Journal of Dermatology and Clinical Research

Cite this article: Ponirovsky EN, Kovalenko DA, Kadamov DS, Baranets MS, Morozova LF (2017) Cutaneous Leishmaniasis in Central Asia Countries. J Der-matolog Clin Res 5(5): 1111.

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*Corresponding authorEN Ponirovsky, FSАEIHО, Sechenov’s University, Russia, Email:

Submitted: 11 April 2017

Accepted: 28 July 2017

Published: 31 July 2017

Copyright© 2017 Ponirovsky et al.

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Cutaneous Leishmaniasis in Central Asia CountriesEN Ponirovsky1*, DA Kovalenko2, DS Kadamov3, MS Baranets1, LF Morozova1

1FSАEIHО, Sechenov’s University, Russia2Institute of Medical Parasitology, MoH of Republic of Uzbekistan, Uzbekistan3Institutw of Zoology and Parasitology, Akademysciese of Republic Tajikistan, Tajikistan

Abstract

The review of main scientific research studies of cutaneous leishmaniasis which were held on the territory of Central Asia in XXth century is given in the article. There are data about epidemiological situation on antroponotic and zoonotic cutaneous leishmaniasis in Kazakhstan, Tajikistan, Turkmenistan and Uzbekistan, and also the most significant scientific achievements that were done by the specialists of above countries and scientific research institutes of Moscow in the sphere of epidemiology, clinical picture, treatment and prophylaxis of these diseases.

Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan are the part of WHO European region under the unifying title: the countries of Central Asia. Regional characteristic pathology for these countries is the presence of leishmaniasis - vector-borne parasitic diseases of humans and animals, which pathogens are protozoa belonging to the genus Leishmania. Except Kyrgyzstan in other 4 countries cutaneous leishmaniasis (CL) occupied the significant place in pathology. In century CL was represented by two forms: zoonoticcutaneous leishmaniasis (ZCL) and antroponotic cutaneous leishmaniasis (ACL).

INTRODUCTIONThe basical studies of CL were founded in Turkmenistan and

Uzbekistan at the end of XIX and at the beginning of XX centuries.In1898 P.F. Borovsky [4] found for the first time causative agent of CL (urban form). In the future due to the works of V.L.Yakimov [26], I.I. Gitelzon [6], P.V. Kojevnikov[10],N.I. Latishev and A.P. Kryukova [12] the existing of two forms of CL was confirmed, they are differ etiologically, clinically and epidemiologically. Leishmania majoris causative agent of ZCL, L. tropica is causative agent of ACL [11]. ACL (urbantype) is characterized by prolonged incubation period from 2-4 months up to 1-2 years, slow ulcer stage development. The duration of the whole process, from initial signs up to scar formation takes about one year. There is tuberculoid form of this type of CL [6]. ACL is spread mainly in the large settlements.

On the territory of CA the source of infection is patient. Parasite vector of disease is antropophillic species of sand fly Phleboto mussergenti. There are some data about ACL morbidity of dogs [11]. ZCL is characterized by short incubation period (from some days upto 1 month). The duration of the whole process, from initial signs upto scar formation takes about2 – 6 months. The main host-reservoir of pathogen in CA is great gerbil (Rhombo mysopimus). Additional host-reservoir of pathogen in natural foci of CA can be the other species of gerbil (Meriones libycus) [8]. The vector is P. papatasi.

ACLThis form of CL was widely spread in Turkmenistan and

Uzbekistan, the main foci were registered in Mary, Ashgabad, Yolotan, Bayram-Ali, Charjou, Kerky (Turkmenistan), Bukhara,

Samarkand, Jizakh, Tashkent, Kokand, Ferghana, Andijan, Namangan (Uzbekistan). The greatest rises in the incidence of morbidity were registered in Turkmenistan in 1930-1932 years. (totally per 3 years – 11 734 cases). In Ashgabad after the earth quake in 1948 ACL morbidity strictly enhanced, but due to vector control measures this form of CL was almost eradicated to 1963. The same situation was observed in Uzbekistan.

Autochthonous cases of ACL were also registered in Tajikistan, Leninabad city and suburbs at the end of 40-s – beginning of the 50-s of the last century [13]. Because of large-scale antimalarial operation 1950-1990 Leishmaniasis was under control in Tajikistan. Sporadic, very few episodes were registered in Panjakent, Darvaz and Sughd Rejion at the time.

Single autochthonous ACL cases were described in Kazakhstan in Kyzyl-Orda and Chimkentcities [13]. In general upto beginning of 60-s years of ХX century ACL on the main territory of CA was eliminated. Antimalarial measures (treating of living and house hold areas by insecticides), treatment of the patients and immune prophylaxis led to sharp decreasing of ACL morbidity in this region. Clinical picture of the tuberculoid form of CL was studied in details and the effective method of treatment of this form by solusurmin was suggested [6,7]. In future the single cases of the disease were registered in Andijan (Uzbekistan) and Ashgabad (Turkmenistan) [13]. Presently ACL cases are registered in Uzbekistan and Tadjikistan.

ZCLThe studies of this form of CL were carried out in 30-s – 40-s

years of the last century. During this time it was confirmed that great gerbil’s and someother rodents holes in desert are dwelling

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places of sand flies – ZCL vectors [5,14]. It was confirmed that the main host-reservoir of ZCL causative agent is R. opimus [8,12] in CA countries.

This discovery had the significant practical importance, it became theoretical basis for conducting control measures against R. opimus in natural ZCL foci. In 50-s – 70-years of the ХХth century the ZCL epidemic situation became more dangerous in the CA countries, mostly it was connected with intensive agricultural and industrial developing of the new territories and as a consequence the flooding of lends led to higher humidity of the soil and increased the density of ZCL vectors – P.papatasi. In order to study and develop ZCL prophylaxis measures the specialists from Ashgabad scientific research institute of epidemiology and hygiene (ASREH), Turkmenistan scientific research institute of cutaneous diseases(TSRCD), Isaevinstitute of medical parasitology(IIMP) (Samarkand), Gamaleiinstitute of epidemiology and microbiology(GIEM) (Moscow), Martsinovsky institute of medical parasitology and tropical medicine (MIMP&TM) (Moscow) were involved.

ZCL problem in the dangerous areas was successfully solved due to formation of anti-leismanial expeditions in which epidemiologists, parasitologists, dermatologists, zoologists, enthomologists, map makers were participated. In Uzbekistan the scientific expeditions of IIMP and MIMP & TM were working. In Turkmenistan the study of ZCL foci was made by the scientists from ASREH, GIEM and MIMP & TM. As a result of comprehensive study of ZCL foci the numbers of patterns of their functioning were identified. In ZCL natural foci on the territory of CA countries in epizootic maintaining among R. opimus three species of leishmania are taking part: L. major, L. turanica, L. gerbilli. Only L. major is pathogenic for human. Antropogenic species of sand fly P. papatasi is the vector of causative agent from rodents to human. P. papatasi, P. caucasicus, P. andrejevi, P. alexandri, P. mongolensis can serve as the vectors of L. turanica among population of gerbils. P. mongolensis [16,23,24] transmits L. gerbilli. ZCL morbidity is seasonal; the highest number of patients is registered in August – September. It depends of enhance of L. major in R. opimus [25] population. The foci in the valley sandriver delt as where the irrigation developing of soil is taking place, are the most epidemic dangerous as the high humidity of the soil leads to increasing density of P. papatasi and parasite circulation [1,18]. In the area of Central, Zaunguz, South-East Karakums (Turkmenistan) and in the Central Kyzylkums (Uzbekistan) where there is no flooding of lands, ZCL human cases are not registered [3,18]. Zoning and typification of the natural ZCL foci in Turan desert and also epidemiological zoning of the foci in Turkmenistan and Uzbekistan [8,18] were made. The main method of non-specific prophylaxis of ZCL is the elimination of the main host-reservoir in Central Asia countries – R. opimus [12]. Revealed that in order to achieve maximum effect of control measures against R. opimus it is necessary to conduct thorough mapping of the rodent’s holes in oasis and near oasis territories with the subsequent release of certain natural foci. The elimination of R. opimus habitat can be done by means of poisoned grain baits or by ploughing of lands[17].

In the second half of XXth century significant progress was achieved in clinical studies, development of treating methods

and immunoprophylaxis of CL. The work on differentiation of CL clinical forms began at 20-30-syears of the ХХthcentury. During this period systematic studies of CL were conducted by N.I. Hodukin in Merv, and continued by I.I. Gitelzon. 7 000 patients were observed by I.I. Gitelzon during his work in Turkmenistan. The most significant was the author description of two clinical CL forms (dry and wet) and also the description of the tuberculoid CL. For the first time I.I. Gitelzon used the method of immunization by live pathogen in Turkmenistan (1929-1933) [6]. In future in Turkmenistan dermato venerological institute ampouled vaccine [19,20] was created under the supervision of P.V. Kojevnikov. Significant ZCL immune prophylaxis (vaccination) was provided by staff members of MIMP&TM among military contingent in Ashgabad and Mari regions in the 60-s years of the last century [21].The same ZCL immunoprophylaxis among rural population was held in Uzbekistan [22]. It was defined that Monomitsini was the most effect medicine for ZCL treatment [2].

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Ponirovsky EN, Kovalenko DA, Kadamov DS, Baranets MS, Morozova LF (2017) Cutaneous Leishmaniasis in Central Asia Countries. J Dermatolog Clin Res 5(5): 1111.

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