- Email: [email protected]
Prevalence of cutaneous leishmaniasis in different regions of Larestan and its relationship with public health condition during 2014–2015
Gene Reports 17 (2019) 100530
Contents lists available at ScienceDirect
Gene Reports journal homepage: www.elsevier.com/locate/genrep
Prevalence of cutaneous leishmaniasis in different regions of Larestan and its relationship with public health condition during 2014–2015
T
Aliyar Pirouzia, Hossein Forouzandeha,b, Amir Raoofic, Iraj Ahmadid, Rahman Abdizadehe, ⁎ Elmira Zareia, Razieh Hoseini Farrashf,g, Azad Khaledih,i, a
Cellular and Molecular Research Center, Gerash University of Medical Sciences, Gerash, Iran Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Shiraz, Iran c Cellular and Molecular Research Center, Sabzavar University of Medical Sciences, Sabzevar, Iran d Physiology Department, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran e Department of Medical Parasitology and Mycology, Faculty of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran f Cutaneous Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran g Departments of Parasitology and Mycology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran h Infectious Diseases Research Center, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran i Department of Microbiology and Immunology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran b
A R T I C LE I N FO
A B S T R A C T
Keywords: Cutaneous leishmaniasis Leishmaniasis Prevalence
This study aimed to investigate the prevalence of cutaneous leishmaniasis in different regions of Larestan and its relationship with public health condition during 2014–2015. This descriptive cross-sectional study was conducted on 223 positive cases during 2014–2015 in Larestan region, in southern Fars province, Iran. The samples were taken from lesion exudates caused by mosquito bites. The parasite was distinguished by Giemsa staining. Presence of Leishman bodies or Amastigotes form indicates the positivity of the case. The included patients were studied in terms of nationality, age, sex, involved organ, number of lesions, parasites sources, type of building, and Patients' place of residence. Data analyzed using SPSS software through Fisher's exact and t-student tests. About 95% of the positive cases were Iranian patients, and the remaining were Afghans. And 51% of patients were female. Individuals younger than 9 years old had the most infection cases (55%). A significant correlation was found between age and leishmaniasis. Also, 81% of the diseases were related to urban leishmaniasis. Hands were the most common organs involved with a frequency 39%. It was found that the age group1–9-year-old has contained the most level of infected cases to cutaneous leishmaniasis.
1. Introduction Leishmaniasis is a parasitic disease that appears in various forms including cutaneous (cutaneous leishmaniasis), mucocutaneous, diffuse cutaneous and visceral (visceral leishmaniasis (VL) known as kala-azar) (Alvar et al., 2012). Cutaneous leishmaniasis is a chronic disease that shows itself as a painless lesion in some areas of the body, particularly, on the face. The carrier of the disease is an infected sand fly that infects a person by body biting (Murray et al., 2005). At least 20 different species of the genus Leishmania parasite can be transmitted by sandflies (Desjeux, 2004; Alvar et al., 2012). Two types
of cutaneous leishmaniasis have found up to now. In urban leishmaniasis that is also known as dry leishmaniasis, its sources are dogs and human and it lasts usually about a year (Desjeux, 2004; Khaledi et al., 2016). While, urban leishmaniasis creates deep spots in the site that lesion is formed, but, it heals spontaneously. In rural type leishmaniasis which is also called as wet leishmaniasis, the mouse is the source of the disease and the lesion that caused by it remains several weeks to 6 months and lasts for a maximum period of 18 months. Although the leishmaniasis is common in all seasons of the year but is most common in the autumn (Soto et al., 2004; Reithinger et al., 2007). The Known centers of the world with leishmaniasis almost all are
Abbreviations: VL, Visceral leishmaniasis; WHO, World Health Organization ⁎ Corresponding author at: Department of Microbiology and Immunology, School of Medicine, Kashan University of Medical Sciences, 5th of Qotb-e Ravandi Blvd., P.O. Box: 87155.111, 87154 Kashan, Iran. E-mail address: [email protected] (A. Khaledi). https://doi.org/10.1016/j.genrep.2019.100530 Received 18 September 2019; Received in revised form 28 September 2019; Accepted 30 September 2019 2452-0144/ © 2019 Elsevier Inc. All rights reserved.
Gene Reports 17 (2019) 100530
A. Pirouzi, et al.
is 430 km and to Bandar Abbas is 190 km. The population of Larestan County according to the Statistical Center of Iran: 82,290 people. Larestan County area: 6000 sq. km; Relative Humidity: 63%; The average rainfall: 203 mm; The average temperature: 32 °C. The city of Lar: The central part of Larestan County; Suburban districts (Larestan County): Darz and Sabian districts, Dehkouyeh district. Towns are: Lar, Khour and Latifi; Juyom District; Juyom village, Horm and Kariyan village, Juyom town, Banaruiyeh District; Banaruiyeh village, Deh Fish village, Banaruiyeh town, Sahraye Bagh District; Sahraye Bagh village, Emad Deh village, Emad Deh town, Evaz District; Fishour village, Bid Shahr village, Evaz town; Bayram District; Laverstan village, Humeh village, Bayram town (Hafeznia, 2002). Banaruiyeh is a town in Banaruiyeh District of Larestan County in Fars province and south of Iran. Banaruiyeh is located at 85 km from Lar and it was a part of Juyom district until 2003. From that time until now, it is distinct and becomes an independent town. Banaruiyeh population is about 15,000 people and their income is mostly provided by agriculture, trade and working in the Persian Gulf states. Banaruiyeh district is currently an independent district and includes Banaruiyeh town and Deh Fish rural district which itself includes 6 villages of Sharfuyeh, Marmeh, Bakhtiaruyeh, Hasanabad Marmeh, Deh Fish and Lagharan. Juyom is a name of a town in the south of Fars province and in Larestan district. Based on the available data, this town is located in 53° and 58′ east longitude of Prime Meridian and in 28° and 15′ north latitude of the Earth's equatorial plane. The distance of Juyom district from Larestan County is 120 km (Taleban and Khaleqzade, 2016).
located between two latitudes of 28 to 42 degrees° north (Guerin et al., 2002; Sundar and Rai, 2002). According to the reports of the World Health Organization (WHO), leishmaniasis exists endemically in 88 countries all around the world including, African, Asian, European, North, and South American countries (Organization, 1990). Currently, about 12 million people are infected by this parasite, 0.9 to 1.6 million new cases each year, between 20,000 and 30,000 deaths, and 350 million people are at risk for infection worldwide (Sheets et al., 2010; Khaledi et al., 2016). In general, 1.5 to 2 million cases of cutaneous leishmaniasis and 500 thousand cases of visceral leishmaniasis occur every year worldwide. The disease is considered as the second problem after malaria in terms of public health in the world (Uliana et al., 2018). Most cases of cutaneous leishmaniasis have been seen in Afghanistan, Saudi Arabia, Syria, Iran, North and South America, and 90% of leishmaniasis has been also observed in the Middle East (Organization, 1990; Ashford and Desjeux, 1992). The countries with the most cases of visceral leishmaniasis are India, South Sudan, Sudan, Brazil, Ethiopia, and Somalia. Of the 10 countries in the world with the highest number of cases of cutaneous leishmaniasis, three are in the Americas: Brazil, Colombia, and Peru (Alvar et al., 2012). In addition to economic, social and cultural problems, outbreak and release of most diseases such as leishmaniasis is influenced by ecological factors. Various types of vegetation cover and climate factors among other environmental ones play a fundamental role in the growth process of sandflies as the carrier of the disease and subsequent incidence of cutaneous leishmaniasis disease (Desjeux, 2001; Alvar et al., 2012). Climatic conditions and vegetation cover of the studied area is very convenient for the growth of rodents and the proliferation of mosquitoes that can transmit the disease. Prevalence and development of many diseases have highly dependent on natural conditions factors (Chaves and Pascual, 2006). Globally, nationally and regionally researches conducted in the prevalence of this disease have been focused mainly on aspects of medical problems and less attention has been paid to its environmental aspects (Yazdanpanah and Rostamianpur, 2013). Geographical distribution of leishmaniasis in animals was studied in the central region of Bahia state, Brazil and a variety of vegetation cover and climatic factors were cited as natural barriers for spreading of kala-azar (dos Santos Afonso et al., 2017). Leishmaniasis disease is one of six important diseases of tropical regions that WHO studying, performing and supporting the researches on its various aspects in all over the world (Bailey et al., 2017). It should be collecting information from epidemiological areas about aspects of causing factor of leishmaniasis to management and prevention of it. For that, we can be planed the best surveillance system to eliminate the neglected tropical disease by analyzing this data and rising knowledge. Therefore, this study aimed to investigate the prevalence of cutaneous leishmaniasis in different regions of Larestan and its relationship with public health condition during 2014–2015.
2.3. Type of study This descriptive cross-sectional study was conducted on 223 positive cases during 2014–2015 in Larestan, Fars province, Iran. 2.4. Sampling process The simple direct smear was taken from the exudates of lesions caused by mosquito biting and parasites. Then, samples referred to health and medicinal center of communicable diseases of Larestan County for detection. 2.5. Diagnosis of Leishmania in samples Then smears after staining by Giemsa were surveyed by light microscope to perform Amastigote detection. Presence of Leishman bodies or Amastigote forms was indicative of the positivity of the cases. 2.6. Study of factors associated with leishmaniasis In the current research, many factors such as Patients' place of residence, age, sex, type of building, name, nationality, and, onset time of symptoms and diagnosis, involved organs, number and location of lesions, leishmaniasis type were investigated. For this, a questionnaire including mentioned factors was designed and details filled for each positive people.
2. Methods 2.1. Ethical statements
2.7. Statistical analysis This study was approved by Gerash University of Medical Sciences, Gerash, Iran through the institution's research ethics board approval number (IR.GERUMS.REC.2016.2047).
Results were analyzed using the Statistical Package for the Social Sciences (SPSS-22, Chicago, IL, USA). Fisher's exact and t-student tests were used to assess the correlation between infection and studied variables. P-values less 0.05 were considered statistically significant.
2.2. Study area
3. Results
Larestan is one of the districts of Fars province and is one of 49 primary cities founded in 1938. Earlier than this time, Larestan County was one of the states of Iran, which its space was reached to 12,000 km2. Lar is the center of this county, which is one of the oldest cities of Iran. The distance of Lar to the center of Fars province (Shiraz)
Larestan is one of the districts of Fars province located in the south of this province (Fig. 1). In total, 223 positive cases were reported, of which, 212(95%) patients were from Iran and 11(5%) of Afghans. Of 2
Gene Reports 17 (2019) 100530
A. Pirouzi, et al.
Fig. 1. The location of Larestan in Fars province, Iran. Table 1 Demographic and other variables in the present study and correlation with leishmaniasis. Variables
Subgroups
Percent
Age groups
0–9 10–19 20–29 30–39 40–49 50–59 60–69 > 69 Male Female Iran Afghan Old Tent New building Rural Urban
55 12 9 9 5 6 3 1 49 51 95 5 35 3 62 19 81
Gender Nationality Building type
Type of Lieshmaniasis
45 40
P- value
35
39% 33%
30 25
0.001
20
24%
Hands Hand and neck Legs Body
15 10
00.1
5
00.2
0
0.07
Fig. 2. The common sites affected by cutaneous lesion CL patients in the study.
0.2
region of Larestan County has allocated the highest incidence of infection to itself with a frequency of 38% (Fig. 4).
these, 51% were women. As shown in Table 1, patients were distributed in several age groups. The high incidence rate of CL was in the age group (0–9) and (10–19), while the lowest was reported in the age group of > 69 years old. As well, a significant correlation was found between CL and age (p = 0.001). Most patients live in the new buildings, and there was no significant relationship between building type and life cycle of sand flies (p = 0.07). Also, 81% and 19% of patients had urban and rural CL, respectively. Exception age, no correlation was found between factors studied and infection with CL (p > 0.05). As presented in Fig. 2, the common site affected by a cutaneous lesion in CL patients was associated with hands with an incidence of 39%. Also, almost all body organs were involved. The number of lesions was different in various patients. For example, a two-year-old boy had 14 lesions on his body with involving the head, neck and the legs. About 58% of patients had one lesion on their skin (Fig. 3). From ten cities studied, the central
4. Discussion In the present study, the annual incidence of CL has reported 223 positive cases during 2014–2015. In contrary to our results, Alvar and et al. reported an annual incidence of 290–580 cases in Mali during the 2004–2008 (Alvar et al., 2012). To our knowledge, ten countries with the highest estimated case counts including Afghanistan, Algeria, Colombia, Brazil, Iran, Syria, Ethiopia, North Sudan, Costa Rica, and Peru, together are responsible for about 75% of worldwide estimated CL incidence (Alvar et al., 2012). In our study, the incidence of CL based on gender distribution was a little higher in female than in male which was in line with studies conducted in Lorestan (Amraee et al., 2013), Gonbad-e-Qabus (Mesgarian et al., 2010), and Bam (Aflatonian and Sharifi, 2006). Although which was in contrast to several reports including AlSamarai 3
Gene Reports 17 (2019) 100530
A. Pirouzi, et al.
Fig. 3. The number of lesions in leishmaniasis patients.
Fig. 4. Location of patients in different districts of Larestan.
et al., 2017). Also, the high prevalence in the male in different studies can be reflected outdoors social activities of male such as doing work as laborer and more exposure than female to sand fly bites during the time of sand fly activity, or presence in military services, and less coverage of body with cloths (Youssefi et al., 2011; Menkir and Tsion, 2015). In the present study, a few cases of leishmaniasis were documented
et al. in Iraq, Jamal et al. in Pakistan, and different studies from Iran such as Rostami et al. in Qom, Youssefi et al. in Mazandaran (AlSamarai and AlObaidi, 2009; Youssefi et al., 2011; Jamal et al., 2013; Rostami et al., 2013). This difference in the incidence of disease in women in various studies is attributed to the study population, women's work in livestock breeding or farming on lands in some regions (Khademvatan 4
Gene Reports 17 (2019) 100530
A. Pirouzi, et al.
References
(with frequency 5%) in people who had moved from Afghanistan to Larestan, Iran. Afghans might have a role in parasite maintenance and CL transmission in the area (Rostami et al., 2013). Nevertheless, a significant number of cases were Iranian, so local transmission is happening in this district. Although the disease affects all age groups, the risk of Leishmania infection increases with age; children aged less than three years have lower infection prevalence compared to adults (Oliveira et al., 2009). In contrast, the incidence of CL in the current study for children in the age group of 1–9 years old was higher. Like that, Ramezani et al. in Aran and Bidgol (Iran) (Ramezani et al., 2011), and Razmjou et al. in Shiraz (Iran) reported the highest incidence in the age group of 1–9 years old (Razmjou et al., 2009). Other studies conducted in Pakistan and Afghanistan reported the higher LC in younger groups, too (Reithinger et al., 2003; Brooker et al., 2004; Faulde et al., 2008). In terms of site of lesion in the study of Ramezani et al., the following results were obtained; the hands 29.8%, the face 25.5%, the legs 25.5%, the hands and the legs 7.4%, the hands and the face 6.4% and the other parts of the body 5.4%(Ramezani et al., 2011), while these rates in this study are as following; the hands 39%, the legs 24%, the head and the neck 33%, and the body 3%. Comparable results to our findings were obtained by Babaei et al. in their studies on an area in the south of Lorestan province (BABAEI and Shayan, 2003). The highest number of lesions in children indicates that children are more likely to become infected with leishmaniasis. Due to the high commotion of children related to childhood, they are more outside of the home; and due to lack of adequate sanitation, they are more susceptible to mosquito bites (Ramezani et al., 2011). Low incidence of CL in people over the age of 25 who live in endemic areas, likely due to infection in young age and acquired relative immunity, they are less vulnerable in older ages (BABAEI and Shayan, 2003). It seems that due to the susceptible population group in these infected centers and the existence of appropriate ecological status for reservoirs and carriers of this disease in this area is likely the incidence of CL increases if there is no continuation of the preventive and control programs, the more cases occur in the coming years. In the present study, most of the CL cases belonged to dry or urban leishmaniasis, similarly, a study conducted in Kashan revealed that 71.4% of patients were infected with L. tropica (dry or urban leishmaniasis) (Rasti et al., 2016), also, another one from Mashhad showed the same (Shahbazi et al., 2008). In contrary, previous studies from Aran and Bidgol, Isfahan, Natanz, and Ahvaz reported the L. major (rural form) as the main causative agent (Parvizi et al., 2010; Ghasemian et al., 2011; Izadi et al., 2016). In general, the high number of cases reported in our study indicates the endemicity of the disease in Fars province, especially Larestan region. Considering this fact, the data about vectors and reservoirs of this region would be carefully considered and guidelines for fighting sandfly be carefully implemented and followed. Furthermore, health education, finding the patients and treating them, fighting rodents, improving the environmental condition should be also taken into consideration.
Aflatonian, M., Sharifi, I., 2006. Frequency of cutaneous leishmaniasis among patients referred to the center for disease control in Bam district, 1999-2003. Journal of Rafsanjan University of Medical Sciences 5 (2), 123–128. AlSamarai, A.M., AlObaidi, H.S., 2009. Cutaneous leishmaniasis in Iraq. The Journal of Infection in Developing Countries 3 (2), 123–129. Alvar, J., Velez, I.D., Bern, C., Herrero, M., Desjeux, P., Cano, J., Jannin, J., den Boer, M., Team, W.L.C., 2012. Leishmaniasis worldwide and global estimates of its incidence. PLoS One 7 (5), e35671. Amraee, K., H. A. Rastegar and E. Beiranvand (2013). "An epidemiological study of cutaneous leishmaniasis in Poledokhtar district, Lorestan province, southwestern of Iran, 2001-2011.". Ashford, R., Desjeux, P., 1992. Estimation of population at risk of infection and number of cases of leishmaniasis. Parasitol. Today 8 (3), 104–105. BABAEI, G.R., Shayan, A., 2003. An Epidemiological Study of Cutaneous Leishmaniasis and the Investigation of Scars With Emphesis on Seasons, Age and Sex Groups in Paalam, South of Lorestan Province. Bailey, F., Mondragon-Shem, K., Hotez, P., Ruiz-Postigo, J.A., Al-Salem, W., AcostaSerrano, Á., Molyneux, D.H., 2017. A new perspective on cutaneous leishmaniasis—implications for global prevalence and burden of disease estimates. PLoS Negl. Trop. Dis. 11 (8), e0005739. Brooker, S., Mohammed, N., Adil, K., Agha, S., Reithinger, R., Rowland, M., Ali, I., Kolaczinski, J., 2004. Leishmaniasis in refugee and local Pakistani populations. Emerg. Infect. Dis. 10 (9), 1681. Chaves, L.F., Pascual, M., 2006. Climate cycles and forecasts of cutaneous leishmaniasis, a nonstationary vector-borne disease. PLoS Med. 3 (8), e295. Desjeux, P., 2001. The increase in risk factors for leishmaniasis worldwide. Trans. R. Soc. Trop. Med. Hyg. 95 (3), 239–243. Desjeux, P., 2004. Leishmaniasis: current situation and new perspectives. Comp. Immunol. Microbiol. Infect. Dis. 27 (5), 305–318. dos Santos Afonso, M.M., de Miranda Chaves, S.A., Magalhães, M.F.M., Gracie, R., Azevedo, C., de Carvalho, B.M., Rangel, E.F., 2017. Ecoepidemiology of American visceral leishmaniasis in Tocantins State, Brazil: factors associated with the occurrence and spreading of the vector Lutzomyia (Lutzomyia) longipalpis (Lutz & Neiva, 1912)(Diptera: Psychodidae: Phlebotominae). In: The Epidemiology and Ecology of Leishmaniasis. InTech. Faulde, M., Schrader, J., Heyl, G., Amirih, M., 2008. Differences in transmission seasons as an epidemiological tool for characterization of anthroponotic and zoonotic cutaneous leishmaniasis in northern Afghanistan. Acta Trop. 105 (2), 131–138. Ghasemian, M., Maraghi, S., Samarbafzadeh, A., Jelowdar, A., Kalantari, M., 2011. The PCR-based detection and identification of the parasites causing human cutaneous leishmaniasis in the Iranian city of Ahvaz. Ann. Trop. Med. Parasitol. 105 (3), 209–215. Guerin, P.J., Olliaro, P., Sundar, S., Boelaert, M., Croft, S.L., Desjeux, P., Wasunna, M.K., Bryceson, A.D., 2002. Visceral leishmaniasis: current status of control, diagnosis, and treatment, and a proposed research and development agenda. Lancet Infect. Dis. 2 (8), 494–501. Hafeznia, M.R., 2002. Political Geography of Iran. Samt Publications, Tehran. Izadi, S., Mirhendi, H., Jalalizand, N., Khodadadi, H., Mohebali, M., Nekoeian, S., Jamshidi, A., Ghatee, M.A., 2016. Molecular epidemiological survey of cutaneous leishmaniasis in two highly endemic metropolises of Iran, application of FTA cards for DNA extraction from Giemsa-stained slides. Jundishapur Journal of Microbiology 9 (2). Jamal, Q., Shah, A., Ali, N., Ashraf, M., Awan, M.M., Lee, C.M., 2013. Prevalence and comparative analysis of cutaneous leishmaniasis in Dargai Region in Pakistan. Pakistan Journal of Zoology 45 (2). Khademvatan, S., Salmanzadeh, S., Foroutan-Rad, M., Bigdeli, S., Hedayati-Rad, F., Saki, J., Heydari-Gorji, E., 2017. Spatial distribution and epidemiological features of cutaneous leishmaniasis in southwest of Iran. Alexandria Journal of Medicine 53 (1), 93–98. Khaledi, A., Khademi, F., Esmaeili, D., Esmaeili, S., Rostami, H., 2016. The role of HPaA protein as candidate vaccine against. Helicobacter pylori 235–237. Menkir, S., Tsion, M., 2015. Prevalence and Trends of Leishmaniasis Among Patients Visiting University of Gondar Teaching Referral Hospital, North Ethiopia. Haramaya University. Mesgarian, F., Rahbarian, N., Mahmoudi Rad, M., Hajaran, H., Shahbaz, F., Mesgarian, Z., Taghipour, N., 2010. Identification of Leishmania species isolated from human cutaneous Leishmaniasis in Gonbad-e-Qabus city using a PCR method during 20062007. Tehran University Medical Journal 68 (4). Murray, H.W., Berman, J.D., Davies, C.R., Saravia, N.G., 2005. Advances in leishmaniasis. Lancet 366 (9496), 1561–1577. Oliveira, F., Doumbia, S., Anderson, J.M., Faye, O., Diarra, S.S., Traoré, P., Cisse, M., Camara, G., Tall, K., Coulibaly, C.A., 2009. Discrepant prevalence and incidence of Leishmania infection between two neighboring villages in Central Mali based on Leishmanin skin test surveys. PLoS Negl. Trop. Dis. 3 (12), e565. Organization, W. H, 1990. Control of the Leishmaniases. Report of a WHO Expert Committee, WHO. Parvizi, P., Baghban, N., Novin, E.A., Absavaran, A., 2010. Detection, identification and molecular typing of Leishmania major in Phlebotomus papatasi from a focus of zoonotic cutaneous leishmaniasis in central of Iran. Exp. Parasitol. 124 (2), 232–237. Ramezani, Y., Mousavi, S.G.A., Bahrami, A., Fereydooni, M., Parsa, N., Kazemi, B., 2011. Epidemiological study of cutaneous leishmaniasis in Aran and Bidgol from April to September 2009. KAUMS Journal (FEYZ) 15 (3), 254–258. Rasti, S., Ghorbanzadeh, B., Kheirandish, F., Mousavi, S.G., Pirozmand, A., Hooshyar, H.,
5. Conclusion It was found in this research that the age group 1–9 year(s) old has contained the most level of infected cases to cutaneous leishmaniasis and this group must be a priority in control and training programs. Regarding this fact, a comprehensive strategy, monitoring, and control programs should be implemented for prevention and decrease the burden of CL in this region. Acknowledgments This study received the financial support from Gerash University of Medical Sciences with grant number 63793. 5
Gene Reports 17 (2019) 100530
A. Pirouzi, et al.
(6), 415–430. Soto, J., Arana, B., Toledo, J., Rizzo, N., Vega, J., Diaz, A., Luz, M., Gutierrez, P., Arboleda, M., Berman, J., 2004. Miltefosine for new world cutaneous leishmaniasis. Clin. Infect. Dis. 38 (9), 1266–1272. Sundar, S., Rai, M., 2002. Laboratory diagnosis of visceral leishmaniasis. Clin. Diagn. Lab. Immunol. 9 (5), 951–958. Taleban, A.R., Khaleqzade, M.H., 2016. Larestan lesser-known poets in 11th and 12th centuries. International Journal of Humanities and Cultural Studies (IJHCS) ISSN 2356–5926, 771–779. Uliana, S.R., Trinconi, C.T., Coelho, A.C., 2018. Chemotherapy of leishmaniasis: present challenges. Parasitology 145 (4), 464–480. Yazdanpanah, H.A., Rostamianpur, M., 2013. Analysis of spatial distribution of leishmaniasis and its relationship with climatic parameters (case study: Ilam Province). Bull Env Pharmacol Life Sci 2 (12), 80–86. Youssefi, M.R., Esfandiari, B., Shojaei, J., Jalahi, H., Amoli, S.A., Ghasemi, H., Javadian, M., 2011. Prevalence of cutaneous leishmaniasis during 2010 in Mazandaran Province, Iran. Afr. J. Microbiol. Res. 5 (31), 5790–5792.
Abani, B., 2016. Comparison of molecular, microscopic, and culture methods for diagnosis of cutaneous leishmaniasis. J. Clin. Lab. Anal. 30 (5), 610–615. Razmjou, S., Hejazy, H., Motazedian, M.H., Baghaei, M., Emamy, M., Kalantary, M., 2009. A new focus of zoonotic cutaneous leishmaniasis in Shiraz, Iran. Trans. R. Soc. Trop. Med. Hyg. 103 (7), 727–730. Reithinger, R., Mohsen, M., Aadil, K., Sidiqi, M., Erasmus, P., Coleman, P.G., 2003. Anthroponotic cutaneous leishmaniasis, Kabul, Afghanistan. Emerg. Infect. Dis. 9 (6), 727. Reithinger, R., Dujardin, J.-C., Louzir, H., Pirmez, C., Alexander, B., Brooker, S., 2007. Cutaneous leishmaniasis. Lancet Infect. Dis. 7 (9), 581–596. Rostami, M.N., Saghafipour, A., Vesali, E., 2013. A newly emerged cutaneous leishmaniasis focus in central Iran. Int. J. Infect. Dis. 17 (12), e1198–e1206. Shahbazi, F., Shahabi, S., Kazemi, B., Mohebali, M., Abadi, A.R., Zare, Z., 2008. Evaluation of PCR assay in diagnosis and identification of cutaneous leishmaniasis: a comparison with the parasitological methods. Parasitol. Res. 103 (5), 1159–1162. Sheets, D., Mubayi, A., Kojouharov, H.V., 2010. Impact of socio-economic conditions on the incidence of visceral leishmaniasis in Bihar, India. Int. J. Environ. Health Res. 20
6
Contents lists available at ScienceDirect
Gene Reports journal homepage: www.elsevier.com/locate/genrep
Prevalence of cutaneous leishmaniasis in different regions of Larestan and its relationship with public health condition during 2014–2015
T
Aliyar Pirouzia, Hossein Forouzandeha,b, Amir Raoofic, Iraj Ahmadid, Rahman Abdizadehe, ⁎ Elmira Zareia, Razieh Hoseini Farrashf,g, Azad Khaledih,i, a
Cellular and Molecular Research Center, Gerash University of Medical Sciences, Gerash, Iran Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Shiraz, Iran c Cellular and Molecular Research Center, Sabzavar University of Medical Sciences, Sabzevar, Iran d Physiology Department, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran e Department of Medical Parasitology and Mycology, Faculty of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran f Cutaneous Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran g Departments of Parasitology and Mycology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran h Infectious Diseases Research Center, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran i Department of Microbiology and Immunology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran b
A R T I C LE I N FO
A B S T R A C T
Keywords: Cutaneous leishmaniasis Leishmaniasis Prevalence
This study aimed to investigate the prevalence of cutaneous leishmaniasis in different regions of Larestan and its relationship with public health condition during 2014–2015. This descriptive cross-sectional study was conducted on 223 positive cases during 2014–2015 in Larestan region, in southern Fars province, Iran. The samples were taken from lesion exudates caused by mosquito bites. The parasite was distinguished by Giemsa staining. Presence of Leishman bodies or Amastigotes form indicates the positivity of the case. The included patients were studied in terms of nationality, age, sex, involved organ, number of lesions, parasites sources, type of building, and Patients' place of residence. Data analyzed using SPSS software through Fisher's exact and t-student tests. About 95% of the positive cases were Iranian patients, and the remaining were Afghans. And 51% of patients were female. Individuals younger than 9 years old had the most infection cases (55%). A significant correlation was found between age and leishmaniasis. Also, 81% of the diseases were related to urban leishmaniasis. Hands were the most common organs involved with a frequency 39%. It was found that the age group1–9-year-old has contained the most level of infected cases to cutaneous leishmaniasis.
1. Introduction Leishmaniasis is a parasitic disease that appears in various forms including cutaneous (cutaneous leishmaniasis), mucocutaneous, diffuse cutaneous and visceral (visceral leishmaniasis (VL) known as kala-azar) (Alvar et al., 2012). Cutaneous leishmaniasis is a chronic disease that shows itself as a painless lesion in some areas of the body, particularly, on the face. The carrier of the disease is an infected sand fly that infects a person by body biting (Murray et al., 2005). At least 20 different species of the genus Leishmania parasite can be transmitted by sandflies (Desjeux, 2004; Alvar et al., 2012). Two types
of cutaneous leishmaniasis have found up to now. In urban leishmaniasis that is also known as dry leishmaniasis, its sources are dogs and human and it lasts usually about a year (Desjeux, 2004; Khaledi et al., 2016). While, urban leishmaniasis creates deep spots in the site that lesion is formed, but, it heals spontaneously. In rural type leishmaniasis which is also called as wet leishmaniasis, the mouse is the source of the disease and the lesion that caused by it remains several weeks to 6 months and lasts for a maximum period of 18 months. Although the leishmaniasis is common in all seasons of the year but is most common in the autumn (Soto et al., 2004; Reithinger et al., 2007). The Known centers of the world with leishmaniasis almost all are
Abbreviations: VL, Visceral leishmaniasis; WHO, World Health Organization ⁎ Corresponding author at: Department of Microbiology and Immunology, School of Medicine, Kashan University of Medical Sciences, 5th of Qotb-e Ravandi Blvd., P.O. Box: 87155.111, 87154 Kashan, Iran. E-mail address: [email protected] (A. Khaledi). https://doi.org/10.1016/j.genrep.2019.100530 Received 18 September 2019; Received in revised form 28 September 2019; Accepted 30 September 2019 2452-0144/ © 2019 Elsevier Inc. All rights reserved.
Gene Reports 17 (2019) 100530
A. Pirouzi, et al.
is 430 km and to Bandar Abbas is 190 km. The population of Larestan County according to the Statistical Center of Iran: 82,290 people. Larestan County area: 6000 sq. km; Relative Humidity: 63%; The average rainfall: 203 mm; The average temperature: 32 °C. The city of Lar: The central part of Larestan County; Suburban districts (Larestan County): Darz and Sabian districts, Dehkouyeh district. Towns are: Lar, Khour and Latifi; Juyom District; Juyom village, Horm and Kariyan village, Juyom town, Banaruiyeh District; Banaruiyeh village, Deh Fish village, Banaruiyeh town, Sahraye Bagh District; Sahraye Bagh village, Emad Deh village, Emad Deh town, Evaz District; Fishour village, Bid Shahr village, Evaz town; Bayram District; Laverstan village, Humeh village, Bayram town (Hafeznia, 2002). Banaruiyeh is a town in Banaruiyeh District of Larestan County in Fars province and south of Iran. Banaruiyeh is located at 85 km from Lar and it was a part of Juyom district until 2003. From that time until now, it is distinct and becomes an independent town. Banaruiyeh population is about 15,000 people and their income is mostly provided by agriculture, trade and working in the Persian Gulf states. Banaruiyeh district is currently an independent district and includes Banaruiyeh town and Deh Fish rural district which itself includes 6 villages of Sharfuyeh, Marmeh, Bakhtiaruyeh, Hasanabad Marmeh, Deh Fish and Lagharan. Juyom is a name of a town in the south of Fars province and in Larestan district. Based on the available data, this town is located in 53° and 58′ east longitude of Prime Meridian and in 28° and 15′ north latitude of the Earth's equatorial plane. The distance of Juyom district from Larestan County is 120 km (Taleban and Khaleqzade, 2016).
located between two latitudes of 28 to 42 degrees° north (Guerin et al., 2002; Sundar and Rai, 2002). According to the reports of the World Health Organization (WHO), leishmaniasis exists endemically in 88 countries all around the world including, African, Asian, European, North, and South American countries (Organization, 1990). Currently, about 12 million people are infected by this parasite, 0.9 to 1.6 million new cases each year, between 20,000 and 30,000 deaths, and 350 million people are at risk for infection worldwide (Sheets et al., 2010; Khaledi et al., 2016). In general, 1.5 to 2 million cases of cutaneous leishmaniasis and 500 thousand cases of visceral leishmaniasis occur every year worldwide. The disease is considered as the second problem after malaria in terms of public health in the world (Uliana et al., 2018). Most cases of cutaneous leishmaniasis have been seen in Afghanistan, Saudi Arabia, Syria, Iran, North and South America, and 90% of leishmaniasis has been also observed in the Middle East (Organization, 1990; Ashford and Desjeux, 1992). The countries with the most cases of visceral leishmaniasis are India, South Sudan, Sudan, Brazil, Ethiopia, and Somalia. Of the 10 countries in the world with the highest number of cases of cutaneous leishmaniasis, three are in the Americas: Brazil, Colombia, and Peru (Alvar et al., 2012). In addition to economic, social and cultural problems, outbreak and release of most diseases such as leishmaniasis is influenced by ecological factors. Various types of vegetation cover and climate factors among other environmental ones play a fundamental role in the growth process of sandflies as the carrier of the disease and subsequent incidence of cutaneous leishmaniasis disease (Desjeux, 2001; Alvar et al., 2012). Climatic conditions and vegetation cover of the studied area is very convenient for the growth of rodents and the proliferation of mosquitoes that can transmit the disease. Prevalence and development of many diseases have highly dependent on natural conditions factors (Chaves and Pascual, 2006). Globally, nationally and regionally researches conducted in the prevalence of this disease have been focused mainly on aspects of medical problems and less attention has been paid to its environmental aspects (Yazdanpanah and Rostamianpur, 2013). Geographical distribution of leishmaniasis in animals was studied in the central region of Bahia state, Brazil and a variety of vegetation cover and climatic factors were cited as natural barriers for spreading of kala-azar (dos Santos Afonso et al., 2017). Leishmaniasis disease is one of six important diseases of tropical regions that WHO studying, performing and supporting the researches on its various aspects in all over the world (Bailey et al., 2017). It should be collecting information from epidemiological areas about aspects of causing factor of leishmaniasis to management and prevention of it. For that, we can be planed the best surveillance system to eliminate the neglected tropical disease by analyzing this data and rising knowledge. Therefore, this study aimed to investigate the prevalence of cutaneous leishmaniasis in different regions of Larestan and its relationship with public health condition during 2014–2015.
2.3. Type of study This descriptive cross-sectional study was conducted on 223 positive cases during 2014–2015 in Larestan, Fars province, Iran. 2.4. Sampling process The simple direct smear was taken from the exudates of lesions caused by mosquito biting and parasites. Then, samples referred to health and medicinal center of communicable diseases of Larestan County for detection. 2.5. Diagnosis of Leishmania in samples Then smears after staining by Giemsa were surveyed by light microscope to perform Amastigote detection. Presence of Leishman bodies or Amastigote forms was indicative of the positivity of the cases. 2.6. Study of factors associated with leishmaniasis In the current research, many factors such as Patients' place of residence, age, sex, type of building, name, nationality, and, onset time of symptoms and diagnosis, involved organs, number and location of lesions, leishmaniasis type were investigated. For this, a questionnaire including mentioned factors was designed and details filled for each positive people.
2. Methods 2.1. Ethical statements
2.7. Statistical analysis This study was approved by Gerash University of Medical Sciences, Gerash, Iran through the institution's research ethics board approval number (IR.GERUMS.REC.2016.2047).
Results were analyzed using the Statistical Package for the Social Sciences (SPSS-22, Chicago, IL, USA). Fisher's exact and t-student tests were used to assess the correlation between infection and studied variables. P-values less 0.05 were considered statistically significant.
2.2. Study area
3. Results
Larestan is one of the districts of Fars province and is one of 49 primary cities founded in 1938. Earlier than this time, Larestan County was one of the states of Iran, which its space was reached to 12,000 km2. Lar is the center of this county, which is one of the oldest cities of Iran. The distance of Lar to the center of Fars province (Shiraz)
Larestan is one of the districts of Fars province located in the south of this province (Fig. 1). In total, 223 positive cases were reported, of which, 212(95%) patients were from Iran and 11(5%) of Afghans. Of 2
Gene Reports 17 (2019) 100530
A. Pirouzi, et al.
Fig. 1. The location of Larestan in Fars province, Iran. Table 1 Demographic and other variables in the present study and correlation with leishmaniasis. Variables
Subgroups
Percent
Age groups
0–9 10–19 20–29 30–39 40–49 50–59 60–69 > 69 Male Female Iran Afghan Old Tent New building Rural Urban
55 12 9 9 5 6 3 1 49 51 95 5 35 3 62 19 81
Gender Nationality Building type
Type of Lieshmaniasis
45 40
P- value
35
39% 33%
30 25
0.001
20
24%
Hands Hand and neck Legs Body
15 10
00.1
5
00.2
0
0.07
Fig. 2. The common sites affected by cutaneous lesion CL patients in the study.
0.2
region of Larestan County has allocated the highest incidence of infection to itself with a frequency of 38% (Fig. 4).
these, 51% were women. As shown in Table 1, patients were distributed in several age groups. The high incidence rate of CL was in the age group (0–9) and (10–19), while the lowest was reported in the age group of > 69 years old. As well, a significant correlation was found between CL and age (p = 0.001). Most patients live in the new buildings, and there was no significant relationship between building type and life cycle of sand flies (p = 0.07). Also, 81% and 19% of patients had urban and rural CL, respectively. Exception age, no correlation was found between factors studied and infection with CL (p > 0.05). As presented in Fig. 2, the common site affected by a cutaneous lesion in CL patients was associated with hands with an incidence of 39%. Also, almost all body organs were involved. The number of lesions was different in various patients. For example, a two-year-old boy had 14 lesions on his body with involving the head, neck and the legs. About 58% of patients had one lesion on their skin (Fig. 3). From ten cities studied, the central
4. Discussion In the present study, the annual incidence of CL has reported 223 positive cases during 2014–2015. In contrary to our results, Alvar and et al. reported an annual incidence of 290–580 cases in Mali during the 2004–2008 (Alvar et al., 2012). To our knowledge, ten countries with the highest estimated case counts including Afghanistan, Algeria, Colombia, Brazil, Iran, Syria, Ethiopia, North Sudan, Costa Rica, and Peru, together are responsible for about 75% of worldwide estimated CL incidence (Alvar et al., 2012). In our study, the incidence of CL based on gender distribution was a little higher in female than in male which was in line with studies conducted in Lorestan (Amraee et al., 2013), Gonbad-e-Qabus (Mesgarian et al., 2010), and Bam (Aflatonian and Sharifi, 2006). Although which was in contrast to several reports including AlSamarai 3
Gene Reports 17 (2019) 100530
A. Pirouzi, et al.
Fig. 3. The number of lesions in leishmaniasis patients.
Fig. 4. Location of patients in different districts of Larestan.
et al., 2017). Also, the high prevalence in the male in different studies can be reflected outdoors social activities of male such as doing work as laborer and more exposure than female to sand fly bites during the time of sand fly activity, or presence in military services, and less coverage of body with cloths (Youssefi et al., 2011; Menkir and Tsion, 2015). In the present study, a few cases of leishmaniasis were documented
et al. in Iraq, Jamal et al. in Pakistan, and different studies from Iran such as Rostami et al. in Qom, Youssefi et al. in Mazandaran (AlSamarai and AlObaidi, 2009; Youssefi et al., 2011; Jamal et al., 2013; Rostami et al., 2013). This difference in the incidence of disease in women in various studies is attributed to the study population, women's work in livestock breeding or farming on lands in some regions (Khademvatan 4
Gene Reports 17 (2019) 100530
A. Pirouzi, et al.
References
(with frequency 5%) in people who had moved from Afghanistan to Larestan, Iran. Afghans might have a role in parasite maintenance and CL transmission in the area (Rostami et al., 2013). Nevertheless, a significant number of cases were Iranian, so local transmission is happening in this district. Although the disease affects all age groups, the risk of Leishmania infection increases with age; children aged less than three years have lower infection prevalence compared to adults (Oliveira et al., 2009). In contrast, the incidence of CL in the current study for children in the age group of 1–9 years old was higher. Like that, Ramezani et al. in Aran and Bidgol (Iran) (Ramezani et al., 2011), and Razmjou et al. in Shiraz (Iran) reported the highest incidence in the age group of 1–9 years old (Razmjou et al., 2009). Other studies conducted in Pakistan and Afghanistan reported the higher LC in younger groups, too (Reithinger et al., 2003; Brooker et al., 2004; Faulde et al., 2008). In terms of site of lesion in the study of Ramezani et al., the following results were obtained; the hands 29.8%, the face 25.5%, the legs 25.5%, the hands and the legs 7.4%, the hands and the face 6.4% and the other parts of the body 5.4%(Ramezani et al., 2011), while these rates in this study are as following; the hands 39%, the legs 24%, the head and the neck 33%, and the body 3%. Comparable results to our findings were obtained by Babaei et al. in their studies on an area in the south of Lorestan province (BABAEI and Shayan, 2003). The highest number of lesions in children indicates that children are more likely to become infected with leishmaniasis. Due to the high commotion of children related to childhood, they are more outside of the home; and due to lack of adequate sanitation, they are more susceptible to mosquito bites (Ramezani et al., 2011). Low incidence of CL in people over the age of 25 who live in endemic areas, likely due to infection in young age and acquired relative immunity, they are less vulnerable in older ages (BABAEI and Shayan, 2003). It seems that due to the susceptible population group in these infected centers and the existence of appropriate ecological status for reservoirs and carriers of this disease in this area is likely the incidence of CL increases if there is no continuation of the preventive and control programs, the more cases occur in the coming years. In the present study, most of the CL cases belonged to dry or urban leishmaniasis, similarly, a study conducted in Kashan revealed that 71.4% of patients were infected with L. tropica (dry or urban leishmaniasis) (Rasti et al., 2016), also, another one from Mashhad showed the same (Shahbazi et al., 2008). In contrary, previous studies from Aran and Bidgol, Isfahan, Natanz, and Ahvaz reported the L. major (rural form) as the main causative agent (Parvizi et al., 2010; Ghasemian et al., 2011; Izadi et al., 2016). In general, the high number of cases reported in our study indicates the endemicity of the disease in Fars province, especially Larestan region. Considering this fact, the data about vectors and reservoirs of this region would be carefully considered and guidelines for fighting sandfly be carefully implemented and followed. Furthermore, health education, finding the patients and treating them, fighting rodents, improving the environmental condition should be also taken into consideration.
Aflatonian, M., Sharifi, I., 2006. Frequency of cutaneous leishmaniasis among patients referred to the center for disease control in Bam district, 1999-2003. Journal of Rafsanjan University of Medical Sciences 5 (2), 123–128. AlSamarai, A.M., AlObaidi, H.S., 2009. Cutaneous leishmaniasis in Iraq. The Journal of Infection in Developing Countries 3 (2), 123–129. Alvar, J., Velez, I.D., Bern, C., Herrero, M., Desjeux, P., Cano, J., Jannin, J., den Boer, M., Team, W.L.C., 2012. Leishmaniasis worldwide and global estimates of its incidence. PLoS One 7 (5), e35671. Amraee, K., H. A. Rastegar and E. Beiranvand (2013). "An epidemiological study of cutaneous leishmaniasis in Poledokhtar district, Lorestan province, southwestern of Iran, 2001-2011.". Ashford, R., Desjeux, P., 1992. Estimation of population at risk of infection and number of cases of leishmaniasis. Parasitol. Today 8 (3), 104–105. BABAEI, G.R., Shayan, A., 2003. An Epidemiological Study of Cutaneous Leishmaniasis and the Investigation of Scars With Emphesis on Seasons, Age and Sex Groups in Paalam, South of Lorestan Province. Bailey, F., Mondragon-Shem, K., Hotez, P., Ruiz-Postigo, J.A., Al-Salem, W., AcostaSerrano, Á., Molyneux, D.H., 2017. A new perspective on cutaneous leishmaniasis—implications for global prevalence and burden of disease estimates. PLoS Negl. Trop. Dis. 11 (8), e0005739. Brooker, S., Mohammed, N., Adil, K., Agha, S., Reithinger, R., Rowland, M., Ali, I., Kolaczinski, J., 2004. Leishmaniasis in refugee and local Pakistani populations. Emerg. Infect. Dis. 10 (9), 1681. Chaves, L.F., Pascual, M., 2006. Climate cycles and forecasts of cutaneous leishmaniasis, a nonstationary vector-borne disease. PLoS Med. 3 (8), e295. Desjeux, P., 2001. The increase in risk factors for leishmaniasis worldwide. Trans. R. Soc. Trop. Med. Hyg. 95 (3), 239–243. Desjeux, P., 2004. Leishmaniasis: current situation and new perspectives. Comp. Immunol. Microbiol. Infect. Dis. 27 (5), 305–318. dos Santos Afonso, M.M., de Miranda Chaves, S.A., Magalhães, M.F.M., Gracie, R., Azevedo, C., de Carvalho, B.M., Rangel, E.F., 2017. Ecoepidemiology of American visceral leishmaniasis in Tocantins State, Brazil: factors associated with the occurrence and spreading of the vector Lutzomyia (Lutzomyia) longipalpis (Lutz & Neiva, 1912)(Diptera: Psychodidae: Phlebotominae). In: The Epidemiology and Ecology of Leishmaniasis. InTech. Faulde, M., Schrader, J., Heyl, G., Amirih, M., 2008. Differences in transmission seasons as an epidemiological tool for characterization of anthroponotic and zoonotic cutaneous leishmaniasis in northern Afghanistan. Acta Trop. 105 (2), 131–138. Ghasemian, M., Maraghi, S., Samarbafzadeh, A., Jelowdar, A., Kalantari, M., 2011. The PCR-based detection and identification of the parasites causing human cutaneous leishmaniasis in the Iranian city of Ahvaz. Ann. Trop. Med. Parasitol. 105 (3), 209–215. Guerin, P.J., Olliaro, P., Sundar, S., Boelaert, M., Croft, S.L., Desjeux, P., Wasunna, M.K., Bryceson, A.D., 2002. Visceral leishmaniasis: current status of control, diagnosis, and treatment, and a proposed research and development agenda. Lancet Infect. Dis. 2 (8), 494–501. Hafeznia, M.R., 2002. Political Geography of Iran. Samt Publications, Tehran. Izadi, S., Mirhendi, H., Jalalizand, N., Khodadadi, H., Mohebali, M., Nekoeian, S., Jamshidi, A., Ghatee, M.A., 2016. Molecular epidemiological survey of cutaneous leishmaniasis in two highly endemic metropolises of Iran, application of FTA cards for DNA extraction from Giemsa-stained slides. Jundishapur Journal of Microbiology 9 (2). Jamal, Q., Shah, A., Ali, N., Ashraf, M., Awan, M.M., Lee, C.M., 2013. Prevalence and comparative analysis of cutaneous leishmaniasis in Dargai Region in Pakistan. Pakistan Journal of Zoology 45 (2). Khademvatan, S., Salmanzadeh, S., Foroutan-Rad, M., Bigdeli, S., Hedayati-Rad, F., Saki, J., Heydari-Gorji, E., 2017. Spatial distribution and epidemiological features of cutaneous leishmaniasis in southwest of Iran. Alexandria Journal of Medicine 53 (1), 93–98. Khaledi, A., Khademi, F., Esmaeili, D., Esmaeili, S., Rostami, H., 2016. The role of HPaA protein as candidate vaccine against. Helicobacter pylori 235–237. Menkir, S., Tsion, M., 2015. Prevalence and Trends of Leishmaniasis Among Patients Visiting University of Gondar Teaching Referral Hospital, North Ethiopia. Haramaya University. Mesgarian, F., Rahbarian, N., Mahmoudi Rad, M., Hajaran, H., Shahbaz, F., Mesgarian, Z., Taghipour, N., 2010. Identification of Leishmania species isolated from human cutaneous Leishmaniasis in Gonbad-e-Qabus city using a PCR method during 20062007. Tehran University Medical Journal 68 (4). Murray, H.W., Berman, J.D., Davies, C.R., Saravia, N.G., 2005. Advances in leishmaniasis. Lancet 366 (9496), 1561–1577. Oliveira, F., Doumbia, S., Anderson, J.M., Faye, O., Diarra, S.S., Traoré, P., Cisse, M., Camara, G., Tall, K., Coulibaly, C.A., 2009. Discrepant prevalence and incidence of Leishmania infection between two neighboring villages in Central Mali based on Leishmanin skin test surveys. PLoS Negl. Trop. Dis. 3 (12), e565. Organization, W. H, 1990. Control of the Leishmaniases. Report of a WHO Expert Committee, WHO. Parvizi, P., Baghban, N., Novin, E.A., Absavaran, A., 2010. Detection, identification and molecular typing of Leishmania major in Phlebotomus papatasi from a focus of zoonotic cutaneous leishmaniasis in central of Iran. Exp. Parasitol. 124 (2), 232–237. Ramezani, Y., Mousavi, S.G.A., Bahrami, A., Fereydooni, M., Parsa, N., Kazemi, B., 2011. Epidemiological study of cutaneous leishmaniasis in Aran and Bidgol from April to September 2009. KAUMS Journal (FEYZ) 15 (3), 254–258. Rasti, S., Ghorbanzadeh, B., Kheirandish, F., Mousavi, S.G., Pirozmand, A., Hooshyar, H.,
5. Conclusion It was found in this research that the age group 1–9 year(s) old has contained the most level of infected cases to cutaneous leishmaniasis and this group must be a priority in control and training programs. Regarding this fact, a comprehensive strategy, monitoring, and control programs should be implemented for prevention and decrease the burden of CL in this region. Acknowledgments This study received the financial support from Gerash University of Medical Sciences with grant number 63793. 5
Gene Reports 17 (2019) 100530
A. Pirouzi, et al.
(6), 415–430. Soto, J., Arana, B., Toledo, J., Rizzo, N., Vega, J., Diaz, A., Luz, M., Gutierrez, P., Arboleda, M., Berman, J., 2004. Miltefosine for new world cutaneous leishmaniasis. Clin. Infect. Dis. 38 (9), 1266–1272. Sundar, S., Rai, M., 2002. Laboratory diagnosis of visceral leishmaniasis. Clin. Diagn. Lab. Immunol. 9 (5), 951–958. Taleban, A.R., Khaleqzade, M.H., 2016. Larestan lesser-known poets in 11th and 12th centuries. International Journal of Humanities and Cultural Studies (IJHCS) ISSN 2356–5926, 771–779. Uliana, S.R., Trinconi, C.T., Coelho, A.C., 2018. Chemotherapy of leishmaniasis: present challenges. Parasitology 145 (4), 464–480. Yazdanpanah, H.A., Rostamianpur, M., 2013. Analysis of spatial distribution of leishmaniasis and its relationship with climatic parameters (case study: Ilam Province). Bull Env Pharmacol Life Sci 2 (12), 80–86. Youssefi, M.R., Esfandiari, B., Shojaei, J., Jalahi, H., Amoli, S.A., Ghasemi, H., Javadian, M., 2011. Prevalence of cutaneous leishmaniasis during 2010 in Mazandaran Province, Iran. Afr. J. Microbiol. Res. 5 (31), 5790–5792.
Abani, B., 2016. Comparison of molecular, microscopic, and culture methods for diagnosis of cutaneous leishmaniasis. J. Clin. Lab. Anal. 30 (5), 610–615. Razmjou, S., Hejazy, H., Motazedian, M.H., Baghaei, M., Emamy, M., Kalantary, M., 2009. A new focus of zoonotic cutaneous leishmaniasis in Shiraz, Iran. Trans. R. Soc. Trop. Med. Hyg. 103 (7), 727–730. Reithinger, R., Mohsen, M., Aadil, K., Sidiqi, M., Erasmus, P., Coleman, P.G., 2003. Anthroponotic cutaneous leishmaniasis, Kabul, Afghanistan. Emerg. Infect. Dis. 9 (6), 727. Reithinger, R., Dujardin, J.-C., Louzir, H., Pirmez, C., Alexander, B., Brooker, S., 2007. Cutaneous leishmaniasis. Lancet Infect. Dis. 7 (9), 581–596. Rostami, M.N., Saghafipour, A., Vesali, E., 2013. A newly emerged cutaneous leishmaniasis focus in central Iran. Int. J. Infect. Dis. 17 (12), e1198–e1206. Shahbazi, F., Shahabi, S., Kazemi, B., Mohebali, M., Abadi, A.R., Zare, Z., 2008. Evaluation of PCR assay in diagnosis and identification of cutaneous leishmaniasis: a comparison with the parasitological methods. Parasitol. Res. 103 (5), 1159–1162. Sheets, D., Mubayi, A., Kojouharov, H.V., 2010. Impact of socio-economic conditions on the incidence of visceral leishmaniasis in Bihar, India. Int. J. Environ. Health Res. 20
6