Emerging cutaneous leishmaniasis in Israel

In Israel cutaneous leishmaniasis (CL) is emerging in several new foci. Between 2001-2003, 75 CL cases from foci near Tiberias were shown to be caused by two different Leishmania tropica strains. Parasites from the northern focus were antigenically similar to L. major and Phlebotomus (Adlerius) arabicus was incriminated as their vector with 5% infected females. In the southern focus P. (Paraphlebotomus) sergenti (10-20% infected) was the only vector. In experimental infection studies, parasites from the northern focus developed only in P. arabicus while parasites from the southern focus infected both Phlebotomus species. Like other permissive vectors, the luminal surface of P. arabicus midgut epithelium was heavily o-glycosylated while that of P. sergenti was not. Rock hyraxes (Procavia capensis) were the most prominent mammals in both foci and L. tropica DNA was detected in 14 out of 121 hyraxes trapped. Between 2006-2008, 72 CL cases from rural areas near Beit She’an, 30 km south of Tiberias, were diagnosed as caused by L. major. Nine of 40 voles (Microtus guentheri) collected near patients’ homes were identified by PCR as L. major, and P. papatasi, the known vector of L. major, was the most abundant sand fly species in the area. Emergence of new CL foci in Israel is probably caused by the encroachment of hyraxes upon human habitation (L. tropica) and the proliferation of voles in agricultural fields near villages (L. major). The adaptation of parasites to new, highly-susceptible vectors (L. tropica/P. arabicus) or host species (L. major/M.guentheri), also plays a role.