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. 2018 Mar 1;12(3):e0006255.
doi: 10.1371/journal.pntd.0006255. eCollection 2018 Mar.

An outbreak of Leishmania major from an endemic to a non-endemic region posed a public health threat in Iraq from 2014-2017: Epidemiological, molecular and phylogenetic studies

Mariwan M M Al-Bajalan  1 , Sirwan M A Al-Jaf  1 , Sherko S Niranji  1 , Dler R Abdulkareem  2 , Khudhair K Al-Kayali  2   3 , Hirotomo Kato  4
Affiliations

An outbreak of Leishmania major from an endemic to a non-endemic region posed a public health threat in Iraq from 2014-2017: Epidemiological, molecular and phylogenetic studies

Mariwan M M Al-Bajalan et al. PLoS Negl Trop Dis. .

Abstract

Background: Cutaneous leishmaniasis (CL) is a neglected worldwide, zoonotic, vector-borne, tropical disease that is a threat to public health. This threat may spread from endemic to non-endemic areas. Current research has exploited epidemiological, molecular and phylogenetical studies to determine the danger of an outbreak of CL in the borderline area between northern and central Iraq from 2014-2017.

Methodology/principal findings: For the first time, using sequence analysis of the cytochrome b gene, the occurrence of CL in the borderline area between northern and central Iraq was confirmed to be due to Leishmania major. The phylogenetic analysis indicated that it was closely related to the L. major MRHO/IR/75/ER strain in Iran.

Conclusions and significance: In conclusion, the genotype confirmation of the L. major strain will improve our understanding of the epidemiology of the disease. This is important for facilitating control programs to prevent the further spread of CL. Furthermore, this area could be considered as a model for further research on the risk of global CL epidemics in other non-endemic countries where both reservoir hosts and sandfly vectors are present.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Geographical map of the study area around the Garmian region.
The map was created by Landsatlook viewer (USGS Products, Data available from the U.S. Geological Survey). The interrupted blue line indicates the borderline between the north and center of Iraq by previous Iraqi governments before 2003.
Fig 2
Fig 2. Year-wise trend of the number of reported CL cases in Iraq.
Data based on WHO reports for Iraq [15, 16, 22].
Fig 3
Fig 3. Year-wise trend of the number of reported CL cases in the Garmian region.
Data were collected from reports of the Department of Transmissible Diseases of Garmian from 2014–2017.
Fig 4
Fig 4. Monthly distribution of the number of reported CL cases in the Garmian region.
Data were collected from reports of the Department of Transmissible Diseases of Garmian from 2014–2017.
Fig 5
Fig 5. PCR products of the L. major cytochrome b gene run on a 1.5% agarose gel.
(MM) Molecular weight marker 100–1500 bp. Panel a: -ve is negative control (without DNA); +ve is positive control (previously confirmed L. major from a dog with cutaneous lesions by sequencing [24]), sample 1 (L. major was initially confirmed from human CL by sequencing), and sample 2 (sample number 14 in Panel b. Panel b:1 to 30: skin aspirate samples; 1, 4, 7, 14, 16, 18, 20, 22, 24, 25, 26, 27, 28, 29, and 30 were positive.
Fig 6
Fig 6. Phylogenetic analysis of cytochrome b gene sequences among Leishmania species.
The scale bar represents 0.01% divergence. Bootstrap values are shown above or below branches. Underlined GenBank accession numbers represent L. major sequences identified in this study.
See this image and copyright information in PMC

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