[Leish-l] FW: PRO/AH/EDR> Leishmaniasis - Syria (05): (HL)

[jeffrey shaw]

Date: 2013/6/7
Subject: PRO/AH/EDR> Leishmaniasis - Syria (05): (HL)
To: promed-ahead-edr at promedmail.org

 
LEISHMANIASIS - SYRIA (05): (ALEPPO)
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 A ProMED-mail post
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ProMED-mail is a program of the International Society for Infectious Diseases <http://www.isid.org>
Date: Wed 5 Jun 2013Source: 
PLoS (Public Library of Science) Blogs [edited]<http://bit.ly/139BDPX>
 

News Reports out of Syria indicate the emergence of epidemic
cutaneous

 leishmaniasis [CL] in the besieged city
of Aleppo,
adding further to

 the misery there.

 

 Even in the best of times the Syrian Arab Republic (Syria) has

 struggled with CL. We reported
previously in PLoS Neglected Tropical

 Diseases that Old World or anthroponotic
CL caused by _Leishmania

 tropica_ is endemic to Syria and elsewhere in the Middle East, North

 Africa, and Central
 Asia.

 

 In the ancient northern Syrian city of Aleppo, CL has been present for

 hundreds of years (if not longer), where
it is known as the "Aleppo

 evil", "Aleppo
ulcer", "Aleppo boil", or "Aleppo button". Aleppo ulcer

 is a disfiguring condition that
disproportionately occurs on the face,

 especially of young people. It typically
lasts one or 2 years before

 the lesion heals spontaneously, and is
often known locally as

 "one-year sore". However, in
many cases specific anti-parasitic

 chemotherapy can hasten the healing
process and improve clinical and

 cosmetic outcomes.

 

 A major problem with one-year sore is
that the scar can produce

 permanent disfigurement of the face.
According to some experts working

 in Afghanistan, Old World CL is a
cause of social isolation and stigma

 particularly among girls and young women
who can be rendered

 unmarriageable. Mothers with CL may not
be allowed to touch their

 children even though human to human
contact does not transmit the

 infection.

 

 Experts working on CL in Syria have written about the rise and fall

 and then a rise again in the incidence
of the disease in the city of

 Aleppo.
During the 1950s the number of cases of CL fell after an

 insecticide campaign aimed at
controlling malaria, but it then rose

 again during the 1960s. However, CL was
mostly controlled during the

 1980s.

 

 There was a subsequent increase after
1992, which has been attributed

 in part to inadequate garbage disposal
and construction waste in areas

 undergoing development outside of the
ancient city center. Garbage

 collection, open sewage, and poverty are
notorious for promoting the

 habitats of _Phlebotomus_ sandflies that
transmit Old World CL.

 Interestingly, a clinical trial
conducted prior to the current civil

 conflict found that use of insecticide-treated
bednets (ITNs) could

 prevent CL in Aleppo.

 

 [Byline: Peter Hotez]

 

 --

 Communicated by:

 ProMED-mail

 <promed at promedmail.org

 

 [There have been several previous
reports on an increased number of

 cutaneous leishmaniasis cases in Syria.
See the ProMED postings listed

 below, and refer to the comments in
archive no. 20130420.1660409.

 

 There is no doubt that the areas of Syria affected by the civil war

 are experiencing an increase in
cutaneous leishmaniasis and this will

 also be seen in the refugee camps in Jordan and Turkey. - Mod.EP

 

 A HealthMap/ProMED-mail map can be
accessed at:

 <http://healthmap.org/r/7cJV.]

 

 [see also:

 Health hazards - Syria: effects of war,
civilians 20130605.1756328

 Leishmaniasis - Syria (04): comment on
canine reservoir

 20130420.1660409

 Leishmaniasis - Syria (03): Turkey ex
Syria 20130409.1633859

 Leishmaniasis - Syria (02)
20130328.1608713

 Leishmaniasis - Syria: RFI
20130227.1562934

 2012

 ----

 Leishmaniasis, tuberculosis - Syria
(02): comment 20121227.1471041

 Leishmaniasis, tuberculosis - Syria
20121226.1470184]

 .................................................sb/ep/mj/dk

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