Fig 1.
Map indicating the location of the outbreak site and healthcare facilities in Somali Region in Ethiopia (UNOCHA, 2021). Map of Ethiopia showing neighboring countries, with the Afar region highlighted in blue and the Somali region in green. The Duunyar district with Badhi Wayne town, where the outbreak occurred, indicated by a red dot, is situated at the border between the two regions, on the Somali side. Duunyar Health Center is located here as well. Sitti Primary Hospital and Jigjiga University Sheik Hassen Yabare Comprehensive Specialized Hospital are situated in the northern part of Somali Region (Red “H”). Other healthcare facilities (including Karamara General Hospital, Shinile Primary Hospital, Gode General Hospital, Fik Primary Hospital, Filtu Primary Hospital, Hargele General Hospital, Warder Primary Hospital, Dawa Primary Hospital and Dollo Ado Primary Hospital) from which CL cases are reported in Somali region are further from the outbreak site and indicated by a blue “H”.
Fig 2.
Pictures of the landscape nearby the outbreak site in Duunyar district, Ethiopia.
A. Dry weather causing a semi-arid to arid landscape, characterized by rocky terrains. B. Settlements of nomadic populations in the district. Pictures: Hailemariam Difabachew.
Fig 3.
Epidemiological curve of cutaneous leishmaniasis outbreak in Somali Region showing the number of cases diagnosed with their date of onset of symptoms.
Data are compiled from 11 reporting healthcare facilities in the Somali Region. A standardized reporting system was introduced in August 2023.
Table 1.
Socio-demographic and lesion characteristics of cutaneous leishmaniasis cases from the line list of 11 reporting hospitals in Somali region.
Fig 4.
Cutaneous leishmaniasis in Somali region, Ethiopia.
A: Solitary infiltrative nodule with central erosion and a yellowish crust on the temporal area. B: Ulcer on the shin of the leg with a clean granulated base and a rim of raised borders. C: Edematous swelling of the helix of the ear, featuring an ulcer with a dry crust. D: Multiple dry, infiltrative papules with crater-like central dimpling on the left side of the face. E: More than 17 skin-colored papules scattered on the nape of the neck, occipital part of the scalp, and posterior auricular area. F: Multiple discrete infiltrative psoriasiform plaques with grey crust/scaling and areas of erosion on the leg below the knee. G: Infiltrative plaque with central crusting, surrounded by a peripheral hypopigmented patch with fine scaling and multiple satellite papulosquamous lesions on the leg. Pictures: Hailemariam Difabachew.
Fig 5.
Mucocutaneous leishmaniasis patients in Somali Region, Ethiopia.
A: Solitary ulcer with a yellowish thick crust on the upper lip mucosa. B: Multiple (more than 18) discrete nodular lesions with central dark grey dry thick crust and infiltrative margins scattered on the face and lip. C: Multiple papular lesions scattered on the left temporal region, nasal bridge, and tip of the nose, along with yellowish crusted ulcers on the upper and lower lips. D: Erosive lesion with a yellowish crust on the right tip of the nose and lower lip. F: Infiltrative swelling of nose cheek and lip with erythema. Erosive ulcer on tip of the nose. Pictures: Hailemariam Difabachew.
Fig 6.
Dendrogram of HSP70 sequences from Leishmania parasites causing cutaneous leishmaniasis in Somali Region, Ethiopia.
The sequence identified as “Somali Region Ethiopia” is representative of the parasites S02/ S05/ S06/ S07/ S11/ SH02/ SH03/ WHO1/ WHO6/ WHO8/ WHO9a/ WHO11/ WHO12. For parasites S04/ WHO4/ WHO9b/ WHO13/ WHO15 several ambiguities were seen from bad sequence quality, but none of these showed a difference from the other Somali Region Ethiopia sequences. Obtained sequences are compared to representatives of Old World Leishmania species. Sequences were recovered from Genbank, and are identified by their accession number, followed by strain identification and country of origin as recorded in the GenBank sequence entry. Bootstrap values from 2000 replicates are shown in percentages at the internodes when higher than 50%. The distance scale is shown at the bottom. The root was placed on the branch leading to the L. donovani species.
Table 2.
Morphological species identification of sandflies captured in and around Badhi Wayne town, Somali Region.