An outbreak of Leishmania major from an endemic to a non-endemic region posed a public health threat in Iraq from 2014-2017: Epidemiological, molecular and phylogenetic studies.

Cutaneous leishmaniasis (CL) is a neglected worldwide, zoonotic, vector-borne, tropical disease that is a threat to public health. This threat may spread from endemic to non-endemic areas. Current research has exploited epidemiological, molecular and phylogenetical studies to determine the danger of an outbreak of CL in the borderline area between northern and central Iraq from 2014-2017.For the first time, using sequence analysis of the cytochrome b gene, the occurrence of CL in the borderline area between northern and central Iraq was confirmed to be due to Leishmania major. The phylogenetic analysis indicated that it was closely related to the L. major MRHO/IR/75/ER strain in Iran.In conclusion, the genotype confirmation of the L. major strain will improve our understanding of the epidemiology of the disease. This is important for facilitating control programs to prevent the further spread of CL. Furthermore, this area could be considered as a model for further research on the risk of global CL epidemics in other non-endemic countries where both reservoir hosts and sandfly vectors are present

Year-wise trend of the number of reported CL cases in Iraq.

<p>Data based on WHO reports for Iraq [<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0006255#pntd.0006255.ref015" target="_blank">15</a>, <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0006255#pntd.0006255.ref016" target="_blank">16</a>, <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0006255#pntd.0006255.ref022" target="_blank">22</a>].</p

Monthly distribution of the number of reported CL cases in the Garmian region.

<p>Data were collected from reports of the Department of Transmissible Diseases of Garmian from 2014–2017.</p

Phylogenetic analysis of cytochrome <i>b</i> gene sequences among <i>Leishmania</i> species.

<p>The scale bar represents 0.01% divergence. Bootstrap values are shown above or below branches. Underlined GenBank accession numbers represent <i>L</i>. <i>major</i> sequences identified in this study.</p