Cutaneous leishmaniasis in Afghanistan.

Area of Science:

• Parasitology and Tropical Medicine
• Epidemiology of Infectious Diseases
• Dermatology

Background:

• Old World cutaneous leishmaniasis (OWCL) is a sand fly-transmitted infection prevalent across Africa and Asia, with Afghanistan experiencing a particularly high burden.
• The primary causative agents in Afghanistan are Leishmania tropica (anthroponotic) and Leishmania major (zoonotic), with L. tropica being more common, especially in urban areas.
• Decades of conflict have severely disrupted Afghanistan's health infrastructure, complicating disease control efforts.

Purpose of the Study:

• To review the epidemiological and clinical characteristics of cutaneous leishmaniasis (CL) in Afghanistan.
• To highlight challenges in disease control and treatment within the country.
• To identify potential areas for future research to improve CL management in Afghanistan.

Main Methods:

• Review of existing literature and data on CL epidemiology and clinical presentation in Afghanistan.
• Analysis of species distribution, focusing on Leishmania tropica and Leishmania major.
• Examination of available treatment options and their reported efficacy, including antimonials and miltefosine.

Main Results:

• CL prevalence in Afghanistan peaks in children aged 5-10 years, with nodules, ulcerated nodules, and papules being the most common lesion types.
• Healed CL lesions result in depigmented scars, often causing significant psychosocial distress.
• Injectable antimonials remain the primary treatment in the public sector, with anecdotal evidence suggesting high efficacy; oral miltefosine also shows promise.

Conclusions:

• Cutaneous leishmaniasis poses a substantial public health problem in Afghanistan, characterized by specific age-related prevalence and lesion types.
• Control strategies are hampered by the fragile health system and ongoing instability.
• Further clinical trials and research are crucial to optimize treatment protocols and control strategies for CL in Afghanistan.