International Conference and Expo on Dermatopathology and Skin Care
American University of Beirut Medical Center,Beirut
Title: The Epidemic of Cutaneous Leishmaniasis among Syrian Refugees in Lebanon
Biography: Ibrahim Khalifeh
Background: Cutaneous leishmaniasis (CL), a potentially chronic and disfiguring condition, has been thrust in to the spotlight following reports among military personnel returning from the Near East. Lebanon (LB), a non-endemic area, is now suffering a health care crisis in the wake of a CL epidemic brought from endemic Syria by the protracted conflict in the region, resulting in the displacement of over 1,500,000 refugees into LB.
Materials and Methods: Punch biopsies (1 patient sampled/displaced family, n=158) were taken for histologic examination (parasitic index) and molecular speciation by PCR. Demographics, migration patterns, lesion number and characteristics including presence of extensive disease (ED) were documented. ED was defined as having ≥1 of the following: Disfiguring, threatening the function of vital sensory organs, lesion present for >12 months, >3cm, ≥5 lesions and special forms of CL (i.e. sporotrichoid).
Results: 1275 refugees with CL fled from endemic and non-endemic areas alike, had been in LB 5 months on average and 77% of them reported the appearance of the first lesion after being in LB for > 2 months (average incubation period 2-8 weeks). Of the 158 sampled patients, PCR resulted in 135 cases of L. tropica and 23 L. major types. In this special conflict population, the preponderance of patients sampled were under 18 years old (80%) and an average of 52% members were affected/family (mean number of members = 6). The majority of patients met criteria for ED (59%) including: 27.3% with disease compromising a sensory organ, 9% special forms, 37.3% disfiguring, 49% >3cm, 20% > 5 lesions and 9% chronic lesions. Parasitic index, molecular subtype and geographic location were similar for ED versus non-ED. ED was more prevalent among children (median 9 vs. 21 years; p=0.002) and was more frequently observed on the face and lower extremities (p=0.002). Both age and anatomic location were predictors of ED by multivariate logistic regression. 82% of the cases had initial cure after treatment.
Conclusion: In studying this epidemic, we are seeing a new face of CL in times of war; stressful and unsanitary living conditions may account for the uncharacteristically high number patients with ED. Furthermore, the majority of patients reported appearance of lesions well beyond average documented incubation periods for CL suggesting the transfer and propagation of CL to LB and other non-endemic countries harboring refugees.