The Geographical Distribution of Cutaneous Leishmaniasis Causative Agents in Iran and Its Neighboring Countries, A Review.

Mohammad Amin Ghatee,Walter R Taylor,Mehdi Karamian

doi:10.3389/fpubh.2020.00011

Abstract

Leishmania tropica and Leishmania major are both the main cause of anthroponotic (ACL) and zoonotic cutaneous leishmaniasis (ZCL), respectively, in the Old World. Leishmania infantum and Leishmania donovani, which are important causes of visceral leishmaniasis, have also occasionally been reported in CL patients. The present study investigates the current distribution of causative species of CL in Iran and neighboring countries in the Middle East. There has been expansion of L. tropica into new urban and rural foci in Iran, with well-documented cases of visceralization, a substantial increase of CL in Syria, and the emergence of new foci and outbreaks in Turkey and Iraq, especially due to L. major. Civil war in Syria and Iraq, population movement, poverty, and climatic change play important roles in the changing CL distribution in this region. Control programs should adopt a multidisciplinary approach based on active surveillance and case finding, especially in vulnerable refugee populations, determination of hazard maps for CL hot points using GIS and other advanced technology, the free distribution of drugs, rodent control, and greater community engagement in poor and marginalized populations. Comprehensive molecular studies that could show the species and strains of Leishmania in different areas of each country can give a better view from the distribution of CL in this region.

Highlights

Leishmaniasis is the complex disease with a spectrum of clinical manifestations, including cutaneous leishmaniasis (CL), mucocutaneous leishmaniasis (MCL), diffuse cutaneous leishmaniasis (DCL), and visceral leishmaniasis (VL, known as kala-azar)
Bushehr province is a known focus of L. major causing zoonotic cutaneous leishmaniasis (ZCL) in southwest Iran [39], but a small study in Bushehr, the provincial capital, identified L. tropica in 6/8 CL patients [40]
In this part of the Middle East, L. major ZCL and L. tropica ACL are present throughout the region in different ecological foci and with varying ratios of the two species

Summary

INTRODUCTION

Leishmaniasis is the complex disease with a spectrum of clinical manifestations, including cutaneous leishmaniasis (CL), mucocutaneous leishmaniasis (MCL), diffuse cutaneous leishmaniasis (DCL), and visceral leishmaniasis (VL, known as kala-azar). Bushehr province is a known focus of L. major causing ZCL in southwest Iran [39], but a small study in Bushehr, the provincial capital, identified L. tropica in 6/8 CL patients [40]. L. tropica is widely distributed in different parts of all provinces in this country, but notable areas of high endemicity include the Afghan refugee camps in northwest Pakistan [102], the west–northwest province of Khyber Pakhtunkhwa province (5.17%), which borders Afghanistan, and Baluchistan province, the south-SW province bordering Iran [103]. The main focus of L. major is Balochistan [104] and central parts of Sind province (Figure 5) [105] where it is mostly a disease in the plains whereas L. tropica is prevalent in mountainous regions and the cities [104, 106].

Findings

DISCUSSION

CONCLUSION