Clinicoepidemiologic pattern of cutaneous leishmaniasis and molecular characterization of its causative agent in Hajjah governorate, northwest of Yemen.

The clinicoepidemiologic profile of 143 cases (93 males and 50 females) with cutaneous leishmaniasis from 18 villages of Hajjah governorate, Yemen was studied. Dry-type lesions were seen in 98.6% and wet-type lesions in 1.4% of patients. Lesions were localized in all cases with different morphological patterns. Microscopic examination of Giemsa-stained slit smears revealed amastigotes in 74.1% of patients with dry-type lesions and 0% in patients with wet-type lesions. The burden of the parasites in the lesions was high indicating active transmission of the disease. Most cases were from villages with moderate altitude range (8001-1600m). All age groups were affected, but most cases were seen in ages from 5 to 15 years. Leishmania species identification was done for all cases by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The biopsic material was scraped from both Giemsa-stained and methanol-fixed smears. The molecular characterization of Leishmania species revealed Leishmania tropica as the causative agent of cutaneous leishmaniasis in Hajjah, Yemen. The risk factors associated with the transmission of the disease and recommendations for improving case detection were discussed.

Current knowledge of sand fly fauna (Diptera: Psychodidae) of northwestern Yemen and how it relates to leishmaniasis transmission.

This report presents the results of the first entomological survey of the sand fly fauna in northwestern Yemen. Sand flies were collected using sticky paper traps and CDC light traps from Hajjah governorate, a cutaneous leishmaniasis focus due to Leishmania tropica. Six Phlebotomus species: P. alexandri, P. arabicus. P. bergeroti, P. orientalis, P. papatasi, P. sergenti and ten Sergentomyia species: S. africana, S. antennata, S. christophersi, S. dolichopa, S. dreyfussi, S. fallax, S. multidens, S. taizi, S. tiberiadis, S. yusafi were identified. P. alexandri was the most predominant Phlebotomus species and P. papatasi was a scarce species. S. fallax was the principal Sergentomyia species and S. dolichopa was the least species encountered. The diversity of the sand fly fauna within and among three altitudinal ranges using Simpson index and Jaccard's diversity coefficient respectively were measured. High species diversity was found in all altitude ranges. There seemed to be more association between sand fly fauna in higher altitudes with fauna from moderate altitudes. Sand fly seasonal activity showed a mono-modal trend in the lowland and a confluent bimodal trend in the highlands. Leishmania DNA could not be detected from 150 Phlebotomus females using PCR-RFLP. A possible zoonotic cutaneous transmission cycle due to Leishmania tropica in northwestern Yemen would involve P. arabicus as the sand fly vector and the rock hyrax as the reservoir host. The vector competence for P. alexandri as a vector of visceral leishmaniasis in Hajjah governorate is discussed.