An outbreak of cutaneous leishmaniasis in an Afghan refugee settlement in north-west Pakistan

✍ Scribed by Mark Rowland; Arif Munir; Naeem Durrani; Harry Noyes; Hugh Reyburn

• Publisher: Elsevier Science
• Year: 1999
• Tongue: English
• Weight: 485 KB
• Volume: 93
• Category: Article
• ISSN: 0035-9203
• DOI: 10.1016/s0035-9203(99)90285-7

✦ Synopsis

Cutaneous leishmaniasis (CL) due to Leishmania tropica appears to be an emerging disease in parts of northeast Afghanistan and north-west Pakistan. Timargara, an Afghan refugee camp of 17 years' standing, in the district of Dir, North West Frontier Province of Pakistan, experienced a major outbreak of CL in 1997 for the first time. As part of the investigation, each section of the camp was surveyed for CL. Around 38% of the 9200 inhabitants bore active lesions and a further 13% had scars from earlier attacks. According to interview statements, 99% of earlier infections had healed within the previous 2 years. To confirm the diagnosis, a sample of current CL lesions was examined parasitologically. Amastigotes were detectable by microscopy in only 36% of lesions. However, 48% of slide-negative cases produced positive cultures and some cases negative to both microscopy and culture were positive by PCR. Overall detection rate was about 80%. The sandtly Phlebotomus ser.qenti, a known vector of L. tropica, was captured within the camn. indicating local transmission. CL has not been reported from this area-of Pakistan before. Although the iijority of rekgees left Afghanistan 2 decades ago, cross-border movement ofmen is common. The Afhanistan caoital. Kabul.

I -I -> is cur&ntly experiencing a major epidemic of CL; infected migrant carriers fi-okKabul are probably the source of the outbreak in Timargara.