Ongoing Epidemic of Cutaneous Leishmaniasis among Syrian Refugees, Lebanon1

Abstract

In September 2012, a cutaneous leishmaniasis outbreak began among Syrian refugees in Lebanon. For 948 patients in whom leishmaniasis was not confirmed, we obtained samples for microscopic confirmation and molecular speciation. We identified Leishmania tropica in 85% and L. major in 15% of patients. After 3 months of megulamine antimonite therapy, patients initial cure rate was 82%.

Cutaneous Leishmaniasis and Human Conflict

“…By the end of 2013, escalating conflict had displaced an estimated 6.5 million people (10). The first reports of problems became apparent amongst refugees displaced by the war to Lebanon and Turkey (8,11). However, now Hayani et al (12) draw attention to the extent of the situation in Syria itself, which previously has not been reported.…”

“…Other risk factors include poor housing and sanitary conditions with lack of waste management and gross household overcrowding, which are likely to increase sandfly breeding and resting sites, promoting transmission. Saroufim et al (8) report makeshift houses of rubble and tents, with inadequate sanitation, waste disposal and insulation in Syrian refugee camps in Lebanon and such temporary settlements are ideal areas for enhanced transmission.…”

Recent updates and perspectives on leishmaniasis

“…Researchers comparing the prevalence and risk factors in old and new foci using leishmanin skin test (LST) in central Tunisia observed [19] that the overall prevalence of LST positivity was 57%, and was significantly higher in the old focus than in the emerging foci. In 2012, a CL outbreak was observed among Syrian refugees in Lebanon [20] due to L. tropica and L. major infection in 85% and 15% of patients, respectively. These infections were cured in 82% of the cases by megulamine antimonite therapy for three months.…”

Addressing a clinical challenge: guidelines for the diagnosis and treatment of leishmaniasis

“…In a GeoSentinel surveillance study, 32% of adult Syrian refugees evaluated for migration-related illness had CL [4]. Increased CL rates were also reported in the neighboring countries of Jordan [5], Lebanon [6, 7], and Turkey [8, 9], primarily among Syrian refugee populations. Poor living conditions, disrupted healthcare infrastructure, vector control programs, inadequate sanitation, and mass migration from non-endemic regions of Syria through endemic areas all likely contribute to an increased disease burden of leishmaniasis in Syrian refugees.…”