Anthroponotic cutaneous leishmaniasis caused by Leishmania tropica has been
endemic in Aleppo, Syria for centuries. The first modem description of the disease
was also done in Aleppo. A surveillance system is in place, and the numbers of
annual recorded cases have been rising from a few hundred to thousands in the
late 1980s, to more than 5,000 in most years from 1990, and to more than 10,000
since 2003.
A retrospective analysis of routinely collected demographic data was
performed. The clinical course was examined in a subset of patients. One hundred
and thirty-two patients were recruited for follow-up study. Parasites were isolated
from the lesions of these patients before treatment and during the course of
treatment. Eighty isolates were tested for drug sensitivity in amastigotemacrophage
system and typed to species level. Molecular fingerprinting was
applied to a subset of isolates. Interviews were held with patients or accompanying
adults about their knowledge, attitudes and practices regarding prevention,
diagnosis and treatment.
Leishmaniasis patients in Aleppo were younger than the general population
(median age 13 vs. 19 years), and females predominated among adults. Children
and males were more likely to have lesions on the face. Smear positivity decreased
with patient age (OR=O.5 in over-forties compared to under-tens). Smear positivity
peaked at two-month lesion duration (OR=2.2 compared to lesion duration of
<1 month). A significant proportion of patients, especially adults, did not complete
their treatment course.