Leishmania major cutaneous leishmaniasis outbreak in the Jordanian side of the Northern Jordan Valley

Abstract

Cutaneous leishmaniasis (CL) is endemic in many foci of Jordan and the Jordanian Mid Jordan Valley (JMJV) is the most affected and the incidence is quite high. The situation in the northern part of the Jordanian side of the Jordan Valley (NJJV) was different; before 2008, CL has rarely been reported from this area. From April 2008 to May 2009, passive detection followed by active detection was used to trace cases of CL from the NJJV. DNA was extracted from seven clinical isolates of Leishmania promastigotes and lesion scrapings spotted on filter papers obtained from 51 suspected CL patients living in the NJJV. The identity of the causative species of CL in the NJJV was investigated using ITS1-PCR followed by RFLP. In 2008/2009, 183 cases were clinically diagnosed of having CL in the NJJV. The parasites in five of the isolates and in 48 PCR-positive scrapings were classified as Leishmania major. In two isolates and in one PCR-positive scraping Leishmania tropica was identified. Investigations on the origin of CL cases revealed that the L. tropica cases were residents of two towns outside the NJJV. Herein, we report the clinical features, parasitological diagnosis, etiology, and the geographical distribution of CL cases from NJJV with the aim of documenting, for the first time, an outbreak in this area.

Keywords:

• Cutaneous leishmaniasis
• PCR diagnosis
• species identification
• ITS1-PCR
• Leishmania major
• RFLP
• CL focus
• CL outbreak
• Jordan

Acknowledgements

We thank the Director of Abu Obeida Hospital, and to the Jordanian Army commanders who facilitated access to the patients during the course of this work. The senior author (IMM) was supported by the Deanship of Scientific Research, University of Jordan, and the Deutsche Forschungsgemeinschaft (DFG), Germany.