Abstract
Leishmaniasis is one of the most common vector-borne parasitic diseases in Iran. Leishmania species identification is necessary for epidemiological aspects, precise prognosis, control and treatment of the disease. We systematically searched all the studies, reports, and documentation related to species identification and geographical distribution of causative agents of cutaneous (CL), mucosal (ML), and visceral leishmaniasis (VL) using DNA-based molecular diagnostic techniques in Iran. International databases including PubMed, ScienceDirect, Embase, Google Scholar, Scopus, and Web of Science were systemically searched for English articles and Iran's databases including SID, IranMedex and Magiran were searched for Persian reports and articles. Searches were performed from 1999 to 2019 (20 years). The current review was conducted using the keywords: cutaneous leishmaniasis, visceral leishmaniasis, Leishmania species, Human, Molecular, PCR, and Iran. The study quality was evaluated using the NOS checklist. This meta-analysis procedure was accomplished using STATA, version 2.7.9. Of the 3,426 records identified in the initial search, 154 articles met inclusion criteria and qualified for the systematic review and meta-analysis. In subgroup analysis, the pooled frequency of causative agents of CL isolates was 67.3% (95% CI: 59.51–74.67%) for L. major and 32.1% (95% CI: 24.72–39.87%) for L. tropica. In addition, the pooled frequency of causative agents of VL isolates was 97.1% (95% CI: 94.6–98.8%) for L. infantum and 2.9% (95% CI: 1.12–5.37%) for L. tropica. The findings of this study showed that the main causative agents of CL and VL in Iran are L. major and L. infantum, respectively. Moreover, kinetoplast DNA (kDNA) and internal transcriber spacer (ITS) were the most used markers for identifying Leishmania species. The current study provides valuable data to encourage and direct researchers as well as public health managers in the comprehensive leishmaniasis control and prevention planning in Iran.
Highlights
Leishmaniasis is a neglected tropical disease (NTD) caused by the Leishmania parasites, which are transmitted by the bite of sand flies [1]
542 isolates for visceral leishmaniasis (VL) cases were determined in 11 provinces (Fars, Ardabil, Tehran, Kohgiluyeh and Boyer-Ahmad, Golestan, Ilam, Lorestan, East-Azerbaijan, Boushehr, Kerman, and Mazandaran), with the majority of VL isolates belonging to Fars (n = 230) in southwestern Iran and Ardabil (n = 107) in northwestern Iran (Figure 3)
Our finding showed that the kinetoplast DNA (kDNA)-based PCR was the most sensitive diagnostic method for leishmaniasis and the ITS1-based PCR could be used as a sensitive/specific method to identify the Leishmania species
Summary
Leishmaniasis is a neglected tropical disease (NTD) caused by the Leishmania parasites, which are transmitted by the bite of sand flies [1]. Despite universal scientific community efforts to reduce cases of human leishmaniasis, numerous cases of such devastating disease are still reported worldwide [3]. The majority (about 90%) of CL cases occur in eight countries mainly including Asian and South American countries [4]. More than 90% of global cases of VL had been reported from seven countries mainly including African and South American countries [4, 5]. In Iran, CL is the most common form of the disease and recent reports estimates >20,000 annual cases [6], but VL has been reported sporadically, with about 100– 300 new serologically positive cases of VL reported annually [7]
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