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<body class='hmmessage'><div dir='ltr'>Date: 2013/6/7<br><div>Subject: PRO/AH/EDR> Leishmaniasis - Syria (05): (HL)<br>To: promed-ahead-edr@promedmail.org<br><br> <br>LEISHMANIASIS - SYRIA (05): (ALEPPO)<br>************************************<br> A ProMED-mail post<br><http://www.promedmail.org><br><br>ProMED-mail is a program of the International Society for Infectious Diseases <http://www.isid.org><br>Date: Wed 5 Jun 2013Source: <br>PLoS (Public Library of Science) Blogs [edited]<http://bit.ly/139BDPX><br> <!--[if gte mso 9]><xml>
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<p class="MsoNormal"><span lang="EN-US">News Reports out of Syria indicate the emergence of epidemic
cutaneous<br>
<span style="mso-spacerun:yes"> </span>leishmaniasis [CL] in the besieged city
of Aleppo,
adding further to<br>
<span style="mso-spacerun:yes"> </span>the misery there.<br>
<span style="mso-spacerun:yes"> </span><br>
<span style="mso-spacerun:yes"> </span>Even in the best of times the Syrian Arab Republic (Syria) has<br>
<span style="mso-spacerun:yes"> </span>struggled with CL. We reported
previously in PLoS Neglected Tropical<br>
<span style="mso-spacerun:yes"> </span>Diseases that Old World or anthroponotic
CL caused by _Leishmania<br>
<span style="mso-spacerun:yes"> </span>tropica_ is endemic to Syria and elsewhere in the Middle East, North<br>
<span style="mso-spacerun:yes"> </span>Africa, and Central
Asia.<br>
<span style="mso-spacerun:yes"> </span><br>
<span style="mso-spacerun:yes"> </span>In the ancient northern Syrian city of Aleppo, CL has been present for<br>
<span style="mso-spacerun:yes"> </span>hundreds of years (if not longer), where
it is known as the "Aleppo<br>
<span style="mso-spacerun:yes"> </span>evil", "Aleppo
ulcer", "Aleppo boil", or "Aleppo button". Aleppo ulcer<br>
<span style="mso-spacerun:yes"> </span>is a disfiguring condition that
disproportionately occurs on the face,<br>
<span style="mso-spacerun:yes"> </span>especially of young people. It typically
lasts one or 2 years before<br>
<span style="mso-spacerun:yes"> </span>the lesion heals spontaneously, and is
often known locally as<br>
<span style="mso-spacerun:yes"> </span>"one-year sore". However, in
many cases specific anti-parasitic<br>
<span style="mso-spacerun:yes"> </span>chemotherapy can hasten the healing
process and improve clinical and<br>
<span style="mso-spacerun:yes"> </span>cosmetic outcomes.<br>
<span style="mso-spacerun:yes"> </span><br>
<span style="mso-spacerun:yes"> </span>A major problem with one-year sore is
that the scar can produce<br>
<span style="mso-spacerun:yes"> </span>permanent disfigurement of the face.
According to some experts working<br>
<span style="mso-spacerun:yes"> </span>in Afghanistan, Old World CL is a
cause of social isolation and stigma<br>
<span style="mso-spacerun:yes"> </span>particularly among girls and young women
who can be rendered<br>
<span style="mso-spacerun:yes"> </span>unmarriageable. Mothers with CL may not
be allowed to touch their<br>
<span style="mso-spacerun:yes"> </span>children even though human to human
contact does not transmit the<br>
<span style="mso-spacerun:yes"> </span>infection.<br>
<span style="mso-spacerun:yes"> </span><br>
<span style="mso-spacerun:yes"> </span>Experts working on CL in Syria have written about the rise and fall<br>
<span style="mso-spacerun:yes"> </span>and then a rise again in the incidence
of the disease in the city of<br>
<span style="mso-spacerun:yes"> </span>Aleppo.
During the 1950s the number of cases of CL fell after an<br>
<span style="mso-spacerun:yes"> </span>insecticide campaign aimed at
controlling malaria, but it then rose<br>
<span style="mso-spacerun:yes"> </span>again during the 1960s. However, CL was
mostly controlled during the<br>
<span style="mso-spacerun:yes"> </span>1980s.<br>
<span style="mso-spacerun:yes"> </span><br>
<span style="mso-spacerun:yes"> </span>There was a subsequent increase after
1992, which has been attributed<br>
<span style="mso-spacerun:yes"> </span>in part to inadequate garbage disposal
and construction waste in areas<br>
<span style="mso-spacerun:yes"> </span>undergoing development outside of the
ancient city center. Garbage<br>
<span style="mso-spacerun:yes"> </span>collection, open sewage, and poverty are
notorious for promoting the<br>
<span style="mso-spacerun:yes"> </span>habitats of _Phlebotomus_ sandflies that
transmit Old World CL.<br>
<span style="mso-spacerun:yes"> </span>Interestingly, a clinical trial
conducted prior to the current civil<br>
<span style="mso-spacerun:yes"> </span>conflict found that use of insecticide-treated
bednets (ITNs) could<br>
<span style="mso-spacerun:yes"> </span>prevent CL in Aleppo.<br>
<span style="mso-spacerun:yes"> </span><br>
<span style="mso-spacerun:yes"> </span>[Byline: Peter Hotez]<br>
<span style="mso-spacerun:yes"> </span><br>
<span style="mso-spacerun:yes"> </span>--<br>
<span style="mso-spacerun:yes"> </span>Communicated by:<br>
<span style="mso-spacerun:yes"> </span>ProMED-mail<br>
<span style="mso-spacerun:yes"> </span><promed@promedmail.org<br>
<span style="mso-spacerun:yes"> </span><br>
<span style="mso-spacerun:yes"> </span>[There have been several previous
reports on an increased number of<br>
<span style="mso-spacerun:yes"> </span>cutaneous leishmaniasis cases in Syria.
See the ProMED postings listed<br>
<span style="mso-spacerun:yes"> </span>below, and refer to the comments in
archive no. 20130420.1660409.<br>
<span style="mso-spacerun:yes"> </span><br>
<span style="mso-spacerun:yes"> </span>There is no doubt that the areas of Syria affected by the civil war<br>
<span style="mso-spacerun:yes"> </span>are experiencing an increase in
cutaneous leishmaniasis and this will<br>
<span style="mso-spacerun:yes"> </span>also be seen in the refugee camps in Jordan and Turkey. - Mod.EP<br>
<span style="mso-spacerun:yes"> </span><br>
<span style="mso-spacerun:yes"> </span>A HealthMap/ProMED-mail map can be
accessed at:<br>
<span style="mso-spacerun:yes"> </span><http://healthmap.org/r/7cJV.]<br>
<span style="mso-spacerun:yes"> </span><br>
<span style="mso-spacerun:yes"> </span>[see also:<br>
<span style="mso-spacerun:yes"> </span>Health hazards - Syria: effects of war,
civilians 20130605.1756328<br>
<span style="mso-spacerun:yes"> </span>Leishmaniasis - Syria (04): comment on
canine reservoir<br>
<span style="mso-spacerun:yes"> </span>20130420.1660409<br>
<span style="mso-spacerun:yes"> </span>Leishmaniasis - Syria (03): Turkey ex
Syria 20130409.1633859<br>
<span style="mso-spacerun:yes"> </span>Leishmaniasis - Syria (02)
20130328.1608713<br>
<span style="mso-spacerun:yes"> </span>Leishmaniasis - Syria: RFI
20130227.1562934<br>
<span style="mso-spacerun:yes"> </span>2012<br>
<span style="mso-spacerun:yes"> </span>----<br>
<span style="mso-spacerun:yes"> </span>Leishmaniasis, tuberculosis - Syria
(02): comment 20121227.1471041<br>
<span style="mso-spacerun:yes"> </span>Leishmaniasis, tuberculosis - Syria
20121226.1470184]<br>
<span style="mso-spacerun:yes"> </span>.................................................sb/ep/mj/dk<br>
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