title: Cutaneous leishmaniasis in the central provinces of Hama and Edlib in Syria: Vector identification and parasite typing.
abstract: BACKGROUND
  Cutaneous leishmaniasis is a disease transmitted by sand fly bites. This disease is highly prevalent in Syria where Leishmania major and Leishmania tropica are the known aetiological agents. In 2011, more than 58,000 cases were reported in the country by the Ministry of Health. The central region of the country harbors 20 % of the reported cases. However, the epidemiology of the disease in this area is not well understood. An epidemiological survey was conducted in 2010 to identity the circulating parasite and the sand fly vector in the central provinces of Edlib and Hama.
  
  
  METHODS
  Sand fly specimens were collected using CDC light traps and identified morphologically. Total DNA was extracted from the abdomens of female specimens and from Giemsa-stained skin lesion smears of 80 patients. Leishmania parasites were first identified by sequencing the ITS1 gene amplicons. Then polymorphism analysis was performed using the RFLP technique.
  
  
  RESULTS
  A total of 2142 sand flies were collected. They belonged to eight species, among which Phlebotomus sergenti and Phlebotomus papatasi were the most predominant. L. tropica ITS1 gene was amplified from two pools of P. sergenti specimens and from skin smears of cutaneous leishmaniasis patients. This suggests that P. sergenti is the potential vector species in the study area. The digestion profiles of the obtained amplicons by TaqI restriction enzyme were identical for all analysed L. tropica parasites. Moreover, L. infantum ITS1 gene was amplified from two pools of Phlebotomus tobbi in the relatively humid zone of Edlib.
  
  
  CONCLUSIONS
  L. tropica is confirmed to be the aetiological agent of cutaneous leishmaniasis cases in the central provinces. RFLP technique failed to show any genetic heterogeneity in the ITS1 gene among the tested parasites. The molecular detection of this parasite in human skin smears and in P. sergenti supports the vector status of this species in the study area. The detection of L. infantum in P. tobbi specimens indicates a potential circulation of this parasite in the humid zone of Edlib. Further epidemiological studies are needed to evaluate the burden of this visceral parasite in the study region.
authors.affiliation: Laboratory of Immunology, Faculty of Public Health, Lebanese University, Fanar, Lebanon. nhaddad@ul.edu.lb.
authors.forename: Nabil
authors.initials: N
authors.lastname: Haddad
authors.affiliation: Laboratory of Immunology, Faculty of Public Health, Lebanese University, Fanar, Lebanon. hanadi.saliba@gmail.com.
authors.forename: Hanadi
authors.initials: H
authors.lastname: Saliba
authors.affiliation: National Leishmaniasis Control Program, Ministry of Health, Damascus, Syria. ateftwil@hotmail.com.
authors.forename: Atef
authors.initials: A
authors.lastname: Altawil
authors.affiliation: US Naval Medical Research Unit No. 3, Cairo, Egypt. cairo.vs@gmail.com.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Villinsky
authors.affiliation: Department of Animal Biology, Faculty of Science, Damascus University, Damascus, Syria. samar.nahhas@yahoo.com.
authors.forename: Samar
authors.initials: S
authors.lastname: Al-Nahhas
mesh_terms: D000818:Animals; D001483:Base Sequence; D016054:DNA, Protozoan / Q000737:chemistry / Q000235:genetics; D021903:DNA, Ribosomal Spacer / Q000737:chemistry / Q000235:genetics; D005260:Female; D005843:Geography; D006801:Humans; D007303:Insect Vectors / Q000469:parasitology*; D018320:Leishmania major / Q000235:genetics / Q000302:isolation & purification*; D007895:Leishmania tropica / Q000235:genetics / Q000302:isolation & purification*; D016773:Leishmaniasis, Cutaneous / Q000453:epidemiology* / Q000469:parasitology; D008297:Male; D008969:Molecular Sequence Data; D010691:Phlebotomus / Q000469:parasitology*; D016133:Polymerase Chain Reaction; D012150:Polymorphism, Restriction Fragment Length; D011576:Psychodidae / Q000145:classification / Q000469:parasitology*; D017422:Sequence Analysis, DNA; D013593:Syria / Q000453:epidemiology
chemical_list: D016054:DNA, Protozoan; D021903:DNA, Ribosomal Spacer