Visceral leishmaniasis in Israel, 1960-2000

Background: Visceral leismaniasis was first reported in Israel (then Palestine) in 1929. In the 1960s and 1970s, it was endemic to northern Israel, but only partial data about the disease have been gathered since then. Objective: To investigate the epidemiologic trends of visceral leismaniasis in Israel from 1960 to 2000, and to delineate some clinical features of the infection. Methods: Data were collected from hospital charts scientific publications, and reports of the Ministry of Health and the Kuvin Center for the Study of Infectious and Tropical Disease. Results: During the last four decades, 87 cases of visceral leismaniasis were diagnosed in Israel, 76 them (87%) in children. In the 1960s, and 54 patients were diagnosed in the northern part of the country. The rate of infections declined significantly in the 1970s (5 cases) and then increased slightly in the 1980s (11 cases) and 1990s (17 cases). More than 50% of the cases in the 1990s were in central Israel. Children accounted 100% of cases in the 1960s but only 58% in the 1990s. Then main clinical features of the patients diagnosed in the last decade were fever, weight loss, hepatosplenomegaly and pancytopenia. Three of the adults were co-infected with human immunodeficiency virus. Discussion: The decline in the incidence of visceral leismaniasis in the 1970s and the slight increase in the 1980s and 1990s can be attributed to changes in the animal reservoir vectors, and in the immunity status of part of the population exposed to Leishmania. Conclusions: Visceral leishmaniasis has reemerged in Israel. This mandates better control of the animal reservoir and vectors and increased awareness to this infection.