Emerging cutaneous leishmaniasis in Sirte-Libya: epidemiology, recognition and management

ABSTRACT

The present work aimed to determine the risk factors, lesion pattern and effective therapy of emerging ZCL in Sirte-Libya. The study was carried out on 163 patients referred to health centers of Al-Gadaheya and Al-Hisha villages in the years 2006 and 2007. Methods consisted of a predesigned questionnaire [personal and demographic data], clinical examination of lesions, and parasitological examination by slit smear, treatment and follow up. Results showed an annual incidence of 0.95%, with onset peak during autumn months. Important local risk factors included increased occupational exposure of farmers and construction worker to infection from fat sand rat burrows, facilitated by lack of prevention knowledge and prophylactic measures; close association of bad-ventilated animal shelters to houses, and increased soil moisture by warm spring ponds. The majority of lesions were multiple [73%] located on legs, arms, and face 66.8%, 52.1% and 41.1%. Most lesions were active 1-2 month duration and 1-3 cm size, ulcerative type [77.3%], and papulo-nodular [21.5%]. Giemsa slit smear proved quite reliable for active lesions, confirmed 79.5% of lesions. The majority of lesions [60.1%] were treated by intra-lesional Pen-tostam. Systemic route was restricted to facial, over-joint, multiple or large lesions producing good response in 31.9%. Cryotherapy and oral Fluconazole gave satisfactory response in 5.5% and 2.5% of cases