Travel history and occupation among diagnosed Cutaneous Leishmaniasis cases in Guyana: A multi-site retrospective case series, 2017-2021.

Abstract

Background: Cutaneous Leishmaniasis (CL) in Guyana has not been systematically characterised in the peer-reviewed literature for several decades. This study aimed to describe the demographic, occupational, geographic, and clinical profile of diagnosed CL cases at Guyana's principal diagnostic sites, and to test, within this case series, whether field-based occupation is associated with reported interior travel and whether travel history is associated with time to presentation.

Methodology/principal findings: Retrospective case series (chart review) of CL diagnoses recorded at three facilities in Georgetown and the interior (2017-2021). Of 223 available case records, a random subsample of 170 was abstracted. Occupation and interior travel were patient-declared; their association was tested directly, then via adjusted logistic regression. Most patients (61.8%) reported interior travel, and 45.3% held field-based occupations, chiefly mining and military. Interior travel was more common among field-based than non-field workers (84.4% vs 43.0%; OR = 7.18 [95% CI, 3.42-15.04]; p < .001), and this association persisted after adjustment for age and sex (OR = 7.08 [3.07-16.30]). Younger age was associated with interior travel (OR = 0.96 [0.94-0.98]; p = .001), whereas sex was not. The sample was predominantly male (81.8%; median age 33 years). Patients with interior travel presented earlier than those without (Mdn = 61 vs 243 days; p < .001).

Conclusions/significance: Most diagnosed CL cases in this series occurred in people reporting interior travel, predominantly those in field-based occupations, and this travel history was associated with earlier presentation. All participants had CL and there was no comparison group, so these findings describe the case population and associations within it rather than risk factors for acquiring infection; they also rest on a single, retrospectively recorded travel variable. They nonetheless indicate where pre-deployment prevention, occupational screening, and traveller advisories could be focused, and they support a case-control study with validated exposure measurement.