Leishmaniasis in Northern Syria during Civil War

Abstract

Since the onset of the ongoing civil war in Syria, the governmental surveillance system for leishmaniasis has lost access to provinces of northern Syria. The MENTOR Initiative, an international not-for-profit organization, was commissioned to implement an integrated leishmaniasis control program, providing an opportunity to reassess the epidemiology of leishmaniasis in northern Syria. Epidemiologic data and biologic samples for molecular species diagnostics were collected from collaborating local health centers. Incidence peaked in March 2015 at 7,743 estimated monthly cases. High levels of transmission were observed in traditional endemic regions but extended to previously hypoendemic regions, such as Al-Raqqa and Al-Hasakah. Incidence decreased to 3,209 in July 2015. Data indicate that the prewar trend of increasing incidence of cutaneous leishmaniasis accelerated during the beginning of armed conflict but declined after implementation of the comprehensive control program by the MENTOR Initiative. Molecular analysis revealed a spectrum of Leishmania species and sporadic cases of visceral leishmaniasis.

Cutaneous leishmaniasis in Syria: A review of available data during the war years: 2011–2018

“…Several authors have noted that the onset of the war coincided with a significant increase in number and distribution of CL cases across the country [10][11][12][13][14][15][16][17][18][19][20][21] and that movements of Syrian refugees led to a general increase in number of CL cases reported from resettlement countries [22][23][24][25][26][27][28][29][30]. Our analysis focuses on a comprehensive quantification of the evolution of CL epidemiology throughout Syria's territory, an exercise that, to our knowledge, has not yet been attempted.…”

Visceral and Cutaneous Leishmaniases in a City in Syria and the Effects of the Syrian Conflict

“…8 Eight species of the sand fly vector were identified in Syria, with Phlebotomus sergenti and Phlebotomus papatasi being the most predominant. 2,9 Cutaneous leishmaniasis is caused by Leishmania tropica in northern Syria and urban areas such as Aleppo, Idlib, Lattakia, Hama, and Damascus, 6,10 whereas Leishmania major on the other hand accounts for 10% of the CL cases in Syria and is prevalent in rural areas close to Damascus, Deir al-Zour, and Al-Hasakah. 11 Leishmania infantum is the causative agent of most VL cases.…”

Relevance of epidemiological surveillance in travelers: an imported case of Leishmania tropica in Mexico

“…Furthermore, environmental aspects such as climate change, growing urbanization, socio-economic development, tourism and migrations are changing the epidemiology of leishmaniasis [9][10][11] . This highlights the need of establishing the molecular diagnostic as an essential tool for the active surveillance to avoid the emergence of outbreaks of exotic parasites.…”

“…Currently, no morphological parameters exist that permit to distinguish between Leishmania species 6,7 . The increasing worldwide travel, ecoturism and displacement of migrants are affecting the distribution and incidence of patients with leishmaniasis, especially in the Middle East countries where L. major and L. tropica are the main pathogenic species [9][10][11] . In Mexico, most of the cutaneous leishmaniasis cases are caused by L. mexicana 12,13 .…”