[leish-l] Leishmaniasis in Afghanistan 2

Mon May 13 13:20:54 BRT 2002

Dear Dr Michaeli,

Thanks for that.  In terms of leishmaniasis, 1969 was a 
long time ago, when it was still not possible to 
differentiate reliably between Leishmania species. We have 
come a long way since the (excellent) work of Gunders and 
his co-workers.

Of course, Psammomys is restricted to arid zones, but it
occurs in relatively humid spots within these, where there 
is abundant growth of Chenopodiaceae. Places in the Jordan 
Valley, both west bank and east bank that I have visited 
with Israeli and Jordanian colleagues are much more humid 
than the surrounding territories. Only in Syria have I seen 
it in truly arid locations.

Israeli workers from the Hadassah have found cases of L. 
tropica, transmitted by P. sergenti, and probably 
associated with hyraxes, which is very interesting.

It may also interest you that there was once a magnificent 
Institute of Malaria and Leishmaniasis in Kabul (The only 
institute in the world with leishmaniasis in its name as 
far as I know). When I was last there, it had been reduced 
to a shell with no roof, as a result of the shelling of the 
entire city by one of the warlords who, as I was told, was 
Minister for Defence at the time, and is currently being 
courted by the international community. The world is full 
of ironies.

You might like to see: 
Ashford, R.W., Kohestany, K.A. and Karimzad, M.A. (1992).  
Cutaneous leishmaniasis in Kabul, Afghanistan: observations 
on a "prolonged epidemic". Annals of Tropical Medicine and 
Parasitology, 86: 361-371.
and
Reyburn, H., Ashford R.W., Mohsen, M., Hewitt, S. and 
Rowland, M. (2000).  A randomised control trial of 
insecticide-treated bednets and chaddars or top sheets, and 
residual spraying of interior rooms for the prevention of 
cutaneous leishmaniasis in Kabul, Afghanistan. Transactions 
of the Royal Society of Tropical Medicine and Hygiene, 94: 
for the latest information on Kabul, or
Ashford, R.W. and Bates, P.A. (1998).  Leishmaniases in the 
Old World.  In: F.E.G. Cox, ed., Topley & Wilson's 
Microbiology and Microbial Infections, 9th edition, Vol 5, 
London: Arnold, pp215-240.
and
Ashford, R.W. (1998).  The leishmaniases.  In: S.R. 
Palmer, L. Soulsby and D.I.H. Simpson, eds, Textbook of 
Zoonoses. Oxford: Oxford University Press, pp528-543. 
361-366. 
for general info on the epidemiology of Leish.

I'm sorry for upsetting you,

With kind regards,

Dick Ashford

On Mon, 13 
May 2002 17:24:46 +0200 dan and micky michaeli 
<michaeli at netvision.net.il> wrote:

> Sorry, but my note is based on well established facts 
that were published in > the Journal of Infectious Diseases 
in 1969 or about it ( I shall send the > references 
tomorrow). I am sorry that the editor changed a little my > 
original text concerning the vector. I wrote that the 
vectors in Israel are > "gerbils and psammomys, both wild 
rodents" this is of course more accurate. > The psammomys 
in the Jericho area lives in dry river beds, and it is > 
relatively close to the Dead Sea and it is true that the 
soil there is salty > and I agree with this comment ,but 
the jerbils were found by another group > in the Jordan 
Valley and I don't have first hand information about the 
soil > there. I don't know of P. sergenti in Israel but P. 
papatasii is very common > and was always considered the 
agent here. It could be different in other > areas of the 
world. > > It is disappointing that before cricising so 
vehemently my notes Dr Ashford > did not ask at least for 
the references. At least I am pleased to know that > my 
guess there is a connection between population movements 
and the present > outbreak. > > Sincerely, > > Dan Michaeli 
> > ----- Original Message ----- > From: "R.W. Ashford" 
<ashford at liverpool.ac.uk> > To: "Fred R. Opperdoes" 
<opperdoes at trop.ucl.ac.be> > Cc: <leish-l at bdt.org.br>; 
<michaeli at netvision.net.il> > Sent: Monday, May 13, 2002 
12:25 PM > Subject: Re: [leish-l] Leishmaniasis in 
Afghanistan 2 > > > > Re the Leishmaniasis in Afghanistan 
mailing: > > > > 1. Cutaneous leish in Afghanistan is of 
two sorts, caused > > by L. major in the northern border 
area, and by L. tropica > > in cities throughout the 
country. > > > > 2. L. tropica does not have reservoir host 
other than Man. > > > > 3. L. tropica is transmitted by  P. 
sergenti, not P. > > papatasi. > > > > 4. In Kabul at 
least, the increasing number of cases is > > almost 
certainly due to increasing movement of people into > > a 
'dependent focus' (ecological 'sink') > > > > 5. Psammomys 
(a gerbil, not a mouse, that lives in humid > > salt-flats 
not dry river valleys) does not occur in > > Afghanistan, 
where the reservoir host of L. major is > > Rhombomys 
opimus, as it is throughout central Asia. > > > > 6. 
Astonishing that such a short article should contain so > > 
many inaccuracies. > > > > P.s. there have been a handful 
of reports of infantile > > visceral leishmaniasis, 
presumably due to L. infantum, from > > Afghanistan. > > > 
> Transmission should be starting about now, and will peak 
in > > September, when large numbers of any international 
troops > > there will become infected. They need 
information, not > > nonsense. > > > > Regards to all, > > 
> > Dick Ashford > > > > On Sat, 11 May 2002 19:38:46 +0200 
"Fred R. Opperdoes" > > <opperdoes at trop.ucl.ac.be> wrote: > 
> > > > At 8:04 -0400 11/05/02, ProMED Digest wrote: > > > 
>Date: Sat, 11 May 2002 07:49:56 -0400 (EDT) > > > >From: 
ProMED-mail <promed at promed.isid.harvard.edu> > > > 
>Subject: PRO/AH> Leishmaniasis - Afghanistan (02) > > > > 
> > > >LEISHMANIASIS - AFGHANISTAN (02) > > > 
>******************************* > > > >A ProMED-mail post 
> > > ><http://www.promedmail.org>; > > > >ProMED-mail, a 
program of the > > > >International Society for Infectious 
Diseases > > > ><http://www.isid.org> > > > > > > > >Date: 
Fri, 10 May 2002 11:05:48 +0200 > > > >From: Dan Michaeli, 
MD <michaeli at netvision.net.il> > > > > > > > > > > > 
>Background information on leishmaniasis in Afghanistan > > 
> >- ----------------------------------------- > > > 
>Cutaneous leishmaniasis is a very old endemic disease. The 
Afghanistan > form > > > >is most probably an example of 
"Leishmaniasis of the Old World" that is > > > >common in 
the Mediterranean area and along the "Silk Route" between 
the > > > >Middle East and the Far East. It is hosted 
mainly by animals. Unlike > > > >_L.donovani_ (the agent 
for kala azar), the cutaneous form (primarily > > > >caused 
by _L.tropica_) is harboured in smaller animals. > > > > > 
> > >The cycle is very interesting because the transmitting 
vector, > _Phlebotomus > > > >papatasii_, protects itself 
from the heat in arid areas in the burrows > of > > > 
>_Psammomys_ mice, which [are found] along dry river beds 
that still > have > > > >some > > > >humidity in their 
soil. In the evening and at night the flies leave the > > > 
>burrows and may fly as far as a kilometer, and that's when 
they bite > > > >exposed areas of the body. Because of the 
heat people may sleep half > naked, > > > >and we have seen 
people who were bitten so many times that they had a > few 
> > > >dozen ulcers. > > > > > > > >It is intriguing to 
observe such a widespread epidemic as the > > > >current 
one, and I wonder whether the people involved migrated only 
> > > >recently to these areas. In Jericho we found at the 
time that most > children > > > >over the age of 6 were 
already protected, having probably been infected > > > 
>before. > > > > > > > >- -- > > > >Dan Michaeli MD > > > 
>Chairman, Clalit Health Services, Israel > > > 
><michaeli at netvision.net.il> > > > > > > > >[Thank you very 
much for the interesting background information. We > have 
no > > > >information as to whether the increase in 
cutaneous leishmaniasis is > due to > > > >an increase of 
the vector or migration of non-immune humans into > endemic 
> > > >areas. - Mod.EP] > > > > > > > >[see also: > > > 
>2002 > > > >- -- > > > >Leishmaniasis - Afghanistan 
(Kabul): alert  20020508.4134 > > > >Leishmania, Pakistan 
ex Afghanistan      20020213.3556 > > > >2001 > > > >- -- > 
> > >Leishmaniasis - India (Calcutta)        20001022.1830 
> > > >Leishmaniasis - India (Calcutta) (02) 20001026.1858 
> > > >Leishmaniasis - Nepal         20000729.1257 > > > 
>Leishmaniasis - Nepal (02) 20000731.1266] > > > 
>.....................................ep/pg/jw > > > > > > 
> >------------------------------ > > > 
_______________________________________________ > > > 
leish-l mailing list > > > leish-l at bdt.org.br > > > 
http://panda.fat.org.br/mailman/listinfo/leish-l > > > > 
---------------------- > > ashford at liverpool.ac.uk > > > > 

----------------------
ashford at liverpool.ac.uk