term "Hboub of Chniwla" among the population to refer to cutaneous
leishmaniasis. These findings suggest a need for enhanced training and
awareness-raising initiatives among healthcare professionals and the
general public to improve case detection, adherence to treatment, and
preventive measures against leishmaniasis. [8]

In a study conducted in Paraguay's San Pedro department, Ruoti et al.

examined the knowledge, attitudes, and practices (KAP) of paraguayan
communities, patients, and health professionals regarding
mucocutaneous leishmaniasis (MCL) caused by Leishmania (V.)
7
braziliensis. The findings revealed a high prevalence of risk factors for
L. braziliensis transmission within the communities. Additionally, age
was identified as the sole independent factor associated with having
observed a CL/MCL lesion. The study also highlighted a pervasive
attitude among communities that CL was not a concern, resulting in
delayed treatment-seeking behaviors and the use of inappropriate
remedies. To address these challenges, the authors proposed several
cost-effective measures to enhance CL control, including raising
community awareness through existing community structures, ensuring
the continued free supply of specific drugs while considering ancillary
support, and providing health professionals with routine and
standardized diagnosis and treatment algorithms for CL and MCL.
Furthermore, they suggested educating all patients during treatment to
promote community-wide awareness. [9]

8
 3. PROBLEM STATEMENT

Cutaneous leishmaniasis (CL) is a neglected tropical disease caused by

protozoan parasites belonging to the Leishmania genus. It is prevalent in
various regions of the world, including Africa and Sudan. With an
estimated annual incidence of 1 million cases globally, CL poses a
significant burden on public health systems [2].

In Africa, CL is endemic in several countries, placing a heavy burden on

the affected populations. Sudan, in particular, has high prevalence rates
of CL, with approximately 7,500 cases reported annually. The disease
not only causes physical disfigurement but also has psychological and
socioeconomic impacts on individuals and communities [10].

Among the medical professionals responsible for the diagnosis and

management of CL, senior general surgery registrars play a crucial role.
However, there exists a knowledge gap and negative attitudes towards
CL among these professionals in Sudan. This problem is multifaceted
and includes the lack of awareness about CL epidemiology, clinical
presentation, and appropriate management strategies.

The lack of knowledge and negative attitudes towards CL among senior

general surgery registrars in Sudan contributes to misdiagnosis and
inappropriate management of cases. This leads to delayed treatment,
increased disease transmission, unnecessary complications, and
treatment failures. Additionally, the malpractice by senior registrars in
misdiagnosis and management further exacerbates the burden of CL on
the healthcare system and affected individuals.

Addressing this problem is essential to improve the overall quality of CL

care and reduce its burden in Sudan. Therefore, it is crucial to assess the
knowledge, attitudes, and practices of senior general surgery registrars
in Sudan regarding CL.
9
 4. JUSTIFICATION / RATIONALE

Cutaneous Leishmaniosis is a significant public health concern in Sudan.

Assessing the knowledge, attitude, and practice of senior general surgery
registrars towards this disease is crucial in understanding their
preparedness to diagnose and manage cases. This study aims to
contribute essential data to enhance public health strategies and
interventions.

Assessment of the knowledge of senior general surgery registrars, the

study aims to identify gaps in their understanding of Cutaneous
Leishmaniosis. This information will help design targeted educational
programs to address these gaps and improve patient care outcomes.

Moreover, assessing the attitude and practice of senior general surgery

registrars is vital for determining the effectiveness of current
management approaches towards Cutaneous Leishmaniosis. The study
aims to identify any misconceptions or suboptimal practices in dealing
with this disease, ultimately leading to improved patient care and
outcomes.

Understanding the knowledge, attitude, and practice of senior general

surgery registrars will aid in the development of appropriate guidelines
and recommendations for the management of Cutaneous Leishmaniosis.
This will lead to a more standardized and effective approach in
diagnosing, treating, and preventing the spread of the disease in Sudan.

The study will provide valuable insights into the education and training
needs of senior general surgery registrars regarding Cutaneous
Leishmaniosis. When identifying areas that require improvement, then,
appropriate measures can be taken to empower these medical
professionals, ensuring that they are adequately equipped to address this
public health concern.
10
 5. OBJECTIVES

5.1 General Objective:

To assess the knowledge, attitude, and practice toward cutaneous

leishmaniosis among senior general surgery registrars in Sudan in the
year 2023.

5.2 Specific Objectives:

1. To determine the level of knowledge regarding cutaneous

leishmaniosis among senior general surgery registrars in Sudan.

2. To evaluate the attitudes of senior general surgery registrars in Sudan

toward cutaneous leishmaniosis.

3. To assess the practices followed by senior general surgery registrars

in Sudan in the diagnosis, treatment, and prevention of cutaneous
leishmaniosis.

4. To identify any gaps or misconceptions in the knowledge, attitude,

and practice of senior general surgery registrars regarding cutaneous
leishmaniosis.

5. To propose recommendations and interventions based on the findings

to improve the knowledge, attitude, and practice of senior general
surgery registrars in Sudan regarding cutaneous leishmaniosis.

11
 6. MATERIALS AND METHODS

6.1 Study design

This is an observational, descriptive, cross sectional, hospital based study

6.2 Study area

This study will be carried among general surgery registrars in all Sudan
states (the safe states)

6.3 Study period

The study will be conducted within the period from December 2023 – March
2024. The detailed schedule of different steps of the study will be showed on
the coming parts of this document.

6.4 Study Population

This study will cover senior registrars (whom in the final and semifinal years
in their internship rotation) of general surgery in the study area within the
study time period, as determined by the criteria below:

6.4.1 Inclusion criteria

 Senior registrars (whom in the final and semifinal years in their

internship rotation) of general surgery who were available in
safe states, Sudan in the study period

 Accept to participate in the study

2.4.2 Exclusion criteria

 Not fulfilled the inclusion criteria above

12
2.5 Sampling

For this study, a total coverage sampling method will be employed due to
the limited number of the target population. The researcher will include all
90 registrars according to the records of the Sudan Medical Specialization
Board/General Surgery Council. This approach ensures that every registrar
is included in the study, providing a comprehensive understanding of their
knowledge, attitude, and practice towards Cutaneous Leishmaniosis. The
total coverage method will minimize sampling errors and enhance the
representativeness of the findings within this specific population.

2.6 Research tools and method of data collection

Data will be collected using a comprehensive, close ended, structured

questionnaire through online interview by the researcher herself.

2.7 Study variables

Variable Type Variable Name Definition

Demographic  Personal characteristics of the participants,

Characteristics including age and gender.

Independent variables  Professional background and experiences

Professional of the participants, including years of
Characteristics experience and exposure to dermatology
training and CL cases.

Epidemiology of
Cutaneous  Understanding of CL distribution, patterns,
Leishmaniosis and risk factors.
(CL)
Knowledge
 Understanding of clinical manifestations
Presentation and
Dependent and appearances of CL lesions, including
Lesion
variables location, size, type, and associated
Morphology
symptoms (including pain).

Attitude Toward  The extent of conviction in the importance

Cutaneous of identifying the skin lesion of
Attitudes leishmaniasis
Leishmaniosis
(CL)  The extent of conviction regarding the
seriousness of error in diagnosing

13
 cutaneous leishmaniasis
 The extent of damage felt from incorrect
surgical intervention in the skin lesion,
cutaneous leishmaniasis, when it is
misdiagnosed
 Does they treat cases of cutaneous
leishmaniasis when they are identified, or
does he refer them to a dermatologist?

 Actual use of diagnostic tests and

Investigations procedures routinely used to confirm CL
infection.

Clinical  Actual application of clinical criteria to

Diagnosis establish a provisional diagnosis of CL.

Practice  Actual use of histopathological

Histopathology
examination to confirm the diagnosis of
Diagnosis
CL.

 Actual implementation of appropriate

treatment approaches for CL, including
Management
antileishmanial medications, local
therapies, and supportive measures.

- Note: the detailed study variables can be found in annex (1):

questionnaire

2.8 Plan of analysis

Data entry, analysis and presentation

- Data will be entered, cleaned, and analyzed using SPSS version 28.0.

- Descriptive statistics in term of frequency tables with percentages and

graphs.

- Means and standard deviations will be presented with relevant graphical

representation for quantitative data.

- A bi-variable analysis will be done to assess the possible relation between

the participants KAP with their characteristics using chi square statistical
test (for categorical data) and t-test (for quantitative data)

- P value < 0.05 will be considered as significant.

- Data will be represented after analysis in form of uni-variable tables, cross

tabulation, figures and narrative illustration.
14
 7.9 Ethical considerations

- Written ethical clearance and approval for conducting this research will be
obtained from Sudan Medical Specialization Board ethical committee and
EDC.

- Study data/information will be used for the research purposes only.

- The privacy issues will be intentionally considered.

- Written consent will be obtained from all study participants before being
involved in the study

7.12 Time schedule

2023 2024

Item Dec Jan Feb Mar

Proposal & ethical clearance

Data collection

Data analysis

Writing thesis

First draft of the thesis

Final draft of the thesis

15
7.13 Budget for facilities and activities required

Item Cost

Stationeries 3,000

Transportation 5,000

Data analysis 8,000

Data entry 2,000

Thesis first draft& editing 3,000

Final copies after exam 3,000

Unseen expenses 4,000

Total 28,000

16
REFERENCES

1. Gradoni L, López-Vélez RMM. Manual on case management and

surveillance of the leishmaniasis in the WHO European Region.
Geneva: World Heal Organization; 2019.

2. Singh OP, Hasker E, Sacks D, Boelaert M, Sundar S. Asymptomatic

leishmania infection: a new challenge for leishmania control. Clin
Infect Dis. 2019;58:1424. https://doi.org/10.1093/cid/ciu102.

3. el-Hassan AM, Zijlstra EE. Leishmaniasis in Sudan. Cutaneous

leishmaniasis. Trans R Soc Trop Med Hyg. 2001;95 Suppl 1:S1-S17.
doi:10.1016/s0035-9203(01)90216-0

4. European Centre for Disease Prevention and Control (ECDC).

Surveillance, prevention and control of leishmaniases in the European
Union and its neighbouring countries. 2022.
https://www.ecdc.europa.eu/sites/default/files/documents/leishmaniasi
s-surveillance-eu.pdf. Accessed 22 Feb 2023.

5. Campino L, Abranches P. Cutaneous leishmaniasis. Unusual disease

in Portugal? Acta Med Port. 2017;15:387–90.

6. Borges BKA, Da Silva JA, Haddad JPA, Moreira ÉC, De Magalhães

DF, Ribeiro LML, et al. Assessment of knowledge and preventive
attitudes concerning visceral leishmaniasis in Belo Horizonte, Minas
Gerais State. Rio de Janeiro: Cad Saude Publica; 2018;777.

7. Rocha, R., Conceição, C., Gonçalves, L. et al. Knowledge,

perceptions and practices of health students and professionals
regarding leishmaniasis in Portugal: a cross-sectional study. Parasites
Vectors 16, 381 (2023). https://doi.org/10.1186/s13071-023-05982-z

17
8. El-Mouhdi K, Fekhaoui M, Elhamdaoui F, Guessioui H, Chahlaoui A.
Knowledge and Experiences of Health Professionals in the Peripheral
Management of Leishmaniasis in Morocco (ELHajeb). J Parasitol
Res. 2020;2020:8819704. Published 2020 Sep 15.
doi:10.1155/2020/8819704

9. Ruoti M, Oddone R, Lampert N, et al. Mucocutaneous leishmaniasis:

knowledge, attitudes, and practices among paraguayan communities,
patients, and health professionals. J Trop Med. 2013;2013:538629.
doi:10.1155/2013/538629

10. Zijlstra EE, el-Hassan AM. Leishmaniasis in Sudan. Post kala-azar

dermal leishmaniasis. Trans R Soc Trop Med Hyg. 2018;95 Suppl
1:S59-S76. doi:10.1016/s0035-9203(01)90219-6

18
 ‫‪Appendixes‬‬
‫‪Sudan Medical Specialization Board‬‬
‫‪Council of Dermatology and venereology‬‬
‫‪Appendix 1: Arabic version of formal consent‬‬

‫‪Assessment of Knowledge and Awareness of Internal Medicine‬‬

‫‪Registrar about Cutaneous Manifestation of Viral Hepatitis, in‬‬
‫‪Sudan 2023‬‬

‫اذن اخذ معلومات بغرض البحث‬

‫انا الباحثة د‪ .‬افاق التهامي عبدالرحمن محمد‪ ،‬نائب اخصائي االمراض الجلدية والتناسلية‪ ،‬اقوم بهذا البحث عن تقييم المعرفة‬

‫والمواقف والممارسات تجاه مرض الليشمانيا الجلدي بين نواب الجراحة العامة في السنوات االخيرة من التدريب في السودان‪2023 ،‬‬

‫الغرض‬

‫تقييم المعرفة والمواقف والممارسات تجاه مرض الليشمانيا الجلدي بين نواب الجراحة العامة في السنوات االخيرة من التدريب في‬

‫السودان‪2023 ،‬‬

‫جراءات الدراسة والخصوصية‬

‫المشاركة في هذا البحث اختيارية‪ ،‬وسيتم التعامل بإجراءات منظمة لحفظ خصوصية المعلومات التي ستدلون بها اجابة على االسئلة‬

‫في االستبيان المرفق كاستخدام ارقام تسلسلية فقط وعدم تسجيل البيانات الشخصية المباشرة مثل االسم ورقم الهاتف والعنوان المفصل‬

‫الخ)‬

‫المخاطر‬

‫وجب التنبيه لعدم وجود مخاطر تقع على المشاركين في البحث بعد اذن الجهات المعنية‪ ،‬بما يحقق الفائدة المرجوة في تحسين‬

‫اجراءات ونتائج المعالجة والوقاية للمرضى بشكل اكثر جودة ونتائج اكثر صحة‪ ،‬وتحسين التعاون وعمل الفريق بين المختصين في‬

‫معالجة المرض‬

‫الفوائد‬

‫ال توجد اي فائدة مادية مباشرة من المشاركة في البحث‬

‫المشاركة واالنسحاب‬

‫وللجميع الحق في االنسحاب متى ما أرادوا ذلك ودون ابدا اسباب وال يؤثر ذلك على تلقيك للخدمة‬

‫د‪ .‬افاق التهامي عبدالرحمن محمد ‪ ،‬نائب اخصائي االمراض الجلدية والتناسلية‬

‫تلفون‬

‫نشكر لكم تعاونكم‬

‫التوقيع بالموافقة‬ ‫وجزاكم هللا خيرا‬

‫‪19‬‬
 Appendix: Sudan Medical Specialization Board
Council of Dermatology and Venereology
Assessment of Knowledge and Awareness of Internal Medicine
Registrar about Cutaneous Manifestation of Viral Hepatitis, in
Sudan 2023

Demographic Characteristics:

1. Age … years

2. Gender

a. Male

b. Female

Professional Characteristics:

3. Years of Rotation

a. R3

b. R4

4. Have you received any training in dermatology or have you encountered any
cases of Cutaneous Leishmaniosis (CL) before?

a. Yes, received training and encountered CL cases

b. Yes, received training but haven't encountered CL cases

c. No, haven't received training but encountered CL cases

d. No, haven't received training and haven't encountered CL cases

Knowledge assessment

Epidemiology of Cutaneous Leishmaniosis (CL)

5. What is cutaneous leishmaniasis (CL)?

a. A vector-borne parasitic disease

b. A bacterial infection

c. A viral infection

20
 d. A fungal infection

Answer: a. A vector-borne parasitic disease

6. What are the risk factors for CL?

a. Exposure to infected sandflies, living or working in endemic areas,

having a weakened immune system, and being malnourished

b. Exposure to contaminated water, poor sanitation, and malnutrition

c. Living in crowded conditions and having a weakened immune

system

d. Exposure to wild animals and having a weakened immune system

Answer: a. Exposure to infected sandflies, living or working in endemic areas,

having a weakened immune system, and being malnourished

7. What factors influence the patterns of CL transmission?

a. The distribution of sandfly vectors, human behavior, and

environmental changes

b. The availability of clean water and sanitation

c. The proximity to wild animals and their habitats

d. The overall health status of the population

Answer: a. The distribution of sandfly vectors, human behavior, and

environmental changes

Presentation and Lesion Morphology

8. How do CL lesions typically present?

a. As painless, round or oval sores on the skin

b. As painful, irregular-shaped sores on the skin

c. As blisters or pustules on the skin

d. As rashes or patches on the skin

Answer: a. As painless, round or oval sores on the skin

9. Where do CL lesions most commonly occur?

a. On exposed areas of the body, such as the face, arms, and legs

21
 b. On covered areas of the body, such as the trunk and back

c. On the hands and feet

d. On the mucous membranes

Answer: a. On exposed areas of the body, such as the face, arms, and legs

10. What is the typical size range of CL lesions?

a. A few millimeters to several centimeters in diameter

b. Less than a millimeter in diameter

c. Larger than several centimeters in diameter

d. Variable, depending on the species of Leishmania parasite

Answer: a. A few millimeters to several centimeters in diameter

11. What are the different types of CL lesions?

a. Anthroponotic (human-to-human transmission), zoonotic (animal-to-

human transmission), and mucocutaneous (affecting the mucous
membranes)

b. Old World CL, New World CL, and Diffuse CL

c. Macular CL, Papular CL, and Nodular CL

d. Cutaneous CL, Visceral CL, and Mucosal CL

Answer: a. Anthroponotic (human-to-human transmission), zoonotic (animal-

to-human transmission), and mucocutaneous (affecting the mucous
membranes)

12. What are the associated symptoms of CL?

a. Pain (may be present or absent), itching, swelling, and secondary

bacterial infection

b. Fever, chills, and muscle aches

c. Rash, nausea, and vomiting

d. No associated symptoms

Answer: Pain (may be present or absent), itching, swelling, and secondary

bacterial infection

22
 Attitudes:

13. Attitude Toward Cutaneous Leishmaniosis (CL):

a. Extremely important

b. Important

c. Neutral

d. Not very important

e. Not important at all

14. How serious do you consider diagnosing CL incorrectly?

a. Very serious

b. Somewhat serious

c. Neutral

d. Not very serious

e. Not serious at all

15. To what extent do you think incorrect surgical intervention in CL lesions

causes damage?

a. It causes significant damage

b. It may cause some damage

c. It has minimal impact

d. It has no impact

16. When you identify cases of CL, do you treat them or refer them to a
dermatologist?

a. I treat them myself

b. I refer them to a dermatologist

c. Depends on the severity of the case

23
 Practice

Investigations

17. What are the diagnostic tests and procedures routinely used to confirm CL
infection?

a. Direct microscopic examination of skin scrapings, serological

tests, and polymerase chain reaction (PCR) assays

b. Blood culture, urine culture, and stool culture

c. X-rays, CT scans, and MRIs

d. Skin biopsy and histopathology examination

Answer: a. Direct microscopic examination of skin scrapings, serological tests,

and polymerase chain reaction (PCR) assays

18. What does direct microscopic examination of skin scrapings involve?

a. Scraping a small sample of skin from the lesion and examining it

under a microscope for the presence of Leishmania parasites

b. Taking a blood sample and testing it for the presence of

Leishmania antibodies

c. Collecting a urine sample and testing it for the presence of

Leishmania DNA

d. Taking a stool sample and testing it for the presence of Leishmania

parasites

Answer: a. Scraping a small sample of skin from the lesion and examining it
under a microscope for the presence of Leishmania parasites

19. What do serological tests, such as the indirect fluorescent antibody test (IFAT)
and the enzyme-linked immunosorbent assay (ELISA), detect?

a. Antibodies to Leishmania parasites in the blood

b. Leishmania parasites in the blood

c. Leishmania DNA in the blood

d. Leishmania parasites in the skin

Answer: a. Antibodies to Leishmania parasites in the blood

24
20. What do PCR assays do?

a. Amplify Leishmania DNA from skin scrapings or blood samples,

making them highly sensitive for detecting the parasite

b. Detect Leishmania parasites in the blood by binding to specific

antigens

c. Grow Leishmania parasites in a culture medium to confirm their

presence

d. Sequence Leishmania DNA to identify the species of the parasite

Answer: a. Amplify Leishmania DNA from skin scrapings or blood samples,

making them highly sensitive for detecting the parasite

Clinical Diagnosis

21. On what is the clinical diagnosis of CL based?

a. The patient's history, physical examination, and laboratory

findings

b. The patient's travel history and exposure to risk factors for CL

c. The physical examination findings, such as the location, size, and

appearance of any lesions

d. The laboratory findings, such as positive diagnostic tests

Answer: a. The patient's history, physical examination, and laboratory findings

22. What should clinicians consider when making a clinical diagnosis of CL?

a. The patient's travel history, exposure to sandflies, and the presence

of skin lesions consistent with CL

b. The patient's age, gender, and overall health status

c. The patient's recent history of other infections

d. The patient's exposure to environmental toxins

Answer: a. The patient's travel history, exposure to sandflies, and the presence
of skin lesions consistent with CL

23. What should physical examination include when making a clinical diagnosis
of CL?

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 a. A thorough examination of the skin, with particular attention to the
location, size, and appearance of any lesions

b. An examination of the lymph nodes for enlargement or tenderness

c. An examination of the lungs and heart for signs of infection

d. An examination of the eyes, ears, nose, and throat for signs of

infection

Answer: a. A thorough examination of the skin, with particular attention to the

location, size, and appearance of any lesions

24. How can laboratory findings support the clinical diagnosis of CL?

a. By identifying Leishmania parasites in skin scrapings or blood

samples

b. By detecting antibodies to Leishmania parasites in the blood

c. By amplifying Leishmania DNA from skin scrapings or blood

samples

d. All of the above

Answer: d. All of the above

Histopathology Diagnosis

25. How can histopathological examination of skin biopsy samples confirm the
diagnosis of CL?

a. By identifying Leishmania amastigotes in macrophages

b. By identifying Leishmania amastigotes in neutrophils

c. By identifying Leishmania amastigotes in lymphocytes

d. By identifying Leishmania amastigotes in the cytoplasm of cells

The correct answer is a. By identifying Leishmania amastigotes in

macrophages.

26. How can histopathology help to differentiate CL from other skin conditions
with similar clinical presentations?

a. By identifying the specific type of Leishmania parasite present in

the lesion

b. By identifying the type of inflammatory response in the lesion

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 c. By identifying the presence of other infectious agents, such as
bacteria or fungi, in the lesion

d. All of the above

The answer to the last question is d. All of the above.

Treatment

27. What factors determine the appropriate treatment approaches for CL?

a. The species of Leishmania parasite

b. The type of CL lesion

c. The patient's overall health

d. All of the above

Answer: d) All of the above

28. Which medications are considered the mainstay of treatment for CL?

a. Antileishmanial medications, such as pentavalent antimony,

miltefosine, and paromomycin

b. Antibiotics

c. Antifungals

d. Antivirals

Answer: a) Antileishmanial medications, such as pentavalent antimony,

miltefosine, and paromomycin

29. When can local therapies, such as cryotherapy, heat therapy, and topical
antileishmanial ointments, be employed?

a. To treat localized CL lesions

b. To treat widespread CL lesions

c. As a primary treatment option for CL

d. As a standalone treatment for CL

Answer: a) To treat localized CL lesions

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30. What role do supportive measures, such as wound care and pain management,
play in CL treatment?

a. Promoting healing and improving patient comfort

b. Eliminating Leishmania parasites

c. Preventing the spread of CL

d. Treating the underlying cause of CL

Answer: a) Promoting healing and improving patient comfort

31. Which of the following practices is considered inappropriate for debridement

of a CL lesion?

a. Debriding the lesion with a scalpel or curette

b. Applying topical antileishmanial ointments to the lesion

c. Covering the lesion with a sterile bandage

d. Allowing the lesion to heal naturally without debridement

The correct answer is a

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