Epidemiology of Cutaneous leishmaniasis in the Northern West Bank ,Palestine

BACKGROUND: Leishmaniasis has been an antique public health problem in south -West Asia and the Arab world reported from time immemorial as the pharaohs ruled in Egypt and Assyrians in Mesopotamia. The disease is caused by the genus Leishmania. There are several species of this parasite that cause leishmaniasis where three forms are confirmed: cutaneous (CL), mucco-cutaneous (MCL), and visceral (VL) leishmaniasis. North of Palestine is the centre of a region where simple CL is hyperendemic. Leishmania parasite is transmitted by the sand fly vector supported by a wide range of reservoirs distributed on all inhabited continents. In Palestine, two forms of leishmaniasis exist. One is the CL caused by L. major or L. tropica and the other is visceral caused by L. infantum. Leishmaniasis in general is reported in all Palestinian districts except Gaza strip with an official incidence rate in the West Bank of more than 10 per 100,000 in 2003. AIM: The epidemiology of CL in Palestine and neighbouring countries appears to be undergoing a transition. From our observation as worker in MOH clinic for infectious diseases, we noticed rise in number of patients with CL in the area of north West Bank. Therefore, this study was designed to study the incidence of CL over 10 years period as well as studying the ecological, epidemiological and social factors that might lead to this rise. Methodology: This study is retrospective cross-sectional study. 1150 files of patients were reviewed in order to fill a questionnaire designed by the authors. The questionnaire includes demographic, clinical, diagnostic, and epidemiological questions. Age, residence, sex and personal information as well as information about domestic and wild animal living around patients were collected. Other information about houses and protective measures taken by respondents to avoid bite of the sand fly vector were also seeked. RESULTS: The most striking results found in this study was that the study confirms that the area understudy is hyperendemic with CL. Tubas and Jenin districts were found to have more incidence by at least 5-10 than other districts in this study. No difference was found between male and female in infection with CL. However, children found to be the most affected age group. Site of infection among patients showed that limbs and legs are predominantly affected. Rat and dogs were reported by patients around their houses. Those animals are known to act as reservoirs for Sand fly vector. More than 70% of CL patients were found resident of suburban areas, although patients from different geographical sites were found.