SHORT COMMUNICATION Revival of a focus of visceral leishmaniasis in central Sudan Human visceral leishmaniasis (VL) caused by Leishmania donovani is endemic over vast areas of eastern, western and southern Sudan. In these areas the disease principally affects children and is complicated, in .50% of cases, by a dermatosis known as post-kala- azar dermal leishmaniasis (El-Hassan et al., 1993; Zijlstra and El-Hassan, 2001; Khalil et al., 2002; Musa et al., 2002). Twenty five years ago, an outbreak of pyrexia of unknown origin erupted in a cluster of four villages (Elkitair, Shatawi, Kadaba and Wad Elsafori) on the western bank of the White Nile, about 100 km south of Khartoum, in central Sudan. Over 100 individuals, adults as well as children, died before the cause of the fever was identified as VL (Ahmed et al., 1988). The outbreak soon fizzled out, however, and no further cases of VL were reported until October 2006, when an outbreak of a febrile illness that did not respond to antimalarial or antibiotic treat- ment occurred in the same area. Overall, 150 individuals, mostly children with high-grade fever and splenomegaly, had to be admitted to various hospitals in Greater Khartoum, and most (100) of these cases were found to have amastigotes in smears of lymph-node and/or bone-marrow aspirates. Another four cases were found positive for kinetoplast DNA in a PCR-based assay that used Leishmania-specific primers — AJS3 (GGG GTT GGT GTA AAA TAG GG) and DBY (CCA GTT TCC CGC CCC GGAG) — produced by Inqaba Biomedical Industries (Hatfield, South Africa). In each case, an 800-bp amplicon, characteristic of L. dono- vani, was produced. Fortunately, all 150 patients responded to treatment with sodium stibogluconate, without any complications. The apparent revival of a VL focus in central Sudan, 25 years after any cases had been detected in the area, is curious. A savannah belt once stretched across central Sudan from VL-endemic areas in the west to similarly endemic areas in the east. The severe drought that hit northern Sudan in the mid 1980s changed large areas of central Sudan from savannah to overt desert, how- ever, in a process that was aggravated by irrational grazing practices and the felling of trees for charcoal production. In the last decade, however, trees, mainly Acacia and Balanites, began to re-appear in these areas, following a national decree that prohibited the use of trees for charcoal preparation and a decreasing demand for charcoal as natural gas became increasingly available as a domestic fuel. This change in the tree cover has probably helped local sandfly popula- tions that were hit by the drought and desertification to recover. In a recent ento- mological survey, uninfected Phlebotomus orientalis were collected in the revived VL focus (unpubl. obs.). It seems possible that L. donovani has been maintained in a sylvatic cycle, in or near the focus, since the 1980s and that it is a recent expansion of the sandfly population that has forced the re-emergence of VL. Further studies in the focus, primarily to determine the extent of current human exposure to L. donovani and to identify the ‘reservoir’ hosts, are now underway. E. A. G. KHALIL A. M. MUSA S. H. H. ELGAWI A. MESHASHA The Leishmaniasis Research Group, Institute of Endemic Diseases, Annals of Tropical Medicine & Parasitology, Vol. 102, No. 1, 79–80 (2008) # 2008 The Liverpool School of Tropical Medicine DOI: 10.1179/136485908X252269