Detection of high levels of anti-α-galactosyl antibodies in sera of patients with Old World cutaneous leishmaniasis: a possible tool for diagnosis and biomarker for cure in an elimination setting.

In the Kingdom of Saudi Arabia (KSA), Old World cutaneous leishmaniasis (CL) is mainly caused by Leishmania major and Leishmania tropica parasites. Diagnosis of CL is predominately made by clinicians, who at times fail to detect the disease and are unable to identify parasite species. Here, we report the development of a chemiluminescent enzyme-linked immunosorbent assay (CL-ELISA) to measure the levels of anti-α-galactosyl antibodies in human sera. Using this assay, we have found that individuals infected with either Leishmania spp. had significantly elevated levels (up to 9-fold higher) of anti-α-Gal IgG compared to healthy control individuals. The assay sensitivity was 96% for L. major (95% CI; 94-98%) and 91% for L. tropica (95% CI; 86-98%) infections and therefore equivalent to restriction fragment length polymorphism-polymerase chain reaction analysis of parasite ITS1 gene. In addition, the assay had higher sensitivity than microscopy analysis, which only detected 68 and 45% of the L. major and L. tropica infections, respectively. Interestingly, up to 2 years following confirmed CL cure individuals had 28-fold higher levels of anti-α-Gal IgG compared to healthy volunteers. Monitoring levels of anti-α-Gal antibodies can be exploited as both a diagnostic tool and as a biomarker of cure of Old World CL in disease elimination settings.

Distribution of sand flies in El-Nekheil province, in Al-Madinah Al-Munawwarah region, western of Saudi Arabia.

An entomological survey for sand flies was conducted at an area of cutaneous leishmaniasis--El-Nekheil in Northeast Al-Madinah Al-Munawwarah, Saudi Arabia. Standardized sampling with Centers for Disease Control (CDC) light traps and sticky traps was employed to determine monthly trends in species composition, density, sex ratio, and reproductive status and Leishmania infection rate of vector sand flies. A total of 621 sand flies were collected from March 2006 to November 2007. Six species representing two genera were identified, three Phlebotomus species: P. papatasi, P. sergenti, and P. bergeroti; and three Sergentomyia species: S. antennata, S. sergenti, and S. shewtzi. Phlebotomus papatasi was the predominant anthropophagic species found and comprised more than 70% of the sand fly population. A population peak (June) was observed for this species. The density of P. papatasi intra-domiciliary was higher than extra-domiciliary stations and inflated by a greater proportion of female flies. Of 189 dissected Phlebotomus females, 43% were blood-fed. No Leishmania parasites were found. The proportion of gravid P. papatasi increased progressively during the 5-month period from May to September and averaged 38%. Proportions of gravid flies may be a valid indicator of the physiological age and epidemiologic importance of the vector sand fly population at this focus.