JERUSALEM – There is a risk that Middle Eastern refugees entering the U.S. could be infected with a flesh-eating disease that is sweeping across Syria.
Health agencies confirmed that Syrian refugees have transported leishmaniasis to Lebanon and Turkey, where it has been difficult to manage and treat.
Compounding the problem, patients can be infected with the parasitic disease without showing symptoms for weeks, months, or even years, and an asymptomatic patient most likely doesn’t know that he or she is a carrier.
This means the health screening process for refugees could miss the disease entirely.
Breitbart Jerusalem spoke with healthcare experts, including an epidemiologist from the Centers for Disease Control and Prevention, or CDC’s Immigrant, Refugee, and Migrant Health Branch, which is responsible for guiding the medical screening of the Syrian refugees seeking to enter the U.S.
Leishmaniasis is a disease caused by protozoan parasites. It is spread almost entirely by sandflies, including those present in the U.S.
There are three main types of the disease: cutaneous, mucocutaneous, and visceral leishmaniasis.
Cutaneous is the most common form among Syrians. It manifests in skin sores that typically develop within a few weeks or months of a sand fly bite. The sores can initially appear as bumps or nodules and may evolve into volcano-like ulcers.
Mucocutaneous leishmaniasis causes skin ulcers like the cutaneous form, as well as mucosal ulcers that usually damage the nose and mouth.
Visceral leishmaniasis, which has also been found among Syrian refugees, is the most serious form and can be fatal. It damages internal organs, usually the spleen and liver, and also affects bone marrow.
Refugees transmit to Lebanon, Turkey; threat to Europe, U.S.
Last year, the CDC published a study of a September 2012 outbreak among Syrian refugees. The investigation found:
Fifty-nine percent of patients had more than one of the following: disease compromising the function of vital sensory organs (eye, ear, nose, and mouth) (27%); lesions of greater than 5 cm in diameter (49%); disfiguring facial lesions (37%); special forms, such as sporotrichoid or lymphangietic with satellite lesions (9%); and lesions present for more than 12 months’ duration.
Earlier this month, the news media hyped a story that the Islamic State was causing the spread of leishmaniasis, because – as the U.K.’s Mirror newspaper put it - militants were “slaughtering innocent people and dumping their bodies in the street.”
Leishmaniasis has been spreading like wildfire in Syria since the health system collapsed in rebel-held territories in 2011. By 2012, there were already 52,982 documented cases of the disease in Syria
Also in 2012, the CDC documented that “migration patterns of refugees with cutaneous leishmanias is were identified in Lebanon,” with the health agency producing a helpful illustration showing the disease’s “movement from cities in Syria to regions in Lebanon.”
The peer-reviewed medical journal Pathogens noted that Lebanon had no cases of cutaneous leishmaniasis prior to 2008 and only “sporadic cases in the following years.”
After the arrival of refugees, 1,033 cases were confirmed by 2012, “96.6% (998) of which were among Syrian refugees.” Writing at AHC Media, a publication for healthcare professionals, Dr. Philip R. Fischer, Professor of Pediatrics at the Mayo Clinic, documented the spread to Turkey as well:
As Syrians leave their homeland, they sometimes carry their germs with them. There have been dramatic increases in the number of cases of cutaneous leishmaniasis in southeastern Turkey. In Turkey, 69% of cutaneous leishmaniasis patients are Syrians living in tent cities.
Fischer also noted a significant risk of the disease spreading to Europe with the arrival of Syrian refugees.
As recent news reports have shown, many Syrian refuges don’t stay in Turkey and Lebanon. There is a significant risk that cutaneous leishmaniasis will reemerge in southern Europe, where the natural vector of the L. tropica parasitealready exists.
Leishmaniasis has been endemic to Syria for centuries. Fischer noted that in 1756 a British physician “referred to the illness as Aleppo boil and Aleppo evil.” However, it was minimized over time due to the advent of insecticides.
Refugees who enter the U.S. must undergo medical screening according to protocolsestablished by the Centers for Disease Control and Prevention, or CDC. Each refugee must submit to a physical examination, including a skin test and possibly a chest x-ray to check for tuberculosis,as well as a blood test for syphilis.
The blood tests do not currently look for leishmaniasis. Clearly, an attending doctor could easily spot a patient with obvious skin ulcers. However, leishmaniasis cannot be detected upon physical examination if the patient is asymptomatic, as can be the case for years.
Dr. Heather Burke, an epidemiologist from the CDC’s Immigrant, Refugee, and Migrant Health Branch, explained to Breitbart News that there is generally a window of three to six months from the initial physical examination until a refugee departs for the U.S.
She said a medical examination is valid for six months, and explained that patients undergo a second examination just prior to departure - a quicker “fitness to fly” screening. While she conceded that this final examination is not thorough, she said it would pick up any visible skin lesions. Burke told Breitbart Jerusalem that she is not aware of a single case of leishmaniasis entering the U.S. via Syrian refugees.
Dr. Jane Orient, executive director of the Association of American Physicians and Surgeons, warned that “most doctors in the U.S. know nothing about leishmaniasis.”
“We’d all need to refer patients to tropical diseases specialists,” she told Breitbart Jerusalem. “The treatments are toxic and expensive, and some are not widely available.”
For Orient, the only sensible public health policy is “for all refugees to pass through a quarantined place like Ellis Island.”
“Officials need to know where they’ve been and what diseases occur there. We need sophisticated, reliable screening methods and excellent vector control in any areas where refugees stay.”
With research by Brenda J. Elliott.