Incidence Of Cutaneous Leishmaniasis Research Articles

Trend of Cutaneous Leishmaniasis in Jordan From 2010 to 2016: Retrospective Study.

BackgroundCutaneous leishmaniasis (CL) is endemic in the Middle East, with countries such as Syria reporting high incidence rates.ObjectiveThis study aimed to assess the trends in the incidence of cutaneous leishmaniasis (CL) in Jordan from 2010 to 2016.MethodsThis retrospective study included all cases of CL that had been reported to the Leishmaniasis Surveillance System in the Department of Communicable Diseases at the Jordan Ministry of Health during the period from 2010 to 2016. A total of 1243 cases were reported and met the case definition.ResultsA total of 1243 cases (60.65% [754/1243] males and 39.34% [489/1243] females) were diagnosed during the study period. Of this sample, 233 patients (19.13%) were aged <5 years old, 451 (37.03%) were aged between 5-14 years old, 190 (15.60%) were aged between 15-24 years old, and 344 (28.24%) were aged ≥25 years old. Of those, 646 (51.97%) were Jordanians and 559 (44.97%) were Syrians. The average annual incidence rate of 1.70 per 100,000 people between 2010 and 2013 increased to 3.00 per 100,000 people in the years 2014 to 2016. There was no difference in incidence rates between Jordanians and Syrian refugees between 2010 and 2012. After 2012, the incidence rate increased significantly among Syrian refugees from 1.20 per 100,000 people in 2012 to 11.80 per 100,000 people in 2016. On the contrary, the incidence rate did not change significantly among Jordanians.ConclusionsThe incidence rate of leishmaniasis in Jordan has increased in the last three years because of the influx of Syrian refugees into Jordan. A massive effort toward reservoir and vector control, along with actively pursuing diagnosis in endemic foci, will be helpful. Proper and studious reporting of cases is also a necessity for the eradication of this disease.

Spatial Analysis and Geographic Factors Associated with Cutaneous Leishmaniasis in Southern Iran

Introduction: This study aimed to determine the hotspot areas for Cutaneous Leishmaniasis (CL) in Fasa city and assess the relations between the geographical factors with CL incidence using spatial analysis. Materials and Methods: This ecological study was conducted in Fasa city, data of the CL disease such as the total number of CL cases and the population at risk from 2009 to 2014. Weather conditions' data including the means of temperature, humidity, rainfall, sunny days, rainy days, and evaporation were collected from the weather forecast centers in Fars province. The disease cases' information such as the number of disease cases was collected from all healthcare centers located in Fasa City. Ordinary Least Square (OLS) and Global Moran’s Index (GMI) were used to assess the associations of the various environmental variables with CL incidence and to map clustering of CL cases across the region. Results: The cumulative incidence of CL was 16 per 10,000 populations during a six-year period. The results showed the southern area of Fasa as a hotspot area which is considered as hyperendemic foci for CL. OLS revealed a high incidence of CL in areas with maximum temperature, mean of temperature, mean of evaporation, sunny days and wind velocity. Conclusion: A spatial disease pattern was found in the present study. Hence, substantial consideration to environmental data leads to not only suitable protection against CL but also designing a suitable measure for the prevention and control of the disease.

Modelling and evaluating the risk of zoonotic cutaneous leishmaniasis in selected areas of Kerman Province, south of Iran.

Cutaneous leishmaniasis (CL) remains a public health problem in the world, particularly in tropical and sub-tropical countries. This study aimed to determine the hotspots of CL in Kerman Province of Iran and model their potential for the establishment of new disease foci. All documents related to studies conducted in Kerman Province on CL published between 1978 and 2017 were retrieved and categorized. Spatial distributions of the vector, reservoir and human infection of CL were mapped. MaxEnt ecological model was used to predict the environmental suitability of the vector and reservoir(s) of zoonotic cutaneous leishmaniasis (ZCL). The most hazardous sites with the potential for the establishment of new disease foci were determined for field operations. Statistics of new cases of CL was obtained from the Center for Disease Control (CDC) of the ministry of health for the period 2011-2016. A total of 6,056 cases of CL were recorded, while we found a decreasing pattern in the incidence of CL from 46.48 per 100,000 inhabitants to 22.97. The best ecological niches for Phlebotomus papatasi are located in the central, western, northwest and southwest regions of the province. Also, environmental suitability for the reservoirs was highest in the central, southern and southwestern regions. The model predicted the gerbils can be present in some foci of anthroponotic cutaneous leishmaniasis (ACL). However, this result should be confirmed through a precise field study, and if validated, plans should be made to prevent the emergence of new foci of ZCL in the risk areas.

Environmental and socioeconomic risk factors associated with visceral and cutaneous leishmaniasis: a systematic review.

We performed a systematic review of the literature published since 1900 about leishmaniasis a neglected vector-borne disease, focused on environmental and social risk factors for visceral (VL) and cutaneous leishmaniasis (CL) to better understand their impact on the incidence of disease. The search terms were "leishmaniasis" AND "risk factors" using Google Scholar, PudMed, and Scielo. We reviewed 177 articles, 95 studies for VL, 75 for CL, and 7 on both forms. We identified 14 categories of risk factors which were divided into three groups: socioeconomic (7), environmental (5), and climate (2) variables. Socioeconomic factors were also associated with disease incidence in vulnerable human populations of arid and tropical developing regions. Environmental and climate factors showed significant associations with the incidence of VL and CL in all the studies that considered them. Proximity to natural vegetation remnants increased disease risk in both the New and Old World while the climate conditions favorable for disease transmission differed among regions. We propose a common conceptual framework for both clinical forms that highlights networks of interaction among risk factors. In both clinical forms, the interplay of these factors played a major role in disease incidence. Although there are similarities in environmental and socioeconomic conditions that mediate the transmission cycle of tropical, arid, and Mediterranean regions, the behavior of vector and reservoirs in each region is different. Special attention should be given to the possibility of vector adaptation to urban environments in developing countries where populations with low socioeconomic status are particularly vulnerable to the disease.

Antioxidant and Leishmanicidal Evaluation of Pulicaria Inuloides Root Extracts: A Bioguided Fractionation.

Leishmaniasis remains a major world health problem, and in particular, Algeria ranks second for the incidence of cutaneous leishmaniasis. Pulicaria inuloides is a well-known Arabian Peninsula medicinal plant. In the present study, the chloroform, ethyl acetate and n-butanol extracts from the roots of Pulicaria inuloides were analyzed for antioxidant activity and its correlation with the total phenolic and flavonoid contents. The highest antioxidant activity using a DPPH assay was showed by the ethyl acetate extract (IC50 4.08 µg/mL), which also had the highest total phenolic content (307.12 µgAGE). Furthermore, P. inuloides root extracts were evaluated against Leishmania amazonensis and Leishmania donovani. The results highlighted the chloroform extract as the most active one against both tested Leishmania strains. A bioguided fractionation of the chloroform extract led to the isolation of (8R:8S)-(75:25 er)-10-isobutyryloxy-8,9-epoxy-thymol isobutyrate as the main bioactive component, showing a potent leishmanicidal activity on L. amazonensis promatigote and amastigote stages (IC50 5.03 and 2.87 µM, respectively) and a good selectivity index on murine macrophages (CC50 19.37 µM). This study provides the first report of the antioxidant and leishmanicidal activities of P. inuloides root extracts and the results point to this species as a source of potential bioactive agents.

Serum 25-hydroxyvitamin D level and vitamin D receptor (VDR) polymorphisms in patients infected with Leishmania tropica: a case control study.

Leishmania, an obligate intracellular parasite is eliminated by a strong Th-1 host response. As Vitamin D metabolism and its receptor activity are important factors in human native immune system against some microorganisms, we hypothesized that VDR gene polymorphisms and concentration of Vitamin D might have effect on incidence of cutaneous leishmaniasis. The aim of this study was to investigate the association between VDR gene polymorphism and/or the serum vitamin D level and leishmaniasis in the infected patients in comparison to the healthy individuals. In this case-control study, the BsmI, FokI and Taq1 polymorphisms in the VDR gene and serum levels of vitamin D were studied in Iranian infected with Leishmania tropica (n = 50) and healthy controls using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and Electrochemiluminescence methods respectively. Data were statistically analyzed using SPSS software, Chi square and ANOVA tests. The results of this study showed that despite the relatively higher frequency of BsmI-BB, FokI-FF and TaqI-Tt than Non BsmI-BB, Non FokI-FF and Non TaqI-Tt in the patients compared with the healthy individuals, the differences were not statistically significant (P > 0.05). Based on our findings, the relationship between the VDR polymorphism, the serum concentration of 25-hydroxyvitamin D and the susceptibility to Leishmania tropica infection, remains unclear requiring further in-depth studies. However, for better interpretation, it is necessary to consider factors such as the size of the sample examined and the other alleles of VDR, including ApaI.

Epidemiological and molecular investigation of resurgent cutaneous leishmaniasis in Sudan

ObjectivesLocal health personnel have drawn attention to an apparent increase in incidence and severity of cutaneous leishmaniasis (CL) in Sudan. The objective of this study was to investigate CL burden and surveillance. MethodsSurveillance data were compiled from the KalaCORE programme, Leishmania coordinators in Northern Kordofan and Southern Darfur, and Khartoum Dermatology Hospital. CL lesions were sampled from 14 suspected cases from Northern Kordofan and the Hospital for Tropical Diseases in Omdurman. PCR–restriction fragment length polymorphism analysis and multilocus sequencing were used to characterize the disease agent. ResultsAll sites reported substantial increases from 2014 to 2016/7, far exceeding World Health Organization case reports for 2014, consistent with a widespread outbreak. Single seasonal peak incidence was observed, except for two peaks in Southern Darfur. In Northern Kordofan, the odds ratio for CL in the 35–44 years age group was 2.6 times higher than in the >45 years age group (p<0.0001); in Southern Darfur, the OR was 2.38 greater in males than females (p<0.0001). Lesions included severe presentations, despite chemotherapy. Leishmania major was identified as the agent. ConclusionsActive surveillance is required to understand the extent of CL in Sudan, as well as training to standardize surveillance, diagnosis, reporting, and quality control. Point-of-care rapid diagnosis would be valuable. Genotyping and phenotyping are required to monitor the emergence of pathogenic strains, drug resistance, outbreaks, and changes in severity.

Data scarcity and ecological complexity: the cutaneous leishmaniasis dynamics in Ecuador.

Cutaneous leishmaniasis (CL) is a neglected tropical disease transmitted by species of Phlebotominae sand flies. CL is responsible for more than 1000 reported cases per year in Ecuador. Vector collection studies in Ecuador suggest that there is a strong association between the ecological diversity of an ecosystem, the presence of potential alternative or reservoir hosts and the abundance of sand fly species. Data collected from a coastal community in Ecuador showed that Leishmania parasites may be circulating in diverse hosts, including mammalian and potentially avian species, and these hosts may serve as potential hosts for the parasite. There has been limited reporting of CL cases in Ecuador because the disease is non-fatal and its surveillance system is passive. Hence, the actual incidence of CL is unknown. In this study, an epidemic model was developed and analysed to understand the complexity of CL transmission dynamics with potential non-human hosts in the coastal ecosystem and to estimate critical epidemiological quantities for Ecuador. The model is fitted to the 2010 CL outbreak in the town of Valle Hermoso in the Santo Domingo de los Tsachilas province of Ecuador and parameters such as CL transmission rates in different types of hosts (primary and alternative), and levels of case reporting in the town are estimated. The results suggest that the current surveillance in this region fails to capture 38% (with 95% CI (29%, 47%)) of the actual number of cases under the assumption that alternative hosts are dead-end hosts and that the mean CL reproduction number in the town is 3.9. This means that on the average 3.9 new human CL cases were generated by a single infectious human in the town during the initial period of the 2010 outbreak. Moreover, major outbreaks of CL in Ecuador in coastal settings are unavoidable until reporting through the surveillance system is improved and alternative hosts are managed properly. The estimated infection transmission probabilities from alternative hosts to sand flies, and sand flies to alternative hosts are 27% and 32%, respectively. The analysis highlights that vector control and alternative host management are two effective programmes for Ecuador but need to be implemented concurrently to avoid future major outbreaks.

Effects of land use type, spatial patterns and host presence on Leishmania tropica vectors activity

BackgroundLeishmaniasis is a vector-borne disease, caused by the infection of Leishmania parasites which are transmitted by the bite of infected female phlebotomine sand flies. Leishmania tropica is transmitted by Phlebotomus sergenti and Phlebotomus arabicus while the main reservoir host is the rock hyrax. A marked increase in the incidence of cutaneous leishmaniasis (CL) caused by L. tropica has been detected in recent years in Israel; it is associated with infections which have emerged in new urban and rural foci. The objective of this study is to contribute to a better understanding of the preferred habitat, spatial activities and host-sand fly relationships of both species of vectors within various types of land use.MethodsUsing CDC-type traps, we investigated the activity levels of sand flies. A field survey was conducted in 2016 at Elifelet, an agricultural village characterized by various types of land use. Movement patterns of P. sergenti between rock-piles were investigated by using colour-marked sugar baits and analyses of recapture patterns. In 2017, a survey was conducted in the hilly Jordan River area, by comparing sand flies and rock hyrax activities in relation to the size of rock-piles and vegetation cover.ResultsBoth sexes of both species were found to have a clear preference for rocky habitats over other land use types in rural landscapes. Movement patterns of P. sergenti were characterized by their high presence close to the rocks and an exponential decrease in their recapture, commensurate with the distance from the rocks. Host-sand fly relationships were found to have a higher correlation between rock hyrax activity levels for females than for males of both species of sand flies. Males exhibited the strongest association with the size of rock-piles.ConclusionsThe results suggest a strong affinity of both phlebotomine vector species to the rocky habitats of the Mediterranean areas. We suggest that rock-piles are associated with populations of rock hyraxes attracting female sand flies seeking blood sources. Rapid human population growth, coupled with intensive land-use changes and the creation of artificial rock-piles, which created potential habitats for both vectors and hosts in the proximity of many settlements, have increased the prevalence of L. tropica among the human population in the region.

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.

Cutaneous leishmaniasis and co-morbid major depressive disorder: A systematic review with burden estimates.

BackgroundMajor depressive disorder (MDD) associated with chronic neglected tropical diseases (NTDs) has been identified as a significant and overlooked contributor to overall disease burden. Cutaneous leishmaniasis (CL) is one of the most prevalent and stigmatising NTDs, with an incidence of around 1 million new cases of active CL infection annually. However, the characteristic residual scarring (inactive CL) following almost all cases of active CL has only recently been recognised as part of the CL disease spectrum due to its lasting psychosocial impact.Methods and findingsWe performed a multi-language systematic review of the psychosocial impact of active and inactive CL. We estimated inactive CL (iCL) prevalence for the first time using reported WHO active CL (aCL) incidence data that were adjusted for life expectancy and underreporting. We then quantified the disability (YLD) burden of co-morbid MDD in CL using MDD disability weights at three severity levels. Overall, we identified 29 studies of CL psychological impact from 5 WHO regions, representing 11 of the 50 highest burden countries for CL. We conservatively calculated the disability burden of co-morbid MDD in CL to be 1.9 million YLDs, which equalled the overall (DALY) disease burden (assuming no excess mortality in depressed CL patients). Thus, upon inclusion of co-morbid MDD alone in both active and inactive CL, the DALY burden was seven times higher than the latest 2016 Global Burden of Disease study estimates, which notably omitted both psychological impact and inactive CL.ConclusionsFailure to include co-morbid MDD and the lasting sequelae of chronic NTDs, as exemplified by CL, leads to large underestimates of overall disease burden.

Análise temporal da incidência de leishmaniose tegumentar em municípios da Região do Parque Estadual do Aguapeí - SP

A Leishmaniose Tegumentar (LT) é uma doença infecto-parasitária, não contagiosa, transmitida aos mamíferos através da picada de flebotomíneos, infectados por protozoários do gênero Leishmania. Registrada em todas as regiões brasileiras desde 2003, esta doença apresenta incidência variável e diferentes perfis epidemiológicos. O presente estudo analisou temporalmente a incidência da LT na população dos municípios que integram o Parque Estadual do Aguapeí (PEA), São Paulo, Brasil. Para tanto, acessou-se o número de casos humanos confirmados de LT, por município de infecção, de 1998 a 2016, disponíveis no Centro de Vigilância Epidemiológica, da Secretaria de Saúde do Estado e dados na literatura. O registro da doença na área de estudo remonta a década de 1930 e dados recentes indicam a transmissão da LT em intensidade variável. No ano de 2015 a intensidade de transmissão da LT foi considerada alta nos municípios de São João do Pau D’Alho e Nova Independência e média em Junqueirópolis e Monte Castelo. Conclui-se que o Parque está inserido em municípios com histórico de incidência da doença, sendo importante o incentivo à realização de monitoramento de tendências espaço-temporais e de estudos sobre as condições relacionadas à transmissão da LT nesta região.

The role of deforestation on American cutaneous leishmaniasis incidence: spatial-temporal distribution, environmental and socioeconomic factors associated in the Brazilian Amazon.

To analyse the temporal and spatial distribution as well as the environmental and socioeconomic factors associated with cutaneous leishmaniasis incidence in the state of Amazonas, Brazil from 2007 to 2015. Spatial and temporal distribution was evaluated from sequential thematic maps of the mean incidence rates of the disease. A negative binomial regression analysis was performed to evaluate the association of the factors studied with the mean incidence rate of ACL. The average proportion of deforestation was negatively associated with the average incidence rate of cutaneous leishmaniasis in municipalities (β = -2.178; P = 0.019; 95%CI -3.996, -0.361), and the health system performance index (effectiveness) (β = -0.852; P = 0.008; 95%CI -1.481, -0.225). Conversely, the municipal human development index (MHDI) was a factor positively related to the average incidence among the municipalities (β = 7.728; P = 0.003; 95%CI 2.716, 12.738). Our study shows the important impact of socioeconomic and environmental factors on ACL incidence in the Amazonas State.

Cutaneous leishmaniasis: an epidemiological study in southwest of Iran.

The current study was aimed to evaluate the frequency and epidemiological aspects of cutaneous leishmaniasis (CL) in the southwest of Iran, an endemic focus for the leishmaniasis from 2014 to 2017. In the present retrospective cross-sectional study, all suspicious CL persons who were referred to health centers affiliated to Abadan School of Medical Sciences (Abadan and Khorramshahr cities) were tested. In this regard, both clinical and parasitological (staining with Giemsa) verifications were performed to diagnose a case. Furthermore, a structured questionnaire containing some demographic details was applied for each positive patient. In total, 151 and 132 positive CL cases were identified in Abadan and Khorramshahr cities, respectively. More frequency of CL was observed during the Winter season, among male subjects, and in urban inhabitants in both cities. The incidence of CL based on age distribution was higher in the age range of 20-30years than others. Besides, the hands and feet were the most involved organs. Although the frequency of CL has declined in the region, CL is still a public health problem. More appropriate control strategies are required to limit and eliminate the infection in the future.

Climate change and potential distribution of zoonotic cutaneous leishmaniasis in Central Iran: Horizon 2030 and 2050

Objective: To investigate and predict the effects of climate change on the potential distribution of the main vector and reservoir hosts of the disease in Yazd province in the future. Methods: Distribution data for vector and reservoir hosts of zoonotic cutaneous leishmaniasis in Yazd province were obtained from earlier studies conducted in the area. MaxEnt ecological niche modeling was used to predict environmental suitability. BCC-CSM1-1(m) model and two climate change scenarios, RCP 4.5 and RCP 8.5 were used for horizons 2030 and 2050 climate projections. Future projections were based on data of a regional climate change model. Results: With both scenarios in 2030 and 2050, the results of jackknife test indicated that the mean temperature of wettest quarter and temperature annual range had the greatest effect on the model for the vector and the reservoir hosts, respectively. Conclusions: The climate conditions are the major determinants of zoonotic cutaneous leishmaniasis incidence rate in Yazd Province. These climate conditions provide favorable habitats for ease transmission of zoonotic cutaneous leishmaniasis in this endemic area. Habitats suitability for the vector and reservoir will be expanding in the coming years compared with the current conditions, such that, in horizon 2030 & 2050, the probability of the presence of the vector and reservoir within 38 580 and 37 949 km2, respectively, from Yazd province is above 60%. Moreover, an increase is predicted in the presence of the vector in the western parts and the reservoir in the northern and central parts of the province in the future. Understanding the role of environmental and bioclimatic factors in zoonotic cutaneous leishmaniasis occurrence can provide a guide for policy-makers in the creation and implementation of more effective policies for prevention and control.

Cutaneous leishmaniasis in Qasr-e Shirin, a border area in the west of Iran

Aim:The prevalence of cutaneous leishmaniasis (CL) is growing in Iran, and new sources of the disease have been found in the country. The purpose of this study was to describe the epidemiology of CL in Qasr-e Shirin County, Kermanshah Province, West of Iran. Qasr-e Shirin is located near the Iran-Iraq border, and several million pilgrims pass through this area to Iraq every year.Materials and Methods:A descriptive cross-sectional study was carried out for active case detection from April 1, 2014, to March 31, 2015. All individuals with suspicious lesions were identified through house-to-house visits in the aforementioned area. A questionnaire was filled out for everyone with clinical suspicion of CL. A diagnosis was made based on parasitological examination of the lesion exudate. The annual incidence and prevalence of CL were estimated.Results:In total, 5277 individuals were randomly screened for the presence of active lesions or scars suspected of CL. The overall prevalence of CL in the County was 4.8% (60 cases had active lesions and 194 cases had scars). All age groups were affected, but the highest incidence of CL was seen in the age group 20-29 years (1.9%). The incidence and prevalence were higher in women than men (5.5% vs. 4%). Most cases (45.6%) had a single lesion or scar and 44 (17.4%) patients had five or more lesions or scars.Conclusion:The incidence of CL in Qasr-e Shirin County is high. There is a need for further studies on reservoirs and vectors of leishmaniasis in this area. The results of such studies help to perform more efficient and timely spraying against phlebotomine sandfly or detect and decrease the animal reservoir population.

Leishmaniasis in Northern Syria during Civil War.

Since the onset of the ongoing civil war in Syria, the governmental surveillance system for leishmaniasis has lost access to provinces of northern Syria. The MENTOR Initiative, an international not-for-profit organization, was commissioned to implement an integrated leishmaniasis control program, providing an opportunity to reassess the epidemiology of leishmaniasis in northern Syria. Epidemiologic data and biologic samples for molecular species diagnostics were collected from collaborating local health centers. Incidence peaked in March 2015 at 7,743 estimated monthly cases. High levels of transmission were observed in traditional endemic regions but extended to previously hypoendemic regions, such as Al-Raqqa and Al-Hasakah. Incidence decreased to 3,209 in July 2015. Data indicate that the prewar trend of increasing incidence of cutaneous leishmaniasis accelerated during the beginning of armed conflict but declined after implementation of the comprehensive control program by the MENTOR Initiative. Molecular analysis revealed a spectrum of Leishmania species and sporadic cases of visceral leishmaniasis.

Spatio-temporal distribution analysis of zoonotic cutaneous leishmaniasis in Qom Province, Iran.

Geographic information system (GIS) nowadays is one of the most helpful epidemiological tools for identifying the high risk areas of cutaneous leishmaniasis (CL). This study was conducted to determine the spatio-temporal distribution of CL in Qom province during 2009-2017. In a cross-sectional study, for the survey of spatial dispersion of CL in the study region, the incidence rate of disease was calculated in all of 23 villages during 2009-2017. Then, spatial analysis of the infection was performed using two methods: spatial autocorrelation (Moran's I)in order to determine the special distribution pattern of disease and Kriging method to reveal high risk areas for disease. The incidence of CL in Qom province has been decreasing as of 2009-2015 and increasing in 2015-2017. The highest incidence was stated in 2009 (36.5 per 100,000) and the least was reported in 2015 (13.3 per 100,000). The Moran autocorrelation index revealed that the study area has a cluster pattern. The temporal distribution of disease incidence showed that northeast, southwest and northwest parts of Qom province involved highest incidence of CL in 90% significant level. Leishmaniasis incidence is a function of spatial and geographical trends, thus spatial variations of the infection incidence illustrate that the incidence rate does not increase or decrease from one region to another intensively. The results of this study indicate that marking high risk areas using spatial analysis can be helpful as a main tool in CL control and prevention.

Incidence of Endemic Human Cutaneous Leishmaniasis in the United States

Leishmaniasis is recognized as an endemic human disease in Africa, the Middle East, Asia, and South America. Yet despite case reports of endemic human leishmaniasis in the United States, and well-documented occurrences of disease in various animal vectors and reservoirs, the endemicity of leishmaniasis in North America has not yet been established. Moreover, leishmaniasis is not a federally reportable disease in the United States. Clinical awareness of endemic disease therefore remains low, with North American physicians considering leishmaniasis a tropical disease. To assess the endemicity of human leishmaniasis in the United States. This cross-sectional multicenter observational study reviewed cases of human leishmaniasis occurring in the United States from 2007 through 2017. Previously diagnosed, deidentified cases of leishmaniasis were reported by the institutions of the authors and acknowledged contributors, as well as the Texas Department of State Health Services. Cases of leishmaniasis were identified by searching by disease name (leishmaniasis) or International Classification of Diseases, 9th and 10th Revisions diagnosis codes in the respective laboratory information systems. Via examination of deidentified demographics, cases of leishmaniasis were classified as one of the following: (1) documentation of no history of travel outside of the United States within 10 years; (2) positive history of travel outside of the United States within 10 years; or (3) unknown or no documentation of travel history. Cases of leishmaniasis were considered endemic if identified in patients with documentation of no travel history outside of the United States within 10 years. Of the 69 novel cases of human cutaneous leishmaniasis identified in this study, 41 (59%) were endemic; the median age at diagnosis was 61 years (range, 3-89 years), and 28 (68%) of the endemic cases occurred in female patients. Twenty-two (32%) cases had documentation of Leishmania speciation performed by polymerase chain reaction, and in 100% of these cases the infectious organism was identified as Leishmania mexicana. Human cutaneous leishmaniasis is endemic in the United States, and, at least regionally, is acquired endemically more frequently than it is via travel. Our data argue in favor of making leishmaniasis a federally reportable disease and may have substantial implications on North American public health initiatives, with climate models predicting the number of citizens exposed to leishmaniasis will double by 2080.

Spatial modeling of cutaneous leishmaniasis in Iranian army units during 2014-2017 using a hierarchical Bayesian method and the spatial scan statistic.

OBJECTIVESThis study aimed to map the incidence of cutaneous leishmaniasis (CL) in Iranian army units (IAUs) and to identify possible spatial clusters.METHODSThis ecological study investigated incident cases of CL between 2014 and 2017. CL data were extracted from the CL registry maintained by the deputy of health of AJA University of Medical Sciences. The standardized incidence ratio (SIR) of CL was computed with a Besag, York, and Mollié model. The purely spatial scan statistic was employed to detect the most likely high-and low-rate clusters and to obtain the observed-to-expected (O/E) ratio for each detected cluster. The statistical significance of the clusters was assessed using the log likelihood ratio (LLR) test and Monte Carlo hypothesis testing.RESULTSA total of 1,144 new CL cases occurred in IAUs from 2014 to 2017, with an incidence rate of 260 per 100,000. Isfahan and Khuzestan Provinces were found to have more CL cases than expected in all studied years (SIR>1), while Kermanshah, Kerman, and Fars Provinces were observed to have been high-risk areas in only some years of the study period. The most significant CL cluster was in Kermanshah Province (O/E, 67.88; LLR, 1,200.62; p<0.001), followed by clusters in Isfahan Province (O/E, 6.02; LLR, 513.24; p<0.001) and Khuzestan Province (O/E, 2.35; LLR, 73.71; p<0.001), while low-rate clusters were located in the northeast areas, including Razavi Khorasan, North Khorasan, Semnan, and Golestan Provinces (O/E, 0.03; LLR, 95.11; p<0.001).CONCLUSIONSThis study identified high-risk areas for CL. These findings have public health implications and should be considered when planning control interventions among IAUs.