Afghanistan calls for help to tackle parasitic disease

Afghanistan has appealed for international help to deal with a parasitic skin disease which can cause disability and permanently disfigure. Cutaneous leishmaniasis, a disease that is transmitted by sandflies, causes ulcers on the face, arms and legs.

WHO

"Although not lethal, epidemics of cutaneous leishmaniasis are of concern in
Afghanistan, where war and civil unrest have favoured the spread of the disease
and made its control difficult," the World Health Organisation says in a report on neglected tropical diseases.

An estimated 65,000 people were infected in the Afghan capital Kabul in 2009.

The report adds that "the true burden of cutaneous leishmaniasis remains largely concealed, partly because those most affected live in remote areas with no access to treatment".

The most up-to-date treatment is too expensive to be widely used in most developing countries.

CDC/Dr. D.S. Martin

Leishmaniasis is prevalent in 88 countries on four continents. It is estimated to cause 1.6 million new cases a year.

Brazil and Sudan are suffering steep increases in cases of the visceral form of the disease (see below for symptoms). Brazil has experienced a sharp increase in cases of visceral leishmaniasis, and it is now common in urban as well as rural areas. In Sudan the number of confirmed cases of visceral disease increased four-fold between 2006 and 2007.

"Treatment centres were overwhelmed,and stocks of first-line drugs were depleted," says the WHO report. "The migration of seasonal workersa nd the movement of large numbers of people caused by civil unrest carried the epidemic to neighbouring countries."

Leishmaniasis: the different forms

• Cutaneous: the most common form of the disease. It can produce up to 200 lesions and lead to disability. There are 1.1 million cases reported a year, 90 per cent of them in Afghanistan, Algeria, Brazil, Iran, Peru, Saudi Arabia, Sudan and Syria.
• Mucocutaneous: attacks the invades the mucous membranes of the upper respiratory tract, causing mutilation as it destroys the soft tissues of the nose, mouth and throat. Brazil, Peru and Bolivia account for 90 per cent of cases.
• Visceral: also known as kala azar, it attacks the internal organs and is the most severe form of the disease. Left untreated, it is usually fatal within two years. Symptoms are irregular bouts of fever, substantial weight loss, swelling of the spleen and liver, and low blood count. After treatment, this form may evolve into cutaneous leishmaniasis. There are 500,000 cases reported a year, 90 per cent of them in Bangladesh, Brazil, Ethiopia, India, Nepal and Sudan.