Abstract
BackgroundEpidemics of cutaneous leishmaniasis (CL) are occurring more frequently and spreading faster and farther than before in many areas of the world. The present study aimed to assess a long-lasting emerging epidemic (2005–2019) of 5532 cases with anthroponotic CL (ACL) in peri-urban areas of Kerman city in southeastern Iran.MethodsThis descriptive-analytical study was carried out for 15 years in Kerman province, southeastern Iran. The data were passively obtained through the health surveillance system and the Kerman Leishmaniasis Research Center. Every subject was diagnosed using direct smear microscopy. The representative causative agent was further examined by ITS1-PCR, PCR-RFLP, 7SL RNA gene sequencing and phylogenetic analyses. For each subject, a case report form designating demographic and clinical data was recorded.ResultsA different pattern of ACL incidence was found in peri-urban areas compared to that in the city of Kerman. The incidence rate of ACL cases has significantly increased (P < 0.001) from 2005 to 2016 in new settlements with a gradual decline after that. The overall average risk of contracting the disease was 7.6 times higher in peri-urban areas compared to Kerman city, an old endemic focus. All isolates consisting of six variants were confirmed to be Leishmania tropica. The overall pattern of the ACL infection indicates that the etiological agent of ACL is propagated and transmitted by the bite of female Phlebotomus sergenti sandflies from person to person from dissimilar clones as reflected by the complexity of the migrants’ backgrounds in the province.ConclusionsThe movement of populations and establishment of new settlements in peri-urban areas close to endemic areas are major risk factors for and are directly linked to CL. The underlying factors of this emerging ACL epidemic caused by L. tropica were disasters and droughts, among others. A robust commitment to a multilateral approach is crucial to make improvements in this area. This will require decisive coordinated actions through all governmental factions and non-governmental organizations. Furthermore, active and passive case detection strategies, early diagnosis, and effective treatment could help control the disease.Graphical
Highlights
Epidemics of cutaneous leishmaniasis (CL) are occurring more frequently and spreading faster and farther than before in many areas of the world
Epidemiological data Cutaneous leishmaniasis patients were categorized into five 3-year periods to display the incidence rate of cases (Table 2 and Fig. 2a)
There was no significant difference among males and females in either the peri-urban area or in Kerman city
Summary
Epidemics of cutaneous leishmaniasis (CL) are occurring more frequently and spreading faster and farther than before in many areas of the world. Leishmaniasis remains a serious concern among the most neglected and vector-borne diseases worldwide [1, 2]. The disease burden is not well known, but based on recent estimates, up to 1.3 million new cases of leishmaniasis, 12 million prevalence, and some 26,000–65,000 deaths in 101 countries and territories occur annually among a population of 1 billion at-risk individuals [3, 4]. Due to confounding factors, ongoing conflict, consequent migration, and unprecedented environmental risks, new CL figures propose that this disease is a large-scale social and medical problem in the affected countries [5]. Etiological agents involve a digenetic lifecycle between an invertebrate vector, phlebotomine sandflies, and a vertebrate reservoir host, such as humans and suitable animals [6]
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