Keziot - a new endemic site of cutaneous Leishmaniasis in Israel. An epidemiological and clinical study of a non-immune population entering an endemic area

In this study we describe a new endemic focus of cutaneous leishmaniasis at Keziot in southern Israel, and the pattern of the disease among a group of soldiers newly based in the area. Interviews and physical examinations were conducted on 296 soldiers, and 247 were subjected to a leishmanin skin test. Positive tests were recorded in 18% of the soldiers; in 16% of them Keziot was identified as the area where the infection was acquired. Positive skin tests were found among 93% and 41% of soldiers with typical cutaneous leishmanial lesions and atypical lesions, respectively. The relatively high proportion of atypical cases with positive leishmanin tests emphasizes the difficulty of distinguishing clinically, in an endemic area, between cutaneous leishmaniasis and other scars and secondarily infected wounds. In a concurrent study Leishmania major was isolated from rodents of the genus Meriones and from Phlebotomus papatasii sandflies in the Keziot area. Keziot should be considered an endemic area for cutaneous leishmaniasis, due to the high morbidity rate and demonstration of all the components of the disease cycle, namely the parasite, the vector and the reservoir.