Leishmania spp. are medically important unicellular parasites transmitted by phlebotomine sand flies. The World Health Organization recently highlighted the importance of reliable diagnostic tools for leishmaniasis. Our study of human infection was conducted in two endemic foci of Leishmania tropica in the Galilee region, northern Israel. Elevated anti-Leishmania antibodies were present in the majority (78.6%) of L. tropica-PCR positive individuals. Moreover, the enzyme-linked immunosorbent assay showed high sensitivity, specificity, and negative and positive predictive values (ranging between 73% and 79%), thus fulfilling the basic requirement for future development of a serodiagnostic and screening tool. The anti-sand fly saliva antibodies used as biomarkers of exposure reflected the composition of the local sand fly fauna as well as the abundance of individual species. High levels of antibodies against vector salivary proteins may further indicate frequent exposure to sand flies and consequently a higher probability of Leishmania transmission.

Department of Microbiology and Molecular Genetics The Institute for Medical Research Israel Canada The Kuvin Centre for the Study of Infectious and Tropical Diseases The Hebrew University Hadassah Medical School The Hebrew University of Jerusalem Jerusalem Israel

Department of Parasitology Charles University Faculty of Science Prague Czech Republic

Department of Pediatrics Carmel Medical Center Haifa Israel

School of Veterinary Medicine Hebrew University Rehovot Israel

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