Leishmaniasis in northern Cyprus: Human cases and their association with risk factors
Emrah Ruh1, Aysegul Bostanci1, Vasfiye Kunter2, Ozgur Tosun3, Turgut Imir1, Henk Schallig4, Aysegul Taylan-Ozkan5
1 Faculty of Medicine, Department of Medical Microbiology and Clinical Microbiology, Near East University, Nicosia, Northern Cyprus
2 Dr Burhan Nalbantoglu State Hospital, Nicosia, Northern Cyprus
3 Faculty of Medicine, Department of Biostatistics, Near East University, Nicosia, Northern Cyprus
4 Department of Medical Microbiology, Parasitology Unit, Academic Medical Centre, Amsterdam, The Netherlands
5 Faculty of Medicine, Department of Medical Microbiology and Clinical Microbiology, Near East University, Nicosia, Northern Cyprus; Faculty of Medicine, Department of Medical Microbiology, Hitit University, Corum, Turkey
Faculty of Medicine, Department of Medical Microbiology and Clinical Microbiology, Near East University, Near East Boulevard, Nicosia
Source of Support: None, Conflict of Interest: None
Background & objectives: Cyprus is located in the eastern part of the Mediterranean Region where leishmaniasis is endemic. The primary objective of this study was to investigate human visceral leishmaniasis (VL) in the northern region of Cyprus where presence of canine leishmaniasis (CanL) and sandflies has been documented in earlier studies. The secondary objective was to assess the association of leishmaniasis with demographic and epidemiological variables.
Methods: Intravenous blood samples were collected from 249 volunteers in Kyrenia district (located in the northern coastal region of Cyprus). Whole blood samples were tested for DNA of Leishmania spp by polymerase chain reaction (PCR), while serum samples were analyzed using direct agglutination test (DAT) and rK39 test. For evaluation of possible risk factors, a questionnaire was applied to the participants.
Results: Only three (1.2%) of 249 participants were found seropositive by DAT (n = 2) or rK39 test (n = 1). The remaining samples were negative in serology, and no PCR positivity was detected in any of the 249 participants. Seven individuals, including the seropositive cases, had a history of cutaneous leishmaniasis (CL). Seropositivity and CL were not significantly related with gender (M/F: 40.2/59.8%), age [Mean: 42.85 ± 17.45, Median: 40 (7–86)], occupation (Indoor/Outdoor: 84.7/12.9%), dog ownership (52.6%), and CanL history (5.3%). However, a statistical association was found between seropositivity and past CL infection. Also, a significant relation was observed between participants living in peripheral area (63.1%) and CL infection. Furthermore, leishmaniasis awareness (28.1%) among the study population was statistically correlated with past CL infection and dog ownership.
Interpretation & conclusion: This study demonstrates the presence of leishmaniasis and highlight the need for implementation of efficient control measures on the northern coast of Cyprus.