Identification of Species and Characteristics of an Outbreak of Cutaneous Leishmaniasis in a New Focus of Iran

Both urban and rural cutaneous leishmaniasis (CL) are endemic in different parts of Iran and have long been recognized in most provinces. However, there is no report of endemicity of CL in rural areas of Kashan, 200 km north of Isfahan and 260 km south of Tehran, Iran. To our knowledge, this is the first report of outbreak of cutaneous leishmaniasis in this area. To study and identify the nature of infection in this area, a survey was conducted in a borough, 30 Km south-east of Kashan on 3,530 people, using questionnaire for obtaining clinical status, and leishmanin skin test as an indicator of the prevalence of infection. In addition, 42 lesion samples from patients residing in this area were cultured, which twenty eight of them were positive. By enzyme immunoassay, using three species-specific monoclonal antibodies against common species of Leishmania in Iran, species of isolates were identified. Some of these isolates were also analyzed by PCR. The results showed the prevalence of 6% patients with lesion(s) in the population and 3.1% of people displayed lesion scar(s). Also 12% of population showed sensitivity to leishmanin. In this study the Leishmania major strain was identified in majority of cases, which showed two different patterns when analyzed by PCR. Both patterns belonged to different endemic strains of L. Major in Isfahan, which indicates the possible transmission of infection from Isfahan to this area.