Molecular epidemiology of human cutaneous leishmaniasis in Jericho and its vicinity in Palestine from 1994 to 2015
Date
2016-06-05
Authors
Al-Jawabreh, A.
Dumaidi, K.
Ereqat, S.
Al-Jawabreh, H.
Nasereddin, A.
Azmi, K.
Barghuthy, F.
Sawalha, S.
Salah, I.
Abdeen, Z.
Journal Title
Journal ISSN
Volume Title
Publisher
Elsevier
Abstract
Cutaneous leishmaniases (CL) are vector-borne parasitic diseases endemic inmany countries of the Middle East
including Palestine. Between 1994 and 2015, 2160 clinically suspected human cases of CL from the Jericho District
were examined. Stained skin tissue smears and aspirates were checked by microscopy and cultured for
promastigotes, respectively. For leishmanial species identification, amplification products from a PCR-ITS1
followed by RFLP analysis using Hae III. Data were analyzed using Epi Info free-software. The overall infection
rate was 41.4% (895/2160), 56.3% (504/895) of the cases were male, 43.7% (391/895) female, 60.5% (514/849)
children under age 14, 41.3% (259/627) of the cases were caused by Leishmania major and 57.3% (359/627) by
Leishmania tropica. The case numbers peaked in 1995, 2001, 2004, and 2012. Statistically-significant clusters of
cases caused by L. major were restricted to the Jericho District; those caused by L. tropica were from the districts
of Jericho, Bethlehem, Nablus and Tubas. CL is seasonal and trails the sand fly season. Distribution of cases was
parabolicwith fewest in July. Themonthly total number of cases of CL and just those caused by L.major correlated
significantly with temperature, rainfall, relative humidity, evaporation, wind speed and sunshine (P b 0.05, r2=
0.7–0.9 and P b 0.05, r2=0.5–0.8, respectively). Cases caused by L. tropica, significantly, had a single lesion compared
to cases caused by L. major (P=0.0001), which, significantly, had multiple lesions (P=0.0001). This and
previous studies showed that CL is present in all Palestinian districts. The surveillance of CL has increased public
awareness and molecular biologicalmethodology for leishmanial species identification is an essential addition to
classical diagnosis. The overall results are discussed, correlated to climatic and environmental changes and largescale
human activities.
Description
Keywords
Cutaneous leishmaniasis , Jericho , Palestine , L. tropica , L. major