Leishmaniasis in Turkey

doi:10.1016/S0001-706X(02)00134-1

Acta Tropica

Volume 84, Issue 1, October 2002, Pages 43-48

https://doi.org/10.1016/S0001-706X(02)00134-1 Get rights and content

Abstract

Leishmaniases are widespread in most countries in the Mediterranean basin, including Turkey. Two forms are observed in Turkey; Leishmania infantum is responsible from visceral leishmaniasis (VL), and L. tropica causes cutaneous leishmaniasis (CL). Phlebotomus sergenti, P. papatasi, P. major and P. syriacus are considered to be the probable vectors, and dogs are the main reservoir of L. infantum, while P. sergenti is the main suspected vector of L. tropica.

VL is sporadically seen mainly in the Aegean, Mediterranean, and Central Anatolia Regions, but CL is endemic, especially in the Southeastern and Mediterranean Regions. Major touristic sites are free of both infections, and no infection is reported in any tourist. Mean number of annual VL and CL cases reported to Ministry of Health are 40 and 1,204, respectively, in the last four years.

These data suggest that both VL and CL represent a public health problem in Turkey, but a decline is observed in the number of cases with both infections in recent years.

Introduction

The leishmaniases are visceral, cutaneous and mucosal infections transmitted by sandflies and caused by the genus Leishmania. Leishmaniases are endemic in 88 countries on five continents with a total of 350 million people at risk; estimated annual numbers of new cases of visceral leishmaniasis (VL) and cutaneous leishmaniasis (CL) are about 500 000 and 1 500 000, respectively (Desjeux, 1996; Herwaldt, 1999). There is a sharp increase in number of recorded cases in last years. About 100 000 deaths due to VL were estimated among 280 000 people in the epidemic area of southern Sudan between 1984 and 1994 (Seaman et al., 1996), and an epidemic of CL is ongoing in Afghanistan with hundreds of thousands of cases (Hewitt et al., 1998).

Leishmaniases, caused by three Leishmania species, are endemic in the Mediterranean basin, and represent a public health problem in most countries. VL is mainly caused by L. infantum, while L. tropica and L. major are responsible from anthroponotic and zoonotic CL, respectively. Sporadic cases with CL due to L. infantum infection may also be seen. Main reservoirs are dogs for VL and rodents for zoonotic CL (Belazzoug, 1992).

Turkey represents a crossroad between the two continents, Europe and Asia, and shows different ecological and climatic conditions, which are important in the epidemiology of leishmaniasis. Both VL and CL are observed in Turkey, which consists of seven geographical regions (Fig. 1).

Section snippets

Visceral Leishmaniasis

According to Unat (Unat, 1981), the first case of VL from Turkey was reported from Trabzon, in the eastern part of Black Sea Region, at the beginning of nineteenth century; amastigote forms of Leishmania were identified in 1916, from the splenic or hepatic biopsies of 11 Ottoman soldiers in Bagdat, and VL cases were reported from Izmir, in the Aegean Region, in 1918.

In Turkey, L. infantum is responsible for VL; which is sporadically seen mainly in the Aegean, Mediterranean, and Central Anatolia

Cutaneous Leishmaniasis

CL has been called as ‘Beauty Scar’, ‘Oriental Sore’, ‘Allepo Sore’ or ‘Annual Sore’ by the local people living in endemic areas of Turkey. According to Unat (Unat, 1981), endemic CL has been reported since 1833 especially from Asian part of Turkey and Iran; a brochure about CL was prepared by Reinhart and Server Tevfik in 1910; first cultivation of parasites from a cutaneous lesion was performed in 1911; and Hulusi Behcet, the well-known Turkish dermatologist, described the epitheloid cell

Conclusions

CL and VL are still significant public health problems in Turkey, but a decline is observed in the number of cases with both infections in recent years. A more effective sandfly control through residual insecticide spraying of the houses and the use of insecticide-impregnated bed nets is needed, especially in the Southeastern Anatolia Region, where CL is endemic. Health education and mass screening of both infections will also help early diagnosis and treatment.

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Leishmaniasis in Turkey

Abstract

Introduction

Section snippets

Visceral Leishmaniasis

Cutaneous Leishmaniasis

Conclusions

Trans. R. Soc. Trop. Med. Hyg.

Vet. Parasitol.

Public health aspects and control. Clin. Dermatol.

Trans. R. Soc. Trop. Med. Hyg.

Lancet

Trans. Roy. Soc. Trop. Med. Hyg.

J. Eur. Acad. Dermatol. Venereol.

Acta Trop.

Sandflies (Diptera:Psychodidae) associated with epidemic cutaneous leishmaniasis in Sanliurfa

Turkey. J. Med. Entomol.

Visceral leishmaniasis in children in Turkey

Trop. Geogr. Med.

Kala-Azar cases and Phlebotomus species inside Manisa and its interland region between the years 1990–1995

T. Parazitol. Derg.

Investigation of vectors and reservoirs of Leishmania donovani in Aegean Region

T. Parazitol. Derg.

Phlebotomus major syriacus: a possible vector of visceral leishmaniasis in Western Black Sea Region of Turkey

J. Egypt. Soc. Parasitol.