Geographical and temporal patterns of cutaneous leishmaniasis in Pakistan: insight from a decade of epidemiology

Abstract Background Cutaneous leishmaniasis (CL) is a major public health concern in Pakistan. This systematic review aimed to assess geographical distribution, prevalence trends and epidemiological risk factors associated with CL from 2014 to 2024. Methods A systematic literature search was conducted using PubMed, ScienceDirect and Google Scholar for studies published from January 2014 to December 2024. Keywords included ‘cutaneous leishmaniasis’, ‘epidemiology’, ‘Pakistan’ and ‘geographical distribution’. Of 1000 retrieved publications, 600 were screened and 25 met predefined inclusion and quality criteria. The extracted data included study area, research design, diagnostic methods, gender distribution and Leishmania species. Results A total of 27 380 confirmed CL cases were reported. The highest burden was in Khyber Pakhtunkhwa (60%), followed by Balochistan (16%), Sindh (8%), Punjab (8%) and Azad Jammu and Kashmir and Chitral (4%). A male predominance (approximately 60–65%) was reported. The dominant species were Leishmania tropica and Leishmania major. Diagnosis relied mainly on microscopy (80%), with an annual incidence rate of 8–10% over the previous decade. Conclusions CL shows a widespread and increasing distribution pattern in Pakistan. The main factors involve poverty, vectors, climate change and migration. These findings focus on the need to improve the surveillance network, molecular diagnostic methods and public awareness to decrease the growing impact of the disease.