Awareness and behavioral practice of cutaneous leishmaniasis among hail population, kingdom of Saudi Arabia

Cutaneous Leishmaniasis (CL) is part of a larger number of Leishmaniasis disease caused by an obligatory intracellular protozoa of the genus Leishmania.1 In the Middle East, old World cutaneous leishmaniasis is caused mainly by Leishmania tropica, and Leishmania major.2 Currently CL is endemic in 87 countries worldwide (WHO EMRO 2014). More than 1.5 million cases of Leishmaniasis occur annually, of which 0.7–1.2 million are CL.1 Since CL was First described in Saudi Arabia (1976) by Morsy and Shoura and until (1996) Saudi Arabia was among the top 10 endemic countries globally.3 Currently Saudi Arabia is considered the fourth most endemic area in western Asia.4 The total number of reported incidence of CL in Saudi Arabia from 2006-2015 was 24,970 of which 2100 were recorded from Hail, which was the most consistent endemic region throughout the study with high incidence (>10 cases/100,000 population). As per the incidence data by regions for the year 2015, Hail is the highest endemic focus (282 newly detected cases).5 Phlebotomus papatasi (L. major vector) is the major and most predominant leishmaniasis vector species in many regions including Hail.6 The main animal reservoirs of CL caught in Northern and Western Saudi Arabia are desert rodents including: Meriones libycus, Psammomys obesus, Rattus rattus, jaculus, and Hystrix indica, the first species was the most abundant (90%), and the isoenzyme electrophoresis identification of the Leishmania isolates from both human patients and rodents showed an identical species (zymodeme LON-4).7 Abundance of incidence in the northern region including hail could be explained by the presence of perfect living conditions for Leishmania parasite where transmission is running in some plains at the periphery of cities among populations of rodents (Psammomys obesus) by the efficient sand fly vector (P. papatasi). Through the interruption of this habitat by construction sites and emerging closer neighborhoods or villages, the transmission through sand fly bites increases among human inhabitants of these regions.5