Effect of the Syrian Civil War on Prevalence of Cutaneous Leishmaniasis in Southeastern Anatolia, Turkey

Abstract

Background: Cutaneous leishmaniasis (CL) is a vector-mediated skin disease, characterized by chronic wounds on the skin and caused by macrophages in protozoan parasites. It is an endemic disease in the southern and southeastern Anatolia region and is still an important public health problem in Turkey. Because of the civil war in Syria, immigrants to this region in the last 3 years have begun to more frequently present with this disease. The aim of this study was to draw attention to the dramatic increase in new cases with CL after the beginning of the civil war in Syria.

Material and methods: In this retrospective study, we evaluated demographic, epidemiological, and clinical features of 110 patients diagnosed with cutaneous leishmaniasis who were admitted to the Department of Dermatology at Kahramanmaras Sutcu Imam University Faculty of Medicine between January 2011 and June 2014.

Results: A total of 110 patients included in the study; 50 (45%) were males, and 60 (55%) were females. The age range of the study group was 1-78 years, and the infection was more prevalent in the 0-20 year age group. Of these patients, 76 (69%) were Syrian refugees living in tent camps and 34 (31%) were Turkish citizens. The majority of the cases were diagnosed between October and December.

Conclusions: Immigrations to endemic regions of Turkey from neighbouring countries where CL incidence is higher may lead to large increases in case numbers. In order to decrease the risk of exposure, housing conditions of the refugees must be improved, routine health controls must be performed, effective measures must be set in place for vector control, and infected individuals must be diagnosed and treated to prevent spread of the infection.

Figure 1

Multiple papulonodular lesions in the right cheek of a 11-year-old Syrian boy diagnosed with cutaneous leishmaniasis.

Figure 2

(A) Multiple papulonodular lesions with sporotrikoid pattern extending from the right fifth finger to arm in a 48 -year-old Syrian woman diagnosed with cutaneous leishmaniasis. (B) Significant clinical healing was observed after a single dose injection of intralesional meglumine antimonate in the same patient.

Figure 3

The distribution of leishmaniasis cases in terms of months.

Figure 4

After removing of the crust of the leishmaniasis lesion, “tin-tack” sign was seen over the wound (sign de clou).