Zoonotic cutaneous leishmaniasis outbreak in Mazar-e Sharif, northern Afghanistan: an epidemiological evaluation.

In 2005, 200 cases of zoonotic cutaneous leishmaniasis (ZCL) were recorded among International Security Assistance Force (ISAF) troops stationed in the Mazar-e Sharif airport area. Within the local population, investigations revealed 3782 cases of ZCL, 174 cases of anthroponotic cutaneous leishmaniasis (ACL), and 2 cases of visceral leishmaniasis (VL) in the period from March 21, 2004 to March 20, 2005, and 4045 cases of ZCL, 198 cases of ACL, and no cases of VL from March 21, 2005 to March 20, 2006. The previously unknown transmission dynamics of ZCL, and differing seasonal distribution of ZCL and ACL, are here defined, thus permitting quantification and prediction of infection rates in deployed troops for the first time. At Mazar-e Sharif, Phlebotomus papatasi and Rhombomys opimus occurred in the highest densities yet observed, together with record-high Leishmania major infection rates. Data indicate the existence of high-density, anthropogenically induced ZCL in Afghanistan.