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Epidemiologie und Prophylaxe der Leishmaniasis in Nordafghanistan

Epidemiology and prevention of leishmaniasis in northern Afghanistan

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Zusammenfassung

Hintergrund

Innerhalb der globalen Infektionserkrankungen steht die Leishmaniasis bezüglich ihrer Krankheitslast an neunter Stelle und ist weder durch Impfung noch durch eine Chemoprophylaxe, sondern lediglich durch persönliche Protektionsmaßnahmen zur Verhinderung infizierter Vektorenstiche präventabel.

Fragestellung

Welche Spezies der Leishmanien sind in Nordafghanistan endemisch, welche klinische Ausprägung haben die dortigen kutanisierenden Leishmanienspezies, welche epidemiologischen Besonderheiten liegen vor und welche Präventionsmaßnahmen stehen zur Verfügung.

Material und Methoden

Die medizinische Literatur wurde ausgewertet, auf Wissenslücken analysiert und durch eigene Erkenntnisse vor Ort komplettiert.

Ergebnisse

In Nordafghanistan sind 4 Leishmanienspezies endemisch, von denen Leishmania (L.) tropica, L. major sowie L. donovani kutanisieren und L. donovani sowie L. infantum viszeralisieren können. Transmissionsmodus und -saisonalität fokal epidemisch vorkommender L. tropica und L. major variieren deutlich. Kombinierte Präventionsmaßnahmen erniedrigen die Infektionswahrscheinlichkeit um mehr als das 10.000-Fache.

Schlussfolgerungen

Bei Rückkehrern aus Afghanistan ist mit dem Auftreten von verschiedenen kutanen und viszeralen Formen der Leishmaniasis zu rechnen. Schlecht heilende, eher atypische Hautulzerationen können durch L. donovani hervorgerufen werden. Die strikte Anwendung persönlicher Schutzmaßnahmen gegen Vektoren wird allen Reisenden in die Region empfohlen.

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.

Objectives

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 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.

Conclusion

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.

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Authors and Affiliations

  1. Zentrales Institut des Sanitätsdienstes der Bundeswehr Koblenz, Postfach 7340, 56065, Koblenz, Deutschland

    M.K. Faulde

  2. Institut für Medizinische Mikrobiologie, Immunologie und Parasitologie, Universitätsklinikum Bonn, Bonn, Deutschland

    M.K. Faulde

  3. Kommando Sanitätsdienst der Bundeswehr, Koblenz, Deutschland

    K. Erkens

  4. Fachsanitätszentrum Leipzig, Leipzig, Deutschland

    R. Dieterle

Authors
  1. M.K. Faulde
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  2. K. Erkens
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Correspondence to M.K. Faulde.

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M.K. Faulde, K. Erkens und R. Dieterle geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Faulde, M., Erkens, K. & Dieterle, R. Epidemiologie und Prophylaxe der Leishmaniasis in Nordafghanistan. Hautarzt 66, 347–354 (2015). https://doi.org/10.1007/s00105-015-3602-4

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