In the Journals

Leishmaniasis outbreak in Lebanon most prevalent in Syrian refugees

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October 14, 2014

Early detection and diagnosis, as well as collaboration with local medical personnel, are key elements in controlling an ongoing epidemic of cutaneous leishmaniasis among Syrian refugees in Lebanon, according to recent findings.

In the study, researchers evaluated 1,275 Syrian refugees living in refugee camps in eastern Lebanon. The researchers triaged the patients, who were from 213 displaced families, into three groups: 1) those with diagnosed, confirmed and partially treated leishmaniasis; 2) those with leishmaniasis that was diagnosed and confirmed, but not treated; and 3) undiagnosed leishmaniasis. There were 55 families in the first two groups, and 158 families (948 patients) in the third group. These patients were examined for diagnosis confirmation and were included in the ensuing statistical analyses. Punch biopsy was used for microscopic confirmation, and molecular evaluation was done by PCR.

The researchers also characterized the patient population. The average patient age was 17.6 years, with 80% of patients younger than 18 years. Each family consisted of three to 13 individuals, and the proportion of infected family members ranged from 8% to 100% (mean, 52%).

The refugees came from the following areas of Syria: Aleppo (74 patients; 63%) Homos (30 patients; 27.3%) and Damascus (six patients; 5.4%). Only one of the patients with leishmaniasis was a Lebanese resident who not traveled within the past 5 years.

The leishmaniasis patients had been in Lebanon for a range of 1 and 24 months (mean, 5 months) and reported the first sighting of a cutaneous lesion at between 1 a 7 months (mean, 5 months) before they were medically evaluated. The majority (77%) of the patients said their first lesion was seen more than 2 months into their time in Lebanon, and 53% of the patients had a recollection of an insect bite prior to that time. The most common cutaneous lesions sites were the head and neck (43% of patients), followed by the upper extremities (26% of patients) and the lower extremities (11%). The range of lesions among the patient population was between one and 15 (mean, 3), and lesion size ranged from 1 cm to 15 cm (average size, 2.6 cm). Fifty-six percent of the lesions were verrucous lesions, 43% were plaque/nodular lesions and 2% were papular lesions. The majority of cases (83%) consisted of dry lesions, with seven patients (4%) presenting with primary wet lesions and 12 patients (8%) presenting with both lesion types. PCR analysis revealed L. tropica, a species endemic to the Aleppo region of Syria, in 85% of the patients.

The patients were treated with meglumine antimoniate (85 mg/mL; 5-mL ampoules) donated by WHO. This medicine was delivered intralesionally in 80% of patients and intramuscularly in 20% of patients.

According to the researchers, the refugee population in Lebanon is particularly vulnerable to leishmaniasis, despite the overall low numbers in Lebanon.

“Poverty, malnutrition, population displacement, weakened immunity, and poor housing are all risk factors for cutaneous leishmaniasis,” the researchers wrote. “Such conditions are ideal for vectors of L. tropica and enable leishmaniasis to flourish as an anthroponotic disease.”

Disclosure: The researchers report no relevant financial disclosures.

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