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.
Subject(s)
Disease Outbreaks , Leishmania major/isolation & purification , Leishmaniasis, Cutaneous/epidemiology , DNA, Protozoan/chemistry , DNA, Protozoan/genetics , DNA, Ribosomal Spacer/chemistry , DNA, Ribosomal Spacer/genetics , Humans , Incidence , Jordan/epidemiology , Leishmania major/classification , Leishmania major/genetics , Polymerase Chain Reaction , Polymorphism, Restriction Fragment LengthABSTRACT
BACKGROUND: Antileishmanial chemotherapy can have adverse effects and may fail to cure patients with cutaneous leishmaniasis (CL). OBJECTIVE: To evaluate the efficacy of a weekly cryotherapy regimen in patients with confirmed Leishmania major infection. METHODS: One hundred twenty Jordanian patients with 375 lesions were treated with cryotherapy performed once weekly in 1 to 7 sessions. This regimen was adopted since living parasites were recovered, in several CL patients, even after 3 cryosessions. Scarring was assessed in 78 patients 3 years after treatment. RESULTS: Approximately 84% of the lesions were cured after 1 to 4 sessions. The remaining lesions (16.3%) were cured after an additional 1 to 3 session(s). Cryotherapy caused mild adverse side effects and most of the patients were cured with negligible scarring. Statistically, the lesion size and location significantly affected the clinical response to cryotherapy. LIMITATIONS: A fraction of patients was followed up 3 years after healing. CONCLUSION: Cryotherapy with weekly intervals for 1 to 4 sessions is effective to treat L major CL, especially for smaller lesions. Extra sessions may be necessary to cure larger lesions. The cosmetic results are very good and no relapses were registered.
Subject(s)
Cryotherapy , Leishmania major , Leishmaniasis, Cutaneous/therapy , Adolescent , Adult , Aged , Animals , Child , Child, Preschool , Cryotherapy/adverse effects , Humans , Infant , Middle AgedABSTRACT
The predominant sand fly species collected inside houses in Kfar Adumim, an Israeli village in the Judean Desert that is a focus of cutaneous leishmaniasis, was Phlebotomus papatasi, which was also caught attempting to bite humans. Phlebotomus sergenti, which is rarely seen inside houses, constituted the predominant sand fly species in caves near the village. Leishmania isolates from Ph. sergenti and humans typed as Leishmania tropica. Sand fly and human isolates produced similar small nodular cutaneous lesions in hamsters. Isolates produced excreted factor (EF) of subserotypes A(9) or A(9)B(2), characteristic of L. tropica and reacted with L. tropica-specific monoclonal antibodies. Isoenzyme analysis consigned the strains to the L. tropica zymodemes MON-137 and MON-275. Molecular genetic analyses confirmed the strains were L. tropica and intraspecific microheterogeneity was observed. Genomic fingerprinting using a mini-satellite probe separated the L. tropica strains into two clusters that were not entirely congruent with geographic distribution. These results support the heterogeneous nature of L. tropica and incriminate Ph. sergenti as its vector in this Judean Desert focus.