Abstract
During the coronavirus disease 2019 lockdown period, a surge in sandflies and cutaneous leishmaniasis (CL) cases was observed in Al-Ahsa, Saudi Arabia. Skin punch biopsies were obtained from 100 patients clinically diagnosed with CL in Al-Ahsa who had no travel history in the last 6 months. Impression smears were used following a three-step polymerase chain reaction (PCR) protocol using genus-specific primers targeting kDNA and ITS1.
Leishmania
speciation was determined by ITS1 PCR/nested PCR-restriction fragment length polymorphism and sequencing. A phylogenetic tree was constructed. The associated patient characteristics were analyzed. Using internal transcribed spacer one (ITS1)-PCR/nested PCR, 98 cases were considered true-positive CL.
Leishmania major
was the predominant species, and
Leishmania tropica
was identified in three cases. Microscopy had poor sensitivity and perfect specificity. Direct ITS1-PCR missed nine cases. Sex, residence, and treatment outcome were significantly associated with the occurrence of
Leishmania
; distribution of skin lesion(s) and treatment outcome were significantly associated with
Leishmania
genotype. This is the first time that
L. tropica
was identified as a cause of CL in human in Al-Ahsa, in addition to the predominant zoonotic species,
L. major
. We recommend using ITS1-nested PCR for negative cases by ITS1-PCR. Further exploration of
Leishmania
transmission dynamics in vectors and reservoir animals is essential for designing effective preventive measures.