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Title: Treatment of localised cutaneous Leishmania tropica infection in Aleppo, Syria and drug sensitivity of clinical isolates
Author: Abazid, Nizar
ISNI:       0000 0004 2702 896X
Awarding Body: London School of Hygiene & Tropical Medicine
Current Institution: London School of Hygiene and Tropical Medicine (University of London)
Date of Award: 2010
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Anthroponotic cutaneous leishmaniasis caused by Leishmania tropica has been endemic in Aleppo, Syria for centuries. The first modem description of the disease was also done in Aleppo. A surveillance system is in place, and the numbers of annual recorded cases have been rising from a few hundred to thousands in the late 1980s, to more than 5,000 in most years from 1990, and to more than 10,000 since 2003. A retrospective analysis of routinely collected demographic data was performed. The clinical course was examined in a subset of patients. One hundred and thirty-two patients were recruited for follow-up study. Parasites were isolated from the lesions of these patients before treatment and during the course of treatment. Eighty isolates were tested for drug sensitivity in amastigotemacrophage system and typed to species level. Molecular fingerprinting was applied to a subset of isolates. Interviews were held with patients or accompanying adults about their knowledge, attitudes and practices regarding prevention, diagnosis and treatment. Leishmaniasis patients in Aleppo were younger than the general population (median age 13 vs. 19 years), and females predominated among adults. Children and males were more likely to have lesions on the face. Smear positivity decreased with patient age (OR=O.5 in over-forties compared to under-tens). Smear positivity peaked at two-month lesion duration (OR=2.2 compared to lesion duration of <1 month). A significant proportion of patients, especially adults, did not complete their treatment course. The isolated parasites were insensitive (median ECso=229 fig Sbv Iml) to pentavalent antimony, the drug used in Aleppo, and to paromomycin but were sensitive to amphotericin B. No relationship was found between baseline parasite in vitro sensitivity and treatment duration. All the typed parasites were L. tropica. Parasite schizodemes clustered by place of isolation and by family.
Supervisor: Davies, C. R. ; Yardley, V. ; Croft, S. L. Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral