Cutaneous leishmaniasis in the central provinces of Hama and Edlib in Syria: Vector identification and parasite typing

Abstract

BackgroundCutaneous leishmaniasis is a disease transmitted by sand fly bites. This disease is highly prevalent in Syria where Leishmania major and Leishmania tropica are the known aetiological agents. In 2011, more than 58,000 cases were reported in the country by the Ministry of Health. The central region of the country harbors 20 % of the reported cases. However, the epidemiology of the disease in this area is not well understood. An epidemiological survey was conducted in 2010 to identity the circulating parasite and the sand fly vector in the central provinces of Edlib and Hama.MethodsSand fly specimens were collected using CDC light traps and identified morphologically. Total DNA was extracted from the abdomens of female specimens and from Giemsa-stained skin lesion smears of 80 patients. Leishmania parasites were first identified by sequencing the ITS1 gene amplicons. Then polymorphism analysis was performed using the RFLP technique.ResultsA total of 2142 sand flies were collected. They belonged to eight species, among which Phlebotomus sergenti and Phlebotomus papatasi were the most predominant.L. tropica ITS1 gene was amplified from two pools of P. sergenti specimens and from skin smears of cutaneous leishmaniasis patients. This suggests that P. sergenti is the potential vector species in the study area. The digestion profiles of the obtained amplicons by TaqI restriction enzyme were identical for all analysed L. tropica parasites. Moreover, L. infantum ITS1 gene was amplified from two pools of Phlebotomus tobbi in the relatively humid zone of Edlib.ConclusionsL. tropica is confirmed to be the aetiological agent of cutaneous leishmaniasis cases in the central provinces. RFLP technique failed to show any genetic heterogeneity in the ITS1 gene among the tested parasites. The molecular detection of this parasite in human skin smears and in P. sergenti supports the vector status of this species in the study area. The detection of L. infantum in P. tobbi specimens indicates a potential circulation of this parasite in the humid zone of Edlib. Further epidemiological studies are needed to evaluate the burden of this visceral parasite in the study region.

Leishmaniasis in Northern Syria during Civil War

“…L. infantum and L. donovani , which are considered classical pathogens for VL, were repeatedly confirmed in skin lesions of patients participating in this survey. In Syria, L. infantum has been reported previously as a causative agent of CL in humans ( 21 ); however, L. donovani had previously been isolated only from sand flies ( 23 ). Further, L. donovani has repeatedly been found in the neighboring countries Cyprus, Turkey, Iraq, and Israel ( 24 – 28 ).…”

A distinct cutaneous leishmaniasis lesion on the tip of the patient’s nose: A visual warning for European colleagues

“…Recently, civil war in Syria led massive displacement of people. Therefore, the number of cutaneous leishmaniasis cases increased significantly in neighbouring countries like Turkey, Jordan and Lebanon [3]. Alawieh et al reported that 96.6% of the all new cases in Lebanon in 2013 occured among Syrian refugees [4].…”

“…Cutaneous leishmaniasis is endemic in Syria and increased incidence of the disease has been reported between 1997 and 2011 [3]. Recently, civil war in Syria led massive displacement of people.…”

Cutaneous Leishmaniasis and Conflict in Syria

“…However, in early 2013, an alarming increase to 41,000 cutaneous leishmaniasis cases was reported ( 3 , 4 ). The regions most affected are under Islamic State control; 6,500 cases occurred in Ar-Raqqah, Diyar Al-Zour, and Hasakah.…”

“…papatasi and Ph. sergenti sand fly populations exist in Syria and Iraq ( 4 ). The presence of these vectors in regions of instability can create new cutaneous leishmaniasis foci, which might have debilitating, and often stigmatizing, consequences for residents and deployed military personnel ( 10 ).…”