An outbreak of cutaneous leishmaniasis in an Afghan refugee settlement in north-west Pakistan

Cutaneous leishmaniasis (CL) due to Leishmania tropica appears to be an eme rging disease in parts of northeast Afghanistan and north-west Pakistan. Ti margara, an Afghan refugee camp of 17 years' standing, in the district of D ir, North West Frontier Province of Pakistan, experienced a major outbreak of CL in 1997 for the first time. As part of the: investigation, each secti on of the camp was surveyed for CL. Around 38% of the 9200 inhabitants bore active lesions and a further 13% had scars from earlier attacks. According to interview statements, 99% of earlier infections had healed within the p revious 2 years. To confirm the diagnosis, a sample of current CL lesions w as examined parasitologically. Amastigotes were detectable by microscopy in only 36% of lesions. However, 48% of slide-negative cases produced positiv e cultures and some cases negative to both microscopy and culture were posi tive by PCR. Overall detection rate was about 80%. The sandfly Phlebotomus sergenti, a known vector of L. tropica, was captured within the camp, indic ating local transmission. CL has not been reported from this area of Pakist an before. Although the majority of refugees left Afghanistan 2 decades ago , cross-border movement of men is common. The Afghanistan capital, Kabul, i s currently experiencing a major epidemic of CL; infected migrant carriers from Kabul are probably the source of the outbreak in Timargara.