Cutaneous leishmaniasis emerging among refugees in Lebanon

There are approximately 1.5 million Syrian refugees in Lebanon, placing tremendous political and socio-economic strain on the country. Few cutaneous leishmaniasis cases had been recorded in Lebanon before 2012. But the disease is endemic in Syria and clinicians have reported suspected cases among refugees.  

Cutaneous leishmaniasis causes skin lesions on exposed parts of the body, leaving disfiguring scars. The parasite that causes the disease is transmitted by sandflies, which have been found in high altitude mountains in Lebanon, increasing disease risk. 

Researchers in Lebanon and the UK tested 48 suspected cases of cutaneous leishmaniasis among Syrian refugees in northern Lebanon and confirmed their disease status. Molecular-level analyses of their skin lesions revealed that Leishmania tropica was the parasitic species causing more than 90 per cent of the infections. The skin lesions healed in most patients following one or two courses of intra-lesional treatment with the commonly used anti-leishmania drug, glucantime. 

The researchers also found evidence of possible local disease transmission by indigenous sandflies in three previously healthy refugees who had lived in Lebanon for almost three years, with inadequate sanitation. This raises concerns about the potential of resurgence of the disease in Lebanon. 

“This study adds evidence to our premise that the conflicts in Syria and Iraq, and perhaps now in Yemen, are promoting the re-emergence of neglected tropical disease in the Middle East, and shows how human reservoirs of infection can introduce illness through local vector populations,” says Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine, who was not involved in the study. 

The researchers plan to gather data on the distribution of local sandflies and their infection with leishmania parasites in order to develop a local prevention and control strategy, says the study’s first author, microbiologist Dima El Safadi, of the University of Lebanon.

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