Epidemiological and clinical features of cutaneous leishmaniases in Jenin District,Palestine, including characterisation of the causative agents in clinical samples
During 2002–2009, 466 cases of cutaneous leishmaniasis (CL) were reported from Jenin
District, Palestine, affecting both genders. The average annual incidence was 23 cases per
100 000 inhabitants, increasing with age in children. Most cases presented a single lesion,
generally on the face. Diagnosis and species identification was done by applying internal
transcribed spacer 1 (ITS1) RFLP analysis to 47 isolates, of which 44 (93.6%) were Leishmania
tropica and 3 (6.4%) were L. major. RFLP analysis was also performed on 256 skin tissue scrapings
spotted onto filter papers, showing that 138 (53.9%) were positive, of which 50.7% were
infected with L. tropica, 17.4% with L. major and 2.9% with L. donovani s.l., and 29.0% could
not be identified. This is the first report from Palestine on human CL caused by L. infantum.
Nine of the strains of L. tropica were subjected to multilocus enzyme electrophoresis, six
of which belonged to the zymodeme MON-137 and three to a new zymodeme (MON-307).
This separation was corroborated by excreted factor serotyping. This observation modifies
the classical epidemiological view of CL in Palestine. Jenin District is an active focus of CL
caused by L. tropica, where Phlebotomus sergenti, the putative vector, is abundant. These
data suggest that CL is a zoonotic infection, but an animal reservoir has not been found.This research was supported by the
Deutsche Forschungsgemeinschaft (DFG) as part of a
German–Israeli–Palestinian co-operation project on the
Emergence of Cutaneous Leishmaniasis in the Middle East:
an investigation of Leishmania tropica in the Palestinian
Authority and Israel
