Epidemiological and molecular investigation of resurgent cutaneous leishmaniasis in Sudan

Abstract

Objectives: Local health personnel have drawn attention to an apparent increase in incidence and severity of cutaneous leishmaniasis (CL) in Sudan. The objective of this study was to investigate CL burden and surveillance. Methods: Surveillance data were compiled from the KalaCORE programme, Leishmania coordinators in Northern Kordofan and Southern Darfur, and Khartoum Dermatology Hospital. CL lesions were sampled from 14 suspected cases from Northern Kordofan and the Hospital for Tropical Diseases in Omdurman. PCR–restriction fragment length polymorphism analysis and multilocus sequencing were used to characterize the disease agent. Results: All sites reported substantial increases from 2014 to 2016/7, far exceeding World Health Organization case reports for 2014, consistent with a widespread outbreak. Single seasonal peak incidence was observed, except for two peaks in Southern Darfur. In Northern Kordofan, the odds ratio for CL in the 35–44 years age group was 2.6 times higher than in the >45 years age group (p < 0.0001); in Southern Darfur, the OR was 2.38 greater in males than females (p < 0.0001). Lesions included severe presentations, despite chemotherapy. Leishmania major was identified as the agent. Conclusions: Active surveillance is required to understand the extent of CL in Sudan, as well as training to standardize surveillance, diagnosis, reporting, and quality control. Point-of-care rapid diagnosis would be valuable. Genotyping and phenotyping are required to monitor the emergence of pathogenic strains, drug resistance, outbreaks, and changes in severity.