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.This work received financial support from grants of the Deutsche
Forschungsgemeinschaft (DFG), Scho 448/6-1-3, Scho 448/8-1, Scho
448/8-2 that extended from 1998 until 2015. It also received support
fromEurNegVeg COST Action TD1303 (Cost 037/13). At one time during
the study WHO Eastern Mediterranean Region (EMRO), Division of
Communicable Diseases (DCD) and the WHO Special Programme for
Research and Training in Tropical Diseases (TDR): the EMRO/DCD/TDR
Small Grants Scheme for Operational Research in Tropical and Communicable
Diseases financially supported this work.
We thank Dr. L. F. Schnur for going over our manuscript
