species that cause cutaneous leishmaniasis include
L. aethiopica,
L. infantum,
L. major, and
L. tropica. With the exception of
L. tropica—which is commonly associated with human settlements and therefore considered to be an
anthroponotic species—all of these organisms are
zoonotic. Dogs and rodents serve as the primary animal reservoir hosts in the
sylvatic cycle, but people with chronic PKDL can also serve as important reservoir hosts for cutaneous leishmaniasis. The most common
vectors for cutaneous leishmaniasis in the Old World are sandflies of the genus
Phlebotomus, while
Lutzomyia and those within the family
Psychodidae (especially the genus
Psychodopygus) are the most common vectors in the New World. More than 600 species of
phlebotomine sandflies are known, but only 30 of these are known to be vectors. Cutaneous leishmaniasis has been seen in American and Canadian troops coming back from Afghanistan.
Prevention The sand fly stings mainly at night, and it usually occurs about half a meter above the ground (so sleeping on high beds can prevent infection). To avoid stinging, apply mosquito repellent, and cover the body. Studies conducted in recent years show that the plant
Bougainvillea glabra may protect against the sand fly. The plant was found to be toxic to sand flies and that the lifespan of flies that ate from this plant was significantly shortened and sometimes led to their premature death, before they could spread the disease. A Hebrew University study found that some plants attract sand flies. These plants often attract them up to 14 times more than
B. glabra, but unlike
B. a. glabra, are not toxic to the sand flies. Based on this information, the dispersion of sand flies can be controlled by limiting the growth of these plants near populated areas. Alternatively, these plants may serve to capture and control sand flies by using their odor compounds or the plants themselves alongside simple glue traps, or by spraying them with deadly pesticides for sand flies that are safe for humans and mammals (e.g.,
boric acid or
spinosad), thereby stopping the spread of the disease. Of the dozens of plants examined, the plants that attracted especially sand flies are
Ochradenus baccatus,
Prosopis farcta, and
Tamarix nilotica.
Syria History of cutaneous leishmaniasis in Syria and MENA region Cutaneous leishmaniasis is endemic to
Syria and other countries in the
Middle East and North Africa. As of 2021, Syria had the highest prevalence of cutaneous leishmaniasis in the world. The first reported case of cutaneous leishmaniasis in Syria was as early as 1745. The earliest mentions of cutaneous leishmaniasis can be found in a collection of ancient Egyptian medical documents known as the
Ebers Papyrus, where a skin condition known as "Nile Pimple" is reported. Through history, the disease has been known by different names, usually relating to where the disease is endemic. For example, it has been referred to as Oriental sore, Aleppo boil, Baghdad boil and Jericho boil. In his 1792 book,
The Natural History of Aleppo, Scottish physician and naturalist Alexander Russell reported that the Arabic name for the disease was "
Habt il senne" or year-long boil. According to Russell, it was believed at the time to be spread through water sources.
Cases of cutaneous leishmaniasis in Syria prior to 2011 There were no records of cases of cutaneous leishmaniasis before 1950 in Syria, and until 1960, the disease was endemic only to
Aleppo,
Damascus, and off the banks of the river
Euphrates. The National Leishmaniasis Control Program was established in 1985, and focused on the control of vectors and reservoirs; establishing services such as laboratory diagnosis and the treatment of cases; as well as releasing monthly reports of cases in order to monitor trends and spreads. Cases rose in the early 1990s, which is believed to be due to rapid urbanisation and migration form rural to urban areas.
2011 war and subsequent outbreaks Cases were already increasing prior to the
Arab Spring protests of 2011 and
subsequent civil war, and were exacerbated due to the breakdown of government systems. This is evidenced from the pre-war reports, in which there was already a significant increase in cases recorded. Both leishmaniasis caused by
L. major and
L. tropica are present in Syria. Consequently, the disease is transmitted in two ways: through a person-sandfly-person chain of transmission in the case of
L. tropica and through rodent-sandfly-person in the case of
L. major. Cutaneous leishmaniasis caused by
L. major has an incubation period of less than four months, while
L. tropica is from two to eight months, further complicating the prevention of transmission. The forced migration of populations can lead to exposure of non- immune populations to infection, allowing cutaneous leishmaniasis to change from "a sporadic threat to an epidemic threat." Prior to the civil war in Syria, cases in Lebanon ranged from 0 to 6 between 2005 and 2011, whereas in 2012 there were 1,275 cases. In 2013, out of a total of 1,033 cases, 988 or 96.6% were among the refugee population. Similarly, in 2014, 65.3% of reported cases were Syrian refugees where as in 2015 and 2017, the cases ranged between 81.1 and 89.6%. and there has been an increased prevalence in cases due to the influx of Syrian refugees along with the already existent endemic population. In contrast, a study in Jordan found that the disease was marginally more prevalent amongst male refugees than females (54.8% and 45.2%). In Jordan, refugee camps are often overpopulated, creating a strain on resources such as water, sanitation and medical care. One study which looked at 558 cases reported from 2010 to 2016 found that the majority (92.1%) had been infected before entry to Jordan.
Nepal A recent study with a large series of cases from the midwestern region of
Nepal has demonstrated that cutaneous leishmaniasis is an under-recognized medical condition posing health challenges, mandating new guidelines for its reduction and eradication. ==Other animals==