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In 2006/7, 18 cases of cutaneous leishmaniasis (CL) were reported for the first time from Sde Eliyahu (pop. 650), a village in the Beit She'an valley of Israel. Between 2007–2011, a further 88 CL cases were diagnosed bringing the total to 106 (16.3% of the population of Sde Eliyahu). The majority of cases resided in the south-western part of the village along the perimeter fence. The causative parasite was identified as  Leishmania major  Yakimoff & Schokhor, 1914 (Kinetoplastida: Trypanosomatidae).  Phlebotomus papatasi  (Scopoli), 1786 (Diptera: Psychodidae) was found to be the most abundant phlebotomine species comprising 97% of the sand flies trapped inside the village, and an average of 7.9% of the females were positive for  Leishmania  ITS1 DNA. Parasite isolates from CL cases and a sand fly were characterized using several methods and shown to be  L. major . During a comprehensive survey of rodents 164 Levant voles  Microtus guentheri  Danford & Alston, 1880 (Rodentia: Cricetidae) were captured in alfalfa fields bordering the village. Of these 27 (16.5%) tested positive for  Leishmania  ITS1 DNA and shown to be  L. major  by reverse line blotting. A very high percentage (58.3% - 21/36) of Tristram's jirds  Meriones tristrami  Thomas, 1892 (Rodentia: Muridae), found further away from the village also tested positive for ITS1 by PCR. Isolates of  L. major  were successfully cultured from the ear of a wild jird found positive by ITS1 PCR. Although none of the wild PCR-positive voles exhibited external pathology, laboratory-reared voles that were infected by intradermal  L. major  inoculation, developed patent lesions and sand flies became infected by feeding on the ears of these laboratory-infected voles. This is the first report implicating  M. guentheri  and  M. tristrami  as reservoirs of  Leishmania . The widespread co-distribution of  M. guentheri  and  P. papatasi , suggests a significant threat from the spread of CL caused by  L. major  in the Middle East, central Asia and southern Europe.

A Newly Emerged Cutaneous Leishmaniasis Focus in Northern Israel and Two New Reservoir Hosts of Leishmania major