Visceral leishmaniasis in Afghanistan

Recently, 6 parasitologically confirmed cases of visceral leishmaniasis in patients from 3 Afghan provinces were observed in HealthNet International's leishmaniasis treatment centre in Kabul. The patients' demographic and clinical characteristics are given in Table 1. This increased detection in the number of cases is of concern, since it follows the report of 2 US soldiers stationed in Afghanistan with the disease4 and 2 cases from Baghlan province in 2004 (unpublished data from HealthNet International, Kabul). There is little historical or current data on visceral leishmaniasis in Afghanistan: neither vectors nor reservoirs have been incriminated, and it is unknown whether the transmission cycle is anthroponotic or zoonotic. Epidemiologic research is highly warranted. The increased detection of visceral leishmaniasis in Afghanistan will require a reassessment of leishmaniasis prevention and control strategies. Unlike cutaneous leishmaniasis, the visceral form is potentially fatal, with case-fatality rates as high as 85%. Large-scale occurrence of a potentially fatal disease in a population that is largely malnourished and impoverished would be devastating. Leishmaniasis management guidelines in Afghanistan will have to be updated to include available treatment regimens for the visceral form of the disease. Additional prevention and control measures, such as the reduction of animal reservoirs (if any), the introduction and upscaling of personal protection and vector control, awareness campaigns, and training for health professionals, will require significant input from international funding agencies, above and beyond what is currently available for cutaneous leishmaniasis control. From the Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UIC ([Toby Leslie], [Rosalynn Ord]); HealthNet International, Kabul, Afghanistan ([Sarah Saleheen], [Mohammad Sami], Mayan, [Kathy Fiekert], [Annick Lenglet], [Richard Reithinger]); and the Ministry of Public Health, Kabul, Afghanistan (Mehboob, Fiekert)