Cutaneous Leishmaniasis, Northern Afghanistan

To the Editor: In Afghanistan, most cutaneous leishmaniasis cases are caused by Leishmania tropica, which is transmitted anthroponotically by the sandfly Phlebotomus sergenti (1).Cutaneous leishmaniasis can have devastating effects on local communities because of its clinical symptoms, i.e., large, multiple, or both, disfiguring lesions, that can lead to social ostracism of affected persons (e.g., women are often deemed unsuitable for marriage or to raise children) (2).Cutaneous leishmaniasis is considered a low priority disease by international donor agencies because treatment costs are high and the disease does not cause death (3).Data on the effects of cutaneous leishmaniasis in Afghanistan previously have been available only for Kabul city; recent studies have reported an estimated 67,500 cases (4).Because of the migration of an estimated 4.5 million infected Afghan refugees returning home from other countries, the sporadic treatment of patients infected with cutaneous leishmaniasis, and limited control of the sandfly vector, L. tropica has spread to areas that were previously nonendemic for the disease, e.g., northeastern Afghanistan.A survey in Faizabad city, Badakhshan Province, was conducted in June 2003 by HealthNet International to collect data on the impact of cutaneous leishmaniasis.Leishmaniasis in this region is transmitted from April to October.The city was divided into 10 districts, and 20 households were surveyed along a randomly chosen transect drawn from the center of each district.A team of experienced medical staff clinically diagnosed cutaneous leishmaniasis (based on the presence or absence of