1588 © The Author(s) 2018. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. Journal of Medical Entomology, 55(6), 2018, 1588–1593 doi: 10.1093/jme/tjy110 Advance Access Publication Date: 21 June 2018 Research Article Vector/Pathogen/Host Interaction, Transmission The Potential Role of Humans in the Transmission Cycle of Leishmania major (Kinetoplastida: Trypanosomatidae), the Causative Agent of the Old World Zoonotic Cutaneous Leishmaniasis Mahboubeh Fatemi, 1 Mohammad Reza Yaghoobi-Ershadi, 1 Mehdi Mohebali, 2 Zahra Saeidi, 1 Arshad Veysi, 3 Fatemeh Gholampour, 1 Behnaz Akhoundi, 2 Ameneh Karimi, 1 Mohammad Hossein Arandian, 4 Akram Mir Amin Mohammadi, 5 Yavar Rassi, 1 Alireza Zahraei-Ramazani, 1 Ali Khamesipour, 5,* and Amir Ahmad Akhavan 1,6,* 1 Department of Medical Entomology and Vector Control, School of Public Health, Tehran University of Medical Sciences, Postal code: 1417613151, Tehran, Iran, 2 Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Postal code: 1417613151, Tehran, Iran, 3 Zoonoses Research Center, Kurdistan University of Medical sciences, Postal code: 1417613151, Sanandaj, Iran, 4 Esfahan Health Research Station, National Institute of Health Research, Tehran University of Medical Sciences, Postal code: 1417613151, Esfahan, Iran, 5 Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Postal code: 1417613151, Tehran, Iran, and 6 Corresponding author, e-mail: aaakhavan@tums.ac.ir *Amir Ahmad Akhavan and Ali Khamesipour contributed equally to this work. Subject Editor: David Florin Received 24 January 2018; Editorial decision 27 June 2018 Abstract Zoonotic cutaneous leishmaniasis (ZCL) due to Leishmania major (Yakimoff and Schokhor, 1914) (Kinetoplastida: Trypanosomatidae) is known as a neglected tropical disease, transmitted by Phlebotomus papatasi (Scopoli, 1786) (Diptera: Psychodidae) in North Africa and the Middle East. The main reservoirs of ZCL are desert gerbils and the role of humans as a reservoir host of the disease is not clearly defned and is therefore investigated in this study. In order to achieve this objective, Ph. papatasi sand fies were allowed to take blood through indirect blood sources (human, Rhombomys opimus (Lichtenstein, 1823) (Rodentia: cricetidae) (great gerbil), and BALB/c mice) using artifcial feeding or direct xenodiagnoses from ZCL patients. To detect Leishmania promastigotes inside digestive canal, blood-fed sand fies were dissected and examined under light microscope and then confrmed by nested-PCR. In indirect xenodiagnoses, promastigote forms of Leishmania parasite were observed in 7.1%, 12%, and 13.6% of sand fies which fed on Rh. opimus, BALB/c mice, or human blood sources, respectively. In direct xenodiagnoses, among 93 female lab-reared sand fies which fed on active L. major lesion(s), 2.1% Leishmania infection was subsequently observed in the sand fies. No infection was detected in those sand fies that fed on nonlesioned skin of CL patients. Humans can serve as a reservoir of ZCL since the data indicate that Ph. papatasi is able to acquire L. major parasites from an active lesion of ZCL patients and the parasites can complete metacyclogenesis in the sand fy. Key words: Phlebotomus, Leishmania, human reservoir, zoonotic cutaneous leishmaniasis, artifcial feeding Zoonotic cutaneous leishmaniasis (ZCL) due to Leishmania major (Yakimoff and Schokhor, 1914) is known as a neglected tropical disease, transmitted by Phlebotomus papatasi (Scopoli, 1786) in North Africa and the Middle East. ZCL is endemic in many coun- tries and is a major health problem in some endemic regions (WHO 2010). Annually about 20,000 cases of CL are reported in Iran but the actual number of CL may be 5–6 times more than the reported cases. More than 80% of reported cases of leishmaniasis in Iran are from rural areas in central, northeast, west and southwest and southeast of the country that concentrated in 17 of 31 provinces Downloaded from https://academic.oup.com/jme/article/55/6/1588/5073223 by guest on 05 September 2023