02037nas a2200217   4500000000100000008004100001653001700042653002500059653001800084653001700102653003400119653001500153100001500168700001300183700001500196245007600211300001100287490000700298520150000305022001401805       2015                            d10aEpidemiology10anorthern Afghanistan10aLeishmaniasis10aSkin lesions10acutanizing leishmania species10aPrevention1 aFaulde M K1 aErkens K1 aDieterle R00a[Epidemiology and prevention of leishmaniasis in northern Afghanistan].  a347-540 v663 a<p><strong>BACKGROUND: </strong>Leishmaniasis is estimated to cause the ninth largest disease burden among infectious diseases worldwide and it is not preventable by vaccination or chemoprophylaxis, but only by personal protective measures preventing bites of infectious arthropod vectors.</p>

<p><strong>OBJECTIVES: </strong>Which leishmania species are endemic in northern Afghanistan, what are the clinical characteristics of skin lesions produced by cutanizing leishmania species, what are their epidemiological characteristics, and which preventive measures are feasible?</p>

<p><strong>METHODS: </strong>The medical literature was reviewed, knowledge gaps were analyzed and completed by our own data collected locally.</p>

<p><strong>RESULTS: </strong>Four Leishmania species are considered endemic in northern Afgahanistan, of which Leishmania tropica, L. major, and L. donovani can produce skin lesions while L. donovani and L. infantum visceralize. Transmission modes and seasons vary markedly among focally epidemic urban anthroponotic L. tropica and rural enzootic L. major. Combined preventive measures may reduce the infection rate by more than 10,000-fold.</p>

<p><strong>CONCLUSION: </strong>Cutaneous as well as visceral leishmaniasis can occur among returnees from Afghanistan. Atypical, poorly healing skin lesions can be caused by L. donovani. Extensive use of personal protective measures against arthropod vectors is strongly recommended for all travelers.</p>
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