03415nas a2200325   4500000000100000008004100001260001600042653002900058653001700087653001300104653001700117653001800134100001300152700001700165700001900182700002200201700001500223700001200238700001700250700001800267700001500285700001600300700001600316245012100332856015300453300000800606490000700614520245400621022001403075       2025                            d  bElsevier BV10aLeishmaniasis, Cutaneous10aRisk factors10aSand fly10aSaudi Arabia10aAsir Province1 aAlraey Y1 aAlshahrani A1 aAlshahrani TSM1 aAwdah Al Draim NH1 aSumayli AA1 aMana AM1 aAlqahtani AA1 aAlAbdullah MS1 aMjrashi AM1 aAlqhtani SJ1 aAl Salem WS00aUnveiling risk factors and sandfly ecology in cutaneous leishmaniasis-endemic areas of the Asir Region, Saudi Arabia  uhttps://www.sciencedirect.com/science/article/pii/S187603412500259X/pdfft?md5=fad697ee71afc909f76ea84b4501846c&pid=1-s2.0-S187603412500259X-main.pdf  a1-90 v183 a<p id="sect0010"><strong>Background</strong></p>

<p>Cutaneous leishmaniasis (CL) remains a significant public health challenge in the Asir region of southwest Saudi Arabia. This study aimed to identify risk factors associated with CL transmission through a case-control questionnaire and to investigate the local sandfly population as potential vectors.</p>

<p id="sect0015"><strong>Method</strong></p>

<p>From June to December 2022, sandflies were collected using paper traps from four CL-endemic locations: Khamis Mushait, Belhamr, Mahayel, and Rijal Almaa. Collected specimens were taxonomically identified. Concurrently, between 2022 and 2023, a validated questionnaire was administered to confirmed CL cases and matched controls without prior CL history. The questionnaire assessed demographic data, lesion characteristics, medical history, housing conditions, animal exposure, and use of protective measures. Interviews were conducted in Arabic and English, with translation support as needed.</p>

<p id="sect0020"><strong>Results</strong></p>

<p>A total of 713 sandflies were captured, including 453 males and 260 females. Khamis Mushait showed the highest vector abundance. Two sandfly genera,&nbsp;<em>Phlebotomus</em>&nbsp;and&nbsp;<em>Sergentomyia</em>, were identified. Among six Phlebotomus species,&nbsp;<em>Ph. bergeroti</em>&nbsp;and&nbsp;<em>Ph. sergenti</em>&nbsp;were the most prevalent. Questionnaire analysis revealed that men and married individuals were more frequently affected. Risk factors included outdoor activity, poor housing infrastructure, and proximity to livestock and gardens. In contrast, waste areas showed no significant association, and the use of insecticides and public health awareness were correlated with reduced infection risk.</p>

<p id="sect0025"><strong>Conclusions</strong></p>

<p>This study highlights key environmental, entomological, and behavioral factors influencing the Asir region's cutaneous leishmaniasis (CL) transmission<em>. Ph. bergeroti</em>&nbsp;and&nbsp;<em>Ph. sergenti</em>&nbsp;were the most abundant species, with&nbsp;<em>Ph. bergeroti</em>&nbsp;showing potential as a permissive vector, warranting further investigation. The findings suggest the possibility of a zoonotic transmission cycle in an area traditionally considered non-zoonotic for&nbsp;<em>Leishmania tropica</em>, emphasizing the need for integrated control and public health strategies.</p>
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