title: [Epidemiology and prevention of leishmaniasis in northern Afghanistan].
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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?
  
  
  METHODS
  The medical literature was reviewed, knowledge gaps were analyzed and completed by our own data collected locally.
  
  
  RESULTS
  Four Leishmania species are considered endemic in northern Afghanistan, 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Zentrales Institut des Sanitätsdienstes der Bundeswehr Koblenz, Postfach 7340, 56065, Koblenz, Deutschland, MichaelFaulde@bundeswehr.org.
authors.forename: M K
authors.initials: MK
authors.lastname: Faulde
authors.forename: K
authors.initials: K
authors.lastname: Erkens
authors.forename: R
authors.initials: R
authors.lastname: Dieterle
mesh_terms: D000346:Afghanistan / Q000453:epidemiology; D019353:Endemic Diseases / Q000517:prevention & control* / Q000706:statistics & numerical data*; D006801:Humans; D007896:Leishmaniasis / Q000453:epidemiology* / Q000517:prevention & control*; D015995:Prevalence; D012307:Risk Factors; D012621:Seasons; D014195:Travel / Q000706:statistics & numerical data*; D016896:Treatment Outcome
references.citation: Med Sci Monit. 2012 Apr;18(4):SR22-8
references.pmid: 22460108
references.citation: Iran J Parasitol. 2013 Jul;8(3):348-58
references.pmid: 24454426
references.citation: Ann Trop Med Parasitol. 2011 Mar;105(2):163-76
references.pmid: 21396252
references.citation: Lancet Infect Dis. 2002 May;2(5):268
references.pmid: 12062990
references.citation: Mil Med. 2008 Nov;173(11):1060-7
references.pmid: 19055179
references.citation: Clin Microbiol Infect. 2010 Mar;16(3):209-24
references.pmid: 20222896
references.citation: Med Parazitol (Mosk). 1990 Jul-Aug;(4):10-3
references.pmid: 2146471
references.citation: J R Army Med Corps. 2012 Sep;158(3):225-8
references.pmid: 23472571
references.citation: J Eur Acad Dermatol Venereol. 2007 Nov;21(10):1432-3
references.pmid: 17958865
references.citation: CMAJ. 2006 Aug 1;175(3):245
references.pmid: 16880443
references.citation: Am J Trop Med Hyg. 2011 Jul;85(1):60-3
references.pmid: 21734125
references.citation: Int J Med Microbiol. 2008 Jul;298(5-6):543-50
references.pmid: 17888728
references.citation: Z Tropenmed Parasitol. 1969 Sep;20(3):293-302
references.pmid: 5393302
references.citation: Emerg Infect Dis. 2006 Oct;12(10):1623-4
references.pmid: 17176597
references.citation: Trans R Soc Trop Med Hyg. 2004 Jun;98(6):373-8
references.pmid: 15099994
references.citation: PLoS One. 2012;7(5):e35671
references.pmid: 22693548
references.citation: Acta Trop. 2008 Feb;105(2):131-8
references.pmid: 18068684
references.citation: Lakartidningen. 2012 Feb 8-14;109(6):279-81
references.pmid: 22458122
references.citation: PLoS Negl Trop Dis. 2012 Jan;6(1):e1463
references.pmid: 22272366
references.citation: J Infect. 2014 Nov;69 Suppl 1:S10-8
references.pmid: 25238669
references.citation: Am J Trop Med Hyg. 2012 Jan;86(1):115-8
references.pmid: 22232460
references.citation: Dermatol Online J. 2008 Jun 15;14(6):1
references.pmid: 18713582
references.citation: Trends Parasitol. 2008 Apr;24(4):151-3
references.pmid: 18314394
references.citation: Med Parazitol (Mosk). 1963 Nov-Dec;32:728-35
references.pmid: 14159831
references.citation: Med Parazitol (Mosk). 1995 Jul-Sep;(3):24-8
references.pmid: 7476676
references.citation: J R Army Med Corps. 2012 Sep;158(3):221-4
references.pmid: 23472570
references.citation: Clin Epidemiol. 2014 May 03;6:147-54
references.pmid: 24833919
references.citation: Hautarzt. 2014 Feb;65(2):125-9
references.pmid: 24337239
references.citation: Emerg Infect Dis. 2004 May;10(5):966-7
references.pmid: 15216854
references.citation: Emerg Infect Dis. 2004 Sep;10(9):1681-4
references.pmid: 15498178
references.citation: Med Parazitol (Mosk). 1996 Jan-Mar;(1):13-7
references.pmid: 8700003
references.citation: Acta Trop. 2009 Apr;110(1):28-34
references.pmid: 19161965
references.citation: Expert Opin Biol Ther. 2014 Nov;14(11):1641-9
references.pmid: 25077737