A Prospective Cohort Study of Cutaneous Leishmaniasis Risk and Opium Addiction in South Eastern Iran

Mohammad Reza Aflatoonian,Behnaz Aflatoonian,Ali Reza Fekri,Iraj Sharifi,Hamid Sharifi,Ali Khamesipour,Maryam Hakimi Parizi,Ahmad Khosravi,Maryam Sharifi

doi:10.1371/journal.pone.0089043

Mohammad Reza Aflatoonian, Behnaz Aflatoonian + Show 7 more

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https://doi.org/10.1371/journal.pone.0089043

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Abstract

Opium addiction and cutaneous leishmaniasis (CL) are endemic in different parts of Iran, particularly in Bam, where a massive earthquake occurred. This study was designed to compare the incidence rate and severity of CL cases among opium addicted and non-addicted individuals in south-eastern Iran. This study was carried out as a prospective cohort by active house-to-house visits of 1,481 habitants in Bam. CL cases were confirmed by smear and identification of Leishmania species was performed using nested-PCR. The data was analyzed by χ2 and t-tests, using SPSS software and also Kaplan-Meier survival curve and long-rank test in Stata 11.2 and P<0.05 was considered as significant. A total of 904 individuals consisting of 226 opium addicted and 678 non-addicted individuals were followed-up for a period of seven years. The two cohorts were similar in terms of age, sex and place of residency. A similar pattern of incidence was observed among the two cohort groups. In contrast, the severity of CL in terms of the number, duration and the size of the lesions in opium addicted individuals was significantly (P<0.001) higher than non-opium addicted individuals. In conclusion, the present findings indicate that there is no relationship between the incidence of CL and opium addiction.

Highlights

Opium abuse is a serious public health threat in Iran and in neighbouring countries
According to the United Nation World Drug Report (UNWDR), the highest proportion of opium addiction in the world is reported from Iran; it is estimated that 2.8% of the population over age 15 years old are addicted, while the world consumption rate is about 0.5% [3]
Most of the opium addicted individuals were older than 21 years and opium addiction was significantly higher (P,0.001) in males than females and 249 participants showed active cutaneous leishmaniasis (CL) lesions or scars which was more frequent in the age range 21–65 years than the other age groups

Summary

Introduction

Opiates are the most commonly used drugs, notably in Asia and Europe, while heroin is the most widely consumed opiate, worldwide [1]. Two thirds of opium which is not converted into heroin is consumed in just five countries [2]: Iran (42%), Afghanistan (7%), Pakistan (7%), India (6%) and the Russian Federation (5%). According to the United Nation World Drug Report (UNWDR), the highest proportion of opium addiction in the world is reported from Iran; it is estimated that 2.8% of the population over age 15 years old are addicted, while the world consumption rate is about 0.5% [3]. As a pain killer opiates have been used in Iran for centuries, use and trade are officially illegal with harsh penalties, opiate trafficking and consumption are major health problems in the country [4]. The current situation forced the government to implement a number of actions including support and treatment for addicts and rehabilitation centers to initiate prophylactic measures [5]

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