PREVALENCE OF CUTANEOUS LEISHMANIASIS AMONG REFUGEE CAMPS IN SALAHDEEN PROVINCE, IRAQ

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PREVALENCE OF CUTANEOUS LEISHMANIASIS AMONG REFUGEE CAMPS IN SALAHDEEN PROVINCE, IRAQ

OMAIMA IBRAHIM MAHMOOD ¹; ZIYAD TAHA ² and MUSTAFA HUSAIN ASHOOR ³

^1,2 Dept. Microbiology, College of Veterinary Medicine, Tikrit University, Iraq

³ Dept. Biology, College of Science, Tikrit University, Iraq

Financial Disclosure: have no financial interests related to the material in the manuscript.

Funding/ Support:  This study was not supported.

Received: 10 March 2019;     Accepted: 18 April 2019

INTRODUCTION

Leishmania is the most important protozoan infection in the Middle East region (WHO, 2012). There are three important forms of leishmaniasis (cutaneous, mucocutaneous, and visceral) that are transmitted by sandfly (Herwaldt, 1999). Leishmania tropica is a parasite of cutaneous leishmaniasis (CL) in central Asia, and Middle East, including Iraq (Postigo, 2010).

Several risk factors play an important role in increased frequency of infection, environmental variations and habits of societies (Khan and Muneeb, 2005), but the most significant are those associated with wars, population clustering and moving and migration of susceptible populations, resulting in the exposure of unimmunized individuals to the parasite (Douba et al., 1997).

Among the different regions in Iraq, Salahuddin is known to have high prevalence of CL (Al-Warid     et al., 2017). After 2014  events  in this province and

Corresponding author: Dr. OMAIMA IBRAHIM MAHMOOD

E-mail address: dr_aim_s@yahoo.com

Present address:Dept. Microbiology, College of Veterinary Medicine, Tikrit University, Iraq

because of a different war-related factors, new outbreaks have been reported, especially in the refugees' camps. In this study, we assessed the current leishmaniasis situation between refugees in three camps in Salahuddin province.

MATERIALS AND METHODS

Records from the United Nations Refugee Agency (UNHCR) were reviewed for cases of leishmaniasis from three camps (Tal-Alsebat, Al-Shhama and Dream city) in Salahuddin province reported between January to March 2015. All cases reported were reviewed in terms of age, gender, clinical presentation, presence of single or multiple lesions and number of individual within the family, treatment, and outcome, as well as the socioeconomic and environmental state were collected at the refugee camps. In addition to clinical manifestations, microscopic confirmation was obtained by taking smears of skin lesion, air dried, fixed with methanol, and stained with Giemsa stain, figure (1) (Schnur and Jacobson 1987).

RESULTS

Most infection cases were in Tal-Alsebat camp 63.9% while in Al-Shhama and Dream city camps were 31.2% and 4.8% respectively. 73.6% patients were

Table 1: Distribution of Leishmania cases according to some infection characteristics.

Figure 1: Leishmania tropica, amastigote stained with Giemsa stain  100X

Figure 2: Iraqi refugees in temporary, unhygienic, which are breeding lands for disease and different vectors, Salahuddin province, Iraq, 2015.

Figure 3: Patterns of leishmaniasis among Iraqi refugees in Salahuddin province camps, 2015. (A) Lesions disfiguring the face. (B) lesions on the foot.

DISCUSSION

In recent years, results of many researches have begun to identify the impacts of wars and conflict on global health outcomes and infectious diseases appearance (Desjeux, 2001; Kerridge et al., 2012). Vector borne diseases, such as leishmaniasis may be propagated in many regions as a result of various social and healthcare system failures, including: movement of population, shortage in health programs, neglect in medical care, and the demolition of health-related substructure (Iqbal, 2006; Kerridge et al., 2012).

There are many factors that play critical roles in the incidence of CL in different parts of Salahuddin province after 2014 events particularly, in refugee camps. Those camps had mainly provisional houses of tents, equipped with inadequate sanitation, waste disposal, and insulation (figure 2). Such conditions are ideal for vectors of Leishmania tropica (Killick-Kendrick et al., 1995) and significant in propagating disease within human populations. Crowding, destitution, stress, malnutrition and weakened immunity are all risk factors for CL (Beyrer et al., 2007). The small rodents and dogs are the reservoir hosts for Leishmania (Murray, 2005), which are out of control in those camps. This record agreed with the outbreaks in refugee camps in many countries as in Kabul, Afghanistan (Rowland et al., 1999, Reithinger et al., 2010) and in Syria (Maya et al., 2014).

Result, according the age distribution of those infected with Leishmania, has been inclined towards the younger age groups with a significant difference and this result agreed with (Rahi, 2011). There were no significant differences between male and female, both sex lived in the same place and have the same opportunity to expose to sandfly-associated environmental conditions (Kumar et al., 2007).

The face, neck and upper limbs were the higher parts of lesions localized in infected individual especially in children (66%) and lower limbs (34%) figure (3). This could be correlated with the feeding hours of sand fly, which is more active at the time when young children are sleeping and these body parts are more exposed to vector feeding (Romero et al., 2010).

CONFLICT OF INTEREST

The authors declare no conflicts of interest and no affiliation with companies or institutions that could benefit from this study.

REFERENCES

Al-Warid, HS.; Al-Saqur, IM.; Al-Tuwaijari, SB. and AL Zadaw, KAM. (2017): The distribution of cutaneous leishmaniasis in Iraq: demographic and climate aspects. Asian Biomed., 11, 3, 255–260.

Beyrer, C.; Villar JC.; Suwanvanichkij, V.; Singh, S.; Baral, SD. and Mills, EJ. (2007): Neglected diseases, civil conflicts, and the right to health. Lancet., 370, 9587, 619-627.

Desjeux, P. (2001): Worldwide increasing risk factors for leishmaniasis. Med. Microbiol. Immunol., 190 1,2, 77-79.

Douba, M.; Mowakeh, A. and Wali, A. (1997): Current status of cutaneous leishmaniasis in Aleppo, Syrian Arab Republic. Bull World Health Organ. ,75, 253–9.

Herwaldt, BL. and Leishmaniasis. Lancet. (1999): 354:1191–910.

Iqbal, Z. (2006): Health and human security: the public health impact of violent conflict. Int. Stud. Q., 50,3, 631- 649.

Kerridge, BT.; Khan, MR. and Sapkota, A. (2012): Terrorism, civil war, one-sided violence and global burden of disease. Med. Confl. Surviv., 28, 3, 199-218.

Khan, SJ. and Muneeb, S. (2005): Cutaneous leishmaniasis in Pakistan. Dermatol. Online J., 11,1, 4.

Killick-Kendrick, R.; Killick-Kendrick, M. and Tang, Y. (1995): Anthroponotic cutaneous leishmaniasis in Kabul: the high susceptibility of Phlebotomus sergenti to Leishmania tropica. Trans, R. Soc. Trop. Med. Hyg. 89,477.

Kumar, R.; Bumb, RA.; Ansari, NA.; Mehta, RD. and Salotra, P. (2007): Cutaneous leishmaniasis caused by Leishmania tropica in Bikaner, India: parasite identification and characterization using molecular and immunologic tools. Am. J. Trop. Med. Hyg. 76,896-901.

Maya, S.; Khalil, C.; Grace, I.; Haifaa, K.; Robert, H.; Habib, A.; Nada, G.; Alissar, R. and Ibrahim, K. (2014): Ongoing Epidemic of Cutaneous Leishmaniasis among Syrian Refugees, Lebanon. Emerg. Infect. Dis., 20,10, 1712–1715.

Murray, HW.; Berman, JD.; Davies, CR. and Saravia, NG. (2005): Advances in leishmaniasis. Lancet., 366, 1561–77.

Postigo, JAR. (2010): Leishmaniasis in the World Health Organization Eastern Mediterranean Region. Internat. J. Antimicrob. Agents., 36. 62-65.

Rahi, AA. (2011): Cutaneous leishmaniasis at Wasit governorate. Baghdad Science Journal. 8: 286-8.

Reithinger, R.; Mohsen, M. and Leslie, T. (2010): Risk factors for anthroponotic cutaneous leishmaniasis at the household level in Kabul, Afghanistan. PLoS. Negl. Trop. Dis., 4,639.

Romero, IC.; Tellez, J.; Suárez, Y.; Cardona, MT.; Figueroa, R.; Zelazny, A. and Saravia, NG, (2010): Viability and burden of Leishmania in extralesional sites during human dermal leishmaniasis. PLoS. Negl. Trop. Dis., 4,819.

Rowland, M1.; Munir, A.; Durrani, N.; Noyes, H. and Reyburn, H. (1999): outbreak of cutaneous leishmaniasis in an Afghan refugee settlement in north-west Pakistan. R Soc Trop Med Hyg., 93,2,133-6.

Schnur, LF. and Jacobson, RL. (1987): Appendix III. Parasitological techniques, p. 449-541. In W. Peters and R. Killick-Kendrick (ed.), The leishmaniases in biology and medicine, vol. 1. Academic Press, London, United Kingdom.

World Health Organization (2012): Manual for case management of cutaneous leishmaniasis. Geneva: The Organization.