Differences in transmission seasons as an epidemiological tool for characterization of anthroponotic and zoonotic cutaneous leishmaniasis in northern Afghanistan

Regional epidemiological data, when available from Afghan or international health authorities, usually include cutaneous leishmaniasis cases without further elaboration. Scientific reports from Afghanistan mainly focus on the current status of war and refugee-related anthroponotic cutaneous leishmaniasis (ACL), but little is known about zoonotic cutaneous leishmaniasis (ZCL), its regional and seasonal distribution, or other disease characteristics. Multiple field investigations revealed that both ACL and ZCL are widespread in Afghanistan and may show sharp differences in specific epidemiology and incubation periods. The previously unknown transmission dynamics and differing seasonality of ZCL, with maximum clinical cases in September and October, as opposed to the ACL peak in March and April, are here described, thus permitting for the first time prediction of the causative Leishmania species in undiscriminated CL reports. Results show that epidemiological differences may serve as a convenient tool for discriminating between ACL and ZCL, at least in northern and central Afghanistan, which can be important because specific treatment and control measures may be different.