Cutaneous Leishmaniasis In Iran Research Articles

Economic Burden Evaluation of Cutaneous Leishmaniasis in Iran

Background: Cutaneous leishmaniasis as a prevalent sandfly borne disease in many tropical and subtropical countries has adverse economic consequences for patients and health care systems. Objectives: The aim of present study was evaluation of the economic burden of cutaneous leishmaniasis on families and consequently the health care systems in all of 31 provinces of Iran for year 2017. Methods: This cross-sectional study was carried out based on available data from 14125 cutaneous leishmaniasis cases in all endemic foci of Iran in 2017. The direct and indirect costs paid by patients and government health care systems were extracted through accounting documents via patients and health staff in the office of zoonotic diseases control, CDC, Iranian Ministry of Health. The data was recorded in researcher-made forms. Activity based costing (ABC) is used to evaluate economic burden of health care services in Iran to patients with of CL. Two financial software suites namely Azarakhsh and Roozamad have been employed in addition to Excel V. 2010. Results: The incidence of cutaneous leishmaniasis in Iran was 17.82 per 100,000 people (14125/79,262,000). Economic burden of the disease was estimated at 291,046,430,125 Rials ($ 5,820,928). The average direct, indirect (overhead) and governmental costs paid for each case with CL was 10,631,250 Rials ($ 212.5), 9,653,807 Rials ($ 193) and 20,285,057 Rials ($ 405.5) respectively. The out of pocket for each patient was around 320 thousand Rials ($ 7). Total costs (governmental + out of pocket) during this period was estimated at 20,605,057 Rials ($ 412.5) expenditure per capita. Conclusions: Direct and indirect costs associated with diagnosis and treatment of CL in Iran that was provided by governmental health care systems and out-of-pockets are considerably high. It can have a great economic impact on families and consequently the health care systems. It seems adopting suitable preventive methods will be more affordable for people who live at risk of the disease.

Effectiveness of Paromomycin on Cutaneous Leishmaniasis in Iran: A Systematic Review and Meta-Analysis.

Some treatment reported for cutaneous leishmaniasis. The studies examined the impact of the paromomycin has different characteristics and results. The aim of the present study was to conduct a systematic review and meta-analysis of all randomized clinical trials evaluating the effectiveness of paromomycin in the treatment of cutaneous leishmaniasis in Iran. Literature search was conducted using MEDLINE, Web of Science, Scopus, Scientific Information Database, IranMedex, Magiran, Iranian Registry of Clinical Trials (from February 2000 to May 2016), and references cited in the text of selected studies. Search terms used were "paromomycin", "cutaneous leishmaniasis", "randomized"," aminosidine", "controlled trial", and "clinical trial". Random effects models were used to calculate the measure of association, with 95% confidence intervals, to analyze the efficacy of paromomycin in the treatment of cutaneous leishmaniasis. Initial search yielded 76 citations. Of these original results, 9 met our specific selection criteria. Four of the randomized controlled trials compared the efficacy of paromomycin in the treatment of cutaneous leishmaniasis with that of a placebo; they were included in the meta-analysis. The success rate of treatment with paromomycin was higher than that with the placebo (pooled RR=4.50, 95% CI: 2.54 to 8.02; P=0.001 and I2=26.7%), whereas the difference with the non-placebo treatments was nonsignificant (pooled RR=0.79, 95% CI: 0.58 to 1.073; P=0.131 and I2=83.3%). No significant difference was observed between paromomycin and the other treatments in their effectiveness in the treatment of cutaneous leishmaniasis. Because no single drug is effective against all the forms of leishmaniasis, we suggest multidrug therapy.

Morphometric discrimination between females of two isomorphic sand fly species, Phlebotomus caucasicus and Phlebotomus mongolensis (Diptera: Phlebotominae) in endemic and non-endemic foci of zoonotic cutaneous leishmaniasis in Iran

Objective: To delineate reliable morphological characteristics for identifying and separating female Phlebotomus caucasicus and Phlebotomus mongolensis which exist sympatrically in the main foci of zoonotic cutaneous leishmaniasis in Iran. Methods: Sand flies were collected using sticky trap papers from active colonies of rodent burrows installed from 16 catching sites. Morphometric measurements were analyzed of 87 Phlebotomus caucasicus and 156 Phlebotomus mongolensis. Univariate and multivariate analysis were carried out to determine significant morphometric variables for discrimination of the two species. Finally, seven morphological characteristics of 65 female Phlebotomus caucasicus and 124 female Phlebotomus mongolensis were described. Results: Univariate and multivariate analyses of 10 morphometric variables via Discriminant Function Analysis (DFA) and Principal Component Analysis (PCA) showed that five morphometric variables had an accuracy of 100% for discriminating female Phlebotomus caucasicus and Phlebotomus mongolensis. Moreover, PCA revealed that the five morphometric variables with the highest loadings separated these two species. Morphological studies on antennal flagellum (and its associated structures) and mouth-parts of female specimens demonstrated significant differences in several structures. Conclusions: The results show that morphological and morphometrical features can be used to discriminate two female isomorphic species, Phlebotomus caucasicus and Phlebotomus mongolensis accurately.

Isolation of Crithidia spp. from lesions of immunocompetent patients with suspected cutaneous leishmaniasis in Iran.

Leishmania major has been considered as the main aetiological agent of cutaneous leishmaniasis in Iran. However, there are recent reports about the existence of Crithidia spp in cutaneous lesions in southern Iran. Therefore, this study was designed to decipher some morphological, biological and molecular aspects of this phenomenon. Clinical isolates were obtained from 167 patients with cutaneous ulcers. A set of specific primers based on GAPDH (Glyceraldehyde-3-Phosphate Dehydrogenase) gene were used to distinguish between Crithidia and Leishmania genera. For molecular analysis, Pulsed Field Gel Electrophoresis and Mi-Seq Illumina platform were applied. Then, morphological analysis and some biological features (including potential growth at 37 °C and the ability of infecting mammalian macrophages) were studied. In 92.8% of clinical cases, L. major was the only causative microorganism isolated; in 5.4% of cases, co-infection of L. major and Crithidia spp. was identified; and in 1.8% of lesions, only Crithidia spp. were found. We isolated Crithidia spp. from clinical samples of patients suspected of cutaneous leishmaniasis in Iran, indicating that Crithidia spp. are capable of surviving at human body temperature and infecting macrophage cells. This raises questions on the influence of this phenomenon on pathogenicity, therapeutic outcome and disease control strategies.

Lived Experiences of Patients Suffering from Acute Old World Cutaneous Leishmaniasis: A Qualitative Content Analysis Study from Iran

The aim of this study was to explore the experiences of patients who suffer from acute cutaneous leishmaniasis in Iran, focusing on quality of life. The study was conducted at two different sites in Iran in 2010-2011. Individual in-depth interviews were conducted with six men and six women parasitologically confirmed acute cutaneous leishmaniasis. Interviews were recorded, transcribed verbatim, and translated into English. Qualitative content analysis was used for data analysis. The participants, aged 23 to 63yr, had mild to severe disease. Based on the analysis four main themes were developed. "Fearing an agonizing disease" reflects patients' experiences of disease development resulting in sadness and depression, "struggling to cope" and "taking on the blame" both illustrate how patients experience living with the disease, which included both felt and enacted stigma as major social concerns. "Longing for being seen and heard" refers to patients' experiences with healthcare as well as their expectations and demands from communities and healthcare to be involved in closing the knowledge and awareness gap. Mental and social dimensions of cutaneous leishmaniasis were complex and adversely affected patients' lives by causing psychological burden and limiting their social interactions. Health authorities have to plan programs to increase the disease awareness to prevent the existing stigma to improve patients' social condition and medical care.

Reprint of “Spatial modeling of Cutaneous Leishmaniasis in Iran from 1983 to 2013”

IntroductionCutaneous Leshmaniasis (CL), a parasitic skin infection caused by Leishmania species, is endemic in some regions of Iran. In this study, the effect of location on the incidence and distribution of CL in Iran was studied. MethodsWe collected datas including the number of Cutaneous Leishmaniasis cases and populations at-risk of disease in Iran's different provinces reported by the Iranian ministry of health and the National Bureau of Statistics, respectively. Spatial modeling was performed using Arc GIS software. Descriptive maps, hotspot analysis, and high/low clustering analysis were used to demonstrate distribution of the cutaneous leishmaniasis, to determine regions at risk of disease's incidence, and to reach the most appropriate method for clustering of disease. ResultsThe total number of cases of cutaneous leishmaniasis reported through the study period was 589,913. The annual incidence of CL was estimated to be 30.9 per 100,000 in Iranian population. We also demonstrated that Cutaneous leishmaniasis most prominently occurs in regions with dry and desert climates as well as in central parts of Iran. It affected the southwest of Iran between 1983 and 1997, and subsequently developed towards the center and the eastern between 1998 and 2013. Disease hotspots were focused in the provinces of Yazd, Khozestan and Kohgiloyeh-Boyer-Ahmad (p<0.05). No pattern of spatial clustering was observed. ConclusionCutaneous leishmaniasis is a major health problem which could be a serious threat for inhabitants who live in high-risk provinces of Iran; much more resources need to be allocated in these areas, to warrant the prevention as well as effectively management of this disease.

Spatial modeling of cutaneous leishmaniasis in Iran from 1983 to 2013

IntroductionCutaneous Leshmaniasis (CL), a parasitic skin infection caused by Leishmania species, is endemic in some regions of Iran. In this study, the effect of location on the incidence and distribution of CL in Iran was studied. MethodsWe collected datas including the number of Cutaneous Leishmaniasis cases and populations at-risk of disease in Iran’s different provinces reported by the Iranian ministry of health and the National Bureau of Statistics, respectively. Spatial modeling was performed using Arc GIS software. Descriptive maps, hotspot analysis, and high/low clustering analysis were used to demonstrate distribution of the cutaneous leishmaniasis, to determine regions at risk of disease’s incidence, and to reach the most appropriate method for clustering of disease. ResultsThe total number of cases of cutaneous leishmaniasis reported through the study period was 589,913. The annual incidence of CL was estimated to be 30.9 per 100,000 in Iranian population. We also demonstrated that Cutaneous leishmaniasis most prominently occurs in regions with dry and desert climates as well as in central parts of Iran. It affected the southwest of Iran between 1983 and 1997, and subsequently developed towards the center and the eastern between 1998 and 2013. Disease hotspots were focused in the provinces of Yazd, Khozestan and Kohgiloyeh-Boyer-Ahmad (p<0.05). No pattern of spatial clustering was observed. ConclusionCutaneous leishmaniasis is a major health problem which could be a serious threat for inhabitants who live in high-risk provinces of Iran; much more resources need to be allocated in these areas, to warrant the prevention as well as effectively management of this disease.

Cutaneous leishmaniasis in Iran: Results from an epidemiological study in urban and rural provinces

ObjectiveTo examine the prevalence and clinical manifestations of cutaneous leishmaniasis (CL) in Iran. MethodsThis study was conducted in Iran between 2011 and 2013. Sampling, preparing, developing, and fixing of suspicious skin lesions were completed in healthcare centers in 31 Iranian provinces as well as in the Academic Reference Laboratory and the National Reference Laboratory. The information was then analyzed at the Ministry of Health's Information Management Center of Contagious Diseases. ResultsOver a three-year period, the number of people identified with CL was 56546. The highest incidence was reported in 2011 (27.5 per 100000). Wet CL accounted for 43.7% of cases while 43.3% resulted from sporotrichoid leishmaniasis. The results showed that there was a higher incidence of CL due to Leishmania major (50.2%) than to Leishmania tropica. The results of this study found that the highest incidence of CL had happened respectively in Ilam, Fars and, Khorasan Razavi Provinces between 2011 and 2013. ConclusionsAlthough the incidence of the disease is declining, CL is still a public health concern and disease control protocols need to be established. Therefore, further studies are needed to identify the vectors, reservoirs, and disease species as well as to develop appropriate disease control strategies.

Ecological Niche Modeling of main reservoir hosts of zoonotic cutaneous leishmaniasis in Iran

Zoonotic cutaneous leishmaniasis (ZCL), caused by Leishmania major, is a common zoonotic vector-borne disease in Iran. Close contact with infected reservoir hosts increases the probability of transmission of Leishmania parasite infections to susceptible humans. Four gerbil species (Rodentia: Gerbillidae) serve as the main reservoir hosts for ZCL in different endemic foci of Iran. These species include Rhombomys opimus, Meriones libycus, Meriones hurrianae and Tatera indica; while notable infection has been reported in Nesokia indica as well. The purpose of this study is to model the distribution of these reservoirs to identify the risk areas of ZCL. A data bank was developed including all published data during the period of 1970–2015. Maximum entropy model was used to find the most appropriate ecological niches for each species. The areas under curve obtained were 0.961, 0.927, 0.922, 0.997 and 0.899, instead of 1, for training test in R. opimus, M. libycus, T. indica, M. hurrianae and N. indica, respectively. The environmental variable with the highest gain when used in isolation was slope for R. opimus and N. indica, annual mean temperature for M. libycus, and seasonal precipitation for T. indica and M. hurrianae. Summation of presence probabilities for three main species, i.e., R. opimus, M. libycus and T. indica revealed favorable ecological niches in wide areas of 16 provinces. This is the first study to predict the distribution of ZCL reservoir hosts in Iran. Climatology and topography variables had high contributions toward the prediction of potential distribution of the main reservoir species; therefore, as climate changes, the models should be updated periodically with novel data, and the results should be used in disease-monitoring programs.

Epidemiological Aspects of Cutaneous Leishmaniasis in Iran

Background: The prevalence of Cutaneous Leishmaniasis (CL) has been reported as 1.8% to 37.9% in different provinces of Iran. However, enough knowledge about epidemiological aspects of CL disease is needed to launch a proper program to plan control and preventive strategies about the disease. Objectives: The present study aimed to determine the epidemiological aspect of CL in Iran during the first 6 months of 2014. Patients and Methods: In this cross-sectional study, all cases of CL reported to centers for disease control and prevention (CDC) by state health departments from March 2014 to September 2014 were included. Descriptive statistics including frequency tables, measures of central value, and measures of dispersion to describe the study variables were used to analyze data. Area maps were created using ArcView GIS v. 3.3. Results: Most of the CL cases were observed in eastern, central, and southern provinces. Two thousand thirty-one cases (55.13%) were male and 2,306 (62.6%) were living in urban areas. The mean age of the patients was 27 ± 18 years old. More than 31% of them were under 14 years of age. Also, 3570 individuals (96.91%) were new cases. more wounds were seen so that 62.75% of the wounds were on the hands, 24.8% in the head and neck, and 2.7% in the body. Conclusions: According to the epidemiological features of CL in Iran, Providing a uniform mechanism for control and prevention of this disease is not possible. Thus, initial actions such as staff training, screening in endemic areas, and treatment of patients with urban leishmaniasis as a reservoir for the disease can be useful, according to the geographical position and carrier.

Different Morphologies of Leishmania major Amastigotes with No Molecular Diversity in a Neglected Endemic Area of Zoonotic Cutaneous Leishmaniasis in Iran.

Background:Molecular diversity of Leishmania major and its morphological changes have become a controversial issue among researchers. Some aspects of polymorphic shapes of amastigotes in clinical manifestations along with molecular variation were evaluated among suspected patients of some exceptional zoonotic cutaneous leishmaniasis locations in Northern Khuzestan, Southwestern Iran. Methods:Suspected patients (n = 165) were sampled in zoonotic cutaneous leishmaniasis foci over two consecutive years during 2012-2014. Prepared smears were stained, scaled and measured by ocular micrometer. DNA was extracted from smears; ITS-rDNA and Cytochrome b (Cyt b) markers were amplified, and PCR products were digested by BsuR1 restriction enzyme. Then the RFLP and sequencing were employed. Results:Only L. major was identified in patients containing regular amastigotes' shapes (oval or round) with a size of 2-4 µm in each of classical wet, dry, mixed lesions. Meanwhile, irregular shapes (spindle, pear, or cigarette) were observed separately in non-classical wet lesions with more than 4 µm. Interestingly, a few amastigotes with an external flagellum were observed in some lesions. All sequenced ITS-rDNA and Cyt b genes of L. major did not show any molecular variation (χ 2 P > 0.05), including only one common haplotype (GenBank access no. EF413075). Conclusion:Findings proved that unlike other endemic foci, there is not a meaningful correlation between phenotypic and genotypic features of L. major isolates. This study is considered as the first comprehensive report to incriminate morphometric shapes of L. major amastigotes, which enhances our knowledge concerning their relevance with various clinical appearances and genotypic traits.

Cutaneous Leishmaniasis in Isfahan Province, Iran, During 2001-2011

Background: Isfahan province is one of the common foci of the cutaneous leishmaniasis in Iran, particularly the wet or rural zoonotic cutaneous leishmaniasis (ZCL). Several factors other than the location of the disease are implicated in the epidemiology of cutaneous leishmaniasis, such as the presence of sandflies as vectors and the role of rodents as reservoirs. These factors that contribute to the transmission of the disease include agricultural projects, migration of the non-immune individuals to the endemic areas, rapid and unplanned urbanization, environmental changes (such as irrigation, dam construction, and desertification). Objectives: Due to the lack of information about the epidemiology and prevalence of cutaneous leishmaniasis in Isfahan province, Iran, this study was designed to investigate the aforementioned factors. Patients and Methods: Data were collected from the recorded data of patients with leishmaniasis referred to Isfahan Province Health Care Center, Isfahan, Iran. The patients were diagnosed by direct microscopic examination of the samples in Leishmaniasis and Skin Diseases Research Center and other health care centers. Data concerning demographic features, the number and location of lesions, duration of disease, area of residence, work location, the history of travel within the past two months, address, and telephone number of the patients was collected. The epidemiological status of leishmaniasis was determined from the recorded data. Results: In total, data of 28315 patients with leishmaniasis during 2001 to 2011 were studied .Among them, 10809 (38.2%) patients were female and 17491 (61.8%) patients were male. The mean age of the patients was 22.40 ± 16.52 years (range, 1-100 years). The incidence of lesions in different body parts was as follows: face, 12.1%; hands and legs, 12.3%; face and hands, 4.5%; legs, 24.1%; hands prevalence, 32.3%; and the other parts of body, 11.5%. The number of the lesions on the trunk ranged from one to three. In this study, 12163 (43%) patients had one, 6330 (22.4%) had two, 503 (8.1%) had three, and 8008 (28.3%) had more than three lesions. Overall, 17883 (63.2%) patients lived in urban areas and 8241 (29.1%) in rural areas and most of the cases were seen among those who lived in cities and urban areas. Conclusions: Considering the high prevalence of cutaneous leishmaniasis in the Isfahan province, eliminating the leishmaniasis vector and its reservoirs in this endemic area seems to be necessary. During the years, it has been showed that leishmaniasis is endemic in Isfahan province hence, a more extensive epidemiologic study is recommended.

Diversity of Leishmania species and of strains of Leishmania major isolated from desert rodents in different foci of cutaneous leishmaniasis in Iran.

Zoonotic cutaneous leishmaniasis (ZCL) is a polymorphic disease which may show various symptoms. Genetic diversity of the parasite is suggested to be one of the factors influencing the clinical manifestation of the disease. This study used PCR for the detection and identification of leishmanial parasites at the species level and applied a multilocus microsatellite typing approach for investigating the genetic diversity of Leishmania major isolated from captured rodents in two foci of ZCL in Iran: Turkemen Sahara and Fars province. ITS1-rDNA amplification and subsequent RFLP analyses were performed using DNA extracted from the rodents' ears. Approximately one third of the rodents tested positive for Leishmania; in all rodents L. major was the predominating infecting agent. Seven Rhombomys opimus were positive for L. turanica DNA and one for both L. major and L. turanica. DNA of L. infantum was identified in one Rh. opimus. Seventeen strains of L. major, 15 from Turkemen Sahara and two from Fars province, isolated from different rodents were tested for variation at nine polymorphic microsatellite loci. Ten different MLMT genotypes were observed. They were compared to 89 previously published microsatellite profiles obtained for strains of L. major of different geographical origin. Bayesian model-based and genetic distance based approaches confirmed that strains from Turkemen Sahara and from Fars are genetically different and belong to different genetic groups, largely corresponding to their geographical origins. The considerable genetic variability of L. major might be related to differences in reservoir host and/or to the existence of different populations of the vector, Phlebotomus papatasi.

Heterogeneity of the internal transcribed spacer region in Leishmania tropica isolates from southern Iran

Most of cutaneous leishmaniasis cases occur in only 7 countries, including Iran. Leishmania tropica is the main cause of anthroponotic cutaneous leishmaniasis in Iran. In order to study the heterogeneity and phylogeny of L. tropica in southern Iran, a total of 61 isolates were obtained from Bam district and the cities Kerman and Shiraz. The internal transcribed spacer (ITS) from the ribosomal DNA locus was amplified and then analysed by sequencing. Analysis of the ITS sequences showed four haplotypes in the isolates, including 3 haplotypes among the 58 isolates from the south eastern region, including Bam district and Kerman city, and 2 haplotypes among the 3 isolates from Shiraz city. The results showed a monophyletic structure for the south eastern population. In comparison to GenBank sequences of L. tropica from different countries, most of the southeast Iranian and Indian isolates are comprised in one cluster, while isolates from other countries and few other Iranian isolates group in a different cluster. Analysis of ITS sequences of south eastern L. tropica showed a homogeneous population which could be the basis for other molecular epidemiology studies using more discriminative markers and tracing possible changes in the population structure of L. tropica.

Novel identification of Leishmania major in Hemiechinus auritus and molecular detection of this parasite in Meriones libycus from an important foci of zoonotic cutaneous leishmaniasis in Iran

One of the well-known foci of zoonotic cutaneous leishmaniasis (ZCL) in Iran is Turkemen Sahara, which is located in north eastern Iran. ZCL is a disease of mammals, and humans can become infected as accidental hosts. Many researchers have argued that Rhombomys opimus is the only main reservoir host of ZCL in this region of the Golestan province. No other rodents or mammals are thought to host or have been reported to host Leishmania parasites in this region. This research was designed and developed to isolate, detect and firmly identify Leishmania parasites in mammals and rodents other than R. opimus. Wild mammals were caught from gerbil burrows. Leishmania parasites were detected to assess the infection of reservoir hosts in 2010. Each genomic DNA sample was screened for Leishmania infection via nested PCR and sequencing using the internal transcribed spacer ribosomal DNA (ITS-rDNA) identification protocol for parasites. The greatest number of infections (8/19) were found in Meriones libycus. One in three infections was found in Hemiechinus auritus, and this is the first report of infection in this species. Only Leishmania major was definitively identified and unambiguously typed in M. libycus and H. auritus. The infection rates in these two wild mammals were not significantly different, and no other gerbil parasites were detected in M. libycus or H. auritus at our study site. Recent findings of Leishmania turanica in R. opimus and failures to detect L. turanica in M. libycus may be attributable to unidentified Leishmania infections in two M. libycus due to unreadable sequences. These cases may represent mixed infections by L. major and L. turanica. The assumptions that gerbil parasites can be co-infectors provide a starting point for the identification of the causative and potential parasites responsible for the frequent infections that are mainly mediated via sandfly vectors.

Performance of an ELISA and indirect immunofluorescence assay in serological diagnosis of zoonotic cutaneous leishmaniasis in iran.

Serological assays have been extensively evaluated for diagnosis of visceral leishmaniasis (VL) and considered as a routine method for diagnosis of VL while these methods are not properly evaluated for diagnosis of cutaneous leishmaniasis (CL). This study aimed to assess the performance of indirect immunofluorescent-antibody test (IFA) and enzyme-linked immunosorbent assay (ELISA) for serodiagnosis of cutaneous leishmaniasis in Iran. Sixty-one sera samples from parasitologically confirmed CL patients and 50 sera from healthy controls along with 50 sera from non-CL patients were collected. Antigen was prepared from promastigotes and amastigotes of Leishmania major. IFA was used to detect anti-Leishmania IgG while ELISA was used to detect anti-Leishmania IgM, total IgG, or IgG subclasses (IgG1 and 4). ELISA, for detection of total IgG and IgM, showed sensitivity of 83.6% and 84.7% and specificity of 62.7% and 54.6%, respectively. Sensitivity and specificity of ELISA for detecting IgG1 and IgG4 were 64%, 75% and 85%, 49%, respectively. Sensitivity and specificity of IFA were 91.6% and 81%. Conclusion. Findings of this study demonstrated that serological test, especially IFA, can be used for proper diagnosis of CL.

Identification of Leishmania isolates from Varzaneh city, Isfahan province, Iran using nested polymerase chain reaction method

Background:Leishmaniasis, a parasitic disease, is caused by the Leishmania genus, a protozoan parasite transmitted by sand fly arthropods. Cutaneous leishmaniasis (CL) in old world is usually caused by L. major, L. tropica, and L. aethiopica complexes. One of the most important hyper endemic areas of CL in Iran is Isfahan province. Varzaneh is a city in the eastern part of Isfahan province. Due to different biological patterns of parasite strains which are distributed in the region, this study was design to identify Leishmania species from human victims using Kinetoplastid DNA as templates in a molecular PCR method.Materials and Methods:Among 186 suspected cases, 50 cases were confirmed positive by direct microscopy after Giemsa staining. Species characterization of the isolates was done using Nested- PCR as a very effective and sensitive tool to reproduce mini circle strands.Results:After Nested-PCR from all 50 cases, 560 bp bands were produced which according to products of reference strains indicate that the infection etiologic agent has been L. major. 22 (44%) of patients were females and 28 (56%) of them were males. Their age ranges were between 7 months and 60 years.Conclusion:According to the results of the study and the particular pattern of infection prevalent in the region, genetic studies and identification of Leishmania parasites are very important in the disease control and improvement of regional strategy of therapy protocols.

The efficacy of Achilles millefolium topical gel along with intralesional injection of glucantime in the treatment of acute cutaneous leishmaniasis major.

Background:Leishmaniasis is still one of the endemic parasitic infections in many countries comprising Iran. During the past decades, several medical and surgical approaches have been applied and studied to achieve the best option to treat the cutaneous leishmaniasis in Iran and the world. This study was carried out to evaluate the effect of topical Achilles millefolium in conjunction with intralesional glucantime on acute cutaneous leishmanial lesions.Materials and Methods:sixty patients with confirmed acute cutaneous leishmaniasis were recruited in the study. Patients were randomly allocated into two groups to receive twice daily topical gel of Achilles millefolium 5% (containing 5% poly phenol) (group A) or placebo (group B) for four weeks along with weekly injection of intralesional Glucantime.Results:There was no significant difference between the two groups according to age, gender, and duration of the disease. Also, there was no significant difference in complete and relative cure rates between the two groups (P = 0.35) using Visual Analog Scale (VAS). Application site reactions were occurred in 12 patients including redness in 8 cases in group-A and 2 cases in group-B, severe itching in one case in group-A and increasing wound secretion in another case in group-A (P = 0.014).Conclusions:Given the result of the present study, there is no significant difference in cure rates of lesions between yarrow and placebo topical gels as an adjuvant drugs with intralesional glucantime in treatment of acute cutaneous leishmanial lesions.

Molecular characterization of Leishmania spp. in reservoir hosts in endemic foci of zoonotic cutaneous leishmaniasis in Iran

Zoonotic cutaneous leishmaniasis (ZCL) is an expanding disease and a public health issue in Iran. In the present study, rate of natural infection of rodent populations with Leishmania was investigated in six endemic foci including 28 villages in Golestan, Esfahan, Yazd, Fars, Khuzestan and Ilam provinces. A total of 593 rodents were captured and identified as Rhombomys opimus (n = 325), Meriones libycus (n = 171), Meriones persicus (n = 27), Tatera indica (n = 37), Nesokia indica (n = 12), Rattus rattus (n = 13) and Mus musculus (n = 8). Microscopic examinations of Giemsa-stained smears showed that 108 out of 593 (18.2%) rodents were infected with Leishmania spp., whereas infection of 186 out of 593 (31.4%) rodents with Leishmania was then confirmed by ITS1-PCR. The highest rate of infection was found in R. opimus (prevalence of 35%) and M. libycus (31%). Based on Restriction Fragment Length Polymorphism (RFLP), 145 (78%) of 186 samples detected as Leishmania DNA were identified as L. major, 8 (4%) samples as L. turanica and 33 (18%) as mixed infection (L. major and L. turanica). Samples from infected rodents were inoculated subcutaneously at tail base of BALB/c mice. In 35 of them, nodules and ulcers containing amastigotes appeared at the inoculation site. The samples prepared from infected rodents were cultured in NNN medium and only two samples werepositive. Rhombomys opimus, M. libycus, M. persicus, T. indica and N. indica were confirmed as reservoir hosts of ZCL in the studied regions. Leishmania major infection was usually accompanied L. turanica in naturally infected gerbils (R. opimus and M. libycus) in Golestan, Esfahan and Fars provinces.

Effect of large-scale installation of deltamethrin-impregnated screens and curtains in Bam, a major focus of anthroponotic cutaneous leishmaniasis in Iran

Installation of deltamethrin-impregnated screens and curtains was assessed as a preventive measure against transmission of anthroponotic cutaneous leishmaniasis (ACL) by Phlebotomus sergenti in Bam, a well-known focus of ACL in Iran with a population of nearly 100,000. This was a quasi-experiment based on official data from an ACL control program in which one section of the city with about one-quarter of the population received the intervention. In the analysis, the rest of the city was used as control. Data covered June 2007 through October 2010. Comparison of cumulative incidence between the intervention and control areas before and after installation indicate a significant differential reduction in the cumulative ACL incidence in the intervention area and a reversal of the relative risk, beginning four months after the completion of installation, from RR = 1.14 (95% CI:1.05-1.23) to RR = 0.84 (95% CI:0.72-0.98). Results also indicate a return to a higher cumulative relative risk, RR = 1.51 (95% CI:1.30-1.77), several months after the loss of the preventive effect. Findings indicate the short-term effectiveness of such preventive measures but highlight the necessity of long-term, sustainable strategies. Results also suggest that shrinkage in the human reservoir pool in response to the intervention may play a significant role in prolongation of the preventive effect beyond the insecticidal life of impregnated materials in foci of anthroponotic cutaneous leishmaniasis and possibly anthroponotic visceral leishmaniasis due to L. donovani.