Emerging cutaneous leishmaniasis in Sirte-Libya: epidemiology, recognition and management.

The present work aimed to determine the risk factors, lesion pattern and effective therapy of emerging ZCL in Sirte-Libya. The study was carried out on 163 patients referred to health centers of Al-Gadaheya and Al-Hisha villages in the years 2006 & 2007. Methods consisted of a predesigned questionnaire (personal and demographic data), clinical examination of lesions, and parasitological examination by slit smear, treatment and follow up. Results showed an annual incidence of 0.95%, with onset peak during autumn months. Important local risk factors included: increased occupational exposure of farmers and construction worker to infection from fat sand rat burrows, facilitated by lack of prevention knowledge and prophylactic measures; close association of bad-ventilated animal shelters to houses, and increased soil moisture by warm spring ponds. The majority of lesions were multiple (73%) located on legs, arms, and face 66.8%, 52.1% and 41.1%. Most lesions were active 1-2 month duration and 1-3 cm size, ulcerative type (77.3%), and papulo-nodular (21.5%). Giemsa slit smear proved quite reliable for active lesions, confirmed 79.5% of lesions. The majority of lesions (60.1%) were treated by intra-lesional Pentostam. Systemic route was restricted to facial, over-joint, multiple or large lesions producing, good response in 31.9%. Cryotherapy and oral Fluconazole gave satisfactory response in 5.5% & 2.5% of cases.