Endemic Areas Of Iran Research Articles

Bovine Brucellosis: First Comprehensive Evaluation from Hamedan, an Endemic Area in Iran

Bovine Brucellosis: First Comprehensive Evaluation from Hamedan, an Endemic Area in Iran

Field Efficacy of Topical Nano-Liposomal Amphotericin B (Sina Ampholeish®) Alone or in Combination with Glucantime® and Cryotherapy on Human Cutaneous Leishmaniasis.

Cutaneous leishmaniasis (CL) is a parasitic disease that presents a broad spectrum of clinical features. Treatment of CL is problematic. We aimed to compare the field therapeutic efficacy of topical nanoliposomes containing 0.4% amphotericin B (Nano Lip-AmB) alone and in combination with cryotherapy and/or Glucantime® on human CL in the endemic areas of Iran. This retrospective study was performed based on the results of using Nano Lip-AmB alone or with Glucantime® and/or cryotherapy in the treatment of zoonotic cutaneous leishmaniasis (ZCL) in patients referred to health centers of Isfahan, Golestan and Ilam Provinces of Iran as endemic foci of ZCL caused by Leishmania major besides Mashhad and Bam cities as endemic foci of anthroponotic cutaneous leishmaniasis (ACL) caused by with L. tropica. Two hundred and seventy-eight patients with CL were included in the current study. All of the patients (100%) who received Nano Lip-AmB alone or in combination with Glucantime® and/or cryotherapy based on guideline of Iranian national committee for the treatment of CL. Two patients with 7 skin lesions, who was resident in ACL endemic area and received Nano Lip-AmB plus Glucantime® and another patient was a resident of ZCL endemic area and received Nano Lip-AmB plus cryotherapy showed clinical relapses after treatment. Sina Ampholeish® in combination with other standard protocols of treatment of CL is well tolerated and with acceptable clinical efficacy rate.

Rickettsia conorii subsp. israelensis infection: a case report from southeast Iran

BackgroundMediterranean spotted fever (MSF) is a zoonotic and vector-borne disease caused by Rickettsia conorii. We report a case (36 year-old-woman) of MSF caused by Rickettsia conorii from Iran.Case presentationIn September 2019, the patient was admitted to the hospital in Kerman province with flu-like symptoms and maculopapular lesions. According to the laboratory results, thrombocytopenia, elevated liver enzymes, and cardiac enzymes were observed. Skin biopsy was examined for Crimean-Congo Hemorrhagic Fever (CCHF) and MSF using the Real-Time-PCR and ELISA method. Finally, the sample was positive for Rickettsia conorii subsp. israelensis and treated with doxycycline and completely recovered.ConclusionsThis study showed that MSF could be present in Iran. Therefore, identifying endemic areas in Iran for this disease should be on the agenda.

Baseline susceptibility of a wild strain of main vectors of leishmaniasis to WHO-recommended insecticides in southeastern Iran

BackgroundIn Iran, both cutaneous leishmaniases (CL) and visceral leishmaniases (VL) are endemic, recording one of the 10 highest CL prevalence in the world. Parasites are transmitted by the bite of infected Phlebotomus sand fly females. Several sand fly species have been identified as vectors in the studied region of Kerman province. Residual spraying to control adult sand flies, is the only way to decrease the spreading of the diseases but, following control treatment against malaria vectors in endemic areas in Iran, resistance or tolerance to insecticides emerged in some sand fly species. The objective of this study was to survey insecticides susceptibility levels of 3 vector species in wild sand fly populations in different foci of the diseases in Kerman province. Ph. sergenti, and Ph. papatasi respectively vectors of anthroponotic and zoonotic cutaneous leishmaniases and for the first time Ph. alexandri one of the anthroponotic visceral leishmaniases vector were tested against: deltamethrin 0.05%, malathion 5%, dichloro-diphenyl-trichloroethane (DDT) 4%.Materials and methodsIn leishmaniases endemic areas species specific sand fly sites were selected in Kerman province, and specimens were collected by manual aspirators at different time intervals during the spring and summer 2019. All the susceptibility tests were performed according to the WHO tube test recommended procedure.ResultsTwenty five blood-fed female sand flies from the region's prevalent species were used in each pooled test replicates. All wild specimens died within 60 min of exposure to DDT 4%, malathion 5%, and deltamethrin 0.05%, but the mortality rate for Ph. papatasi exposed to malathion and DDT was 91.6% and 66.6%, respectively.ConclusionAccording to current study results, Ph. sergenti and Ph. alexandri are highly susceptible to all the evaluated insecticides in the study areas. However, Ph. papatasi was susceptible to deltamethrin (100% mortality), possibly resistant or tolerant to malathion (91.6% mortality), and confirmed to be resistant to DDT (66.6% mortality).Graphical

Developing, Modifying, and Validating a TaqMan Real-Time PCR Technique for Accurate Identification of Leishmania Parasites Causing Most Leishmaniasis in Iran.

Many laboratory methods are used to diagnose leishmaniasis because it is characterized by varied symptoms and caused by different Leishmania species. A quantitative real-time PCR method based on a TaqMan probe was developed and modified for accurate identification of human cutaneous leishmaniasis (caused by Leishmania major or Leishmania tropica) from endemic areas of Iran. Two gene regions of amino acid permease 3 (AAP3) and cytochrome oxidase II (COII) were considered. Six new sets of species-specific primers and probes were designed. A total of 123 samples were examined and employed to evaluate and validate real-time PCR. According to parasitic load of the genesig® Leishmania Advanced Standard Kit, a serial dilution of purified plasmid (2–2×107 copies/reaction) was prepared under the same conditions for both genes. Specific primers and probes were able to detect three and six parasite copies in AAP3 and COII genes, respectively, and were able to detect three copies of parasites for L. major and L. tropica. The sensitivities of the reference kit and our method were 98.7 and 98.1%, respectively, and specificity was 100% for detecting parasite genomes in all assays. Designed primers and probes performed well in terms of efficiency and regression coefficient. For AAP3 and COII genes, respectively, the linear log range was 7 and the correlation coefficient (R2) was 0.749 and 0.996 for the reference kit using the standard generated curve and 0.98 and 0.96 with serial dilutions of parasite DNA. This research detected L. major and L. tropica definitely and opens the horizon for the other scientists in the multiplex reactions in designing and optimization of the conditions in silico and in vivo.

Species diversity and spatial distribution of CL/VL vectors: assessing bioclimatic effect on expression plasticity of genes possessing vaccine properties isolated from wild-collected sand flies in endemic areas of Iran

BackgroundLeishmaniasis is one of the ten most important neglected tropical diseases worldwide. Understanding the distribution of vectors of visceral and cutaneous leishmaniasis (VL/CL) is one of the significant strategic frameworks to control leishmaniasis. In this study, the extent of the bioclimatic variability was investigated to recognize a rigorous cartographic of the spatial distribution of VL/CL vectors as risk-maps using ArcGIS modeling system. Moreover, the effect of bioclimatic diversity on the fold change expression of genes possessing vaccine traits (SP15 and LeIF) was evaluated in each bioclimatic region using real-time PCR analysis.MethodsThe Inverse Distance Weighting interpolation method was used to obtain accurate geography map in closely-related distances. Bioclimatic indices were computed and vectors spatial distribution was analyzed in ArcGIS10.3.1 system. Species biodiversity was calculated based on Shannon diversity index using Rv.3.5.3. Expression fold change of SP15 and LeIF genes was evaluated using cDNA synthesis and RT-qPCR analysis.ResultsFrequency of Phlebotomus papatasi was predominant in plains areas of Mountainous bioclimate covering the CL hot spots. Mediterranean region was recognized as an important bioclimate harboring prevalent patterns of VL vectors. Semi-arid bioclimate was identified as a major contributing factor to up-regulate salivary-SP15 gene expression (P = 0.0050, P < 0.05). Also, Mediterranean bioclimate had considerable effect on up-regulation of Leishmania-LeIF gene in gravid and semi-gravid P. papatasi population (P = 0.0109, P < 0.05).ConclusionsThe diversity and spatial distribution of CL/VL vectors associated with bioclimatic regionalization obtained in our research provide epidemiological risk maps and establish more effectively control measures against leishmaniasis. Oscillations in gene expression indicate that each gene has its own features, which are profoundly affected by bioclimatic characteristics and physiological status of sand flies. Given the efficacy of species-specific antigens for vaccine production, it is essential to consider bioclimatic factors that have a fundamental role in affecting the regulatory regions of environmentally responsive loci for genes used in vaccine design.

FML-ELISA a novel diagnostic method for detection of feline leishmaniasis in two endemic areas of Iran.

Although canids are regarded as major reservoir hosts for Leishmania infantum, feline leishmaniasis are reported sporadically from different endemic foci of Mediterranean visceral leishmaniasis (VL). Despite the risk of parasite transmission between human and other animals, most of the studies are limited to dogs and few studies are focused to investigate Leishmania sp. among other mammals. This project was aimed to detect L. infantum antibodies of cats in two VL endemic regions of Iran by Fucose Mannose Ligand (FML) and soluble L. infantum antigen (SLA) ELISA. Forty nine stray cats of different age and sex, from Fars and Ardabil provinces (two VL endemic loci of Iran) were sampled, then tested for L. infantum by FML and SLA-ELISA. Sixteen percent (8/49) of cat sera were reported positive by FML-ELISA. SLA-ELISA showed 18.3% (9/48) positive cases in cats. Sensitivity of FML-ELISA was calculated 57% and SLA ELISA 25%. Specificity of FML and SLA ELISA were assessed 78% and 68% respectively. Kappa coefficient of agreement between FML and SLA-ELISA was detected on 0.45. As feline leishmaniasis could be a potential risk in endemic areas, FML-ELISA could be considered as an appropriate examination to detect leishmaniasis in cats.

Genetic and Antigenic Evaluation of Foot-and-mouth Disease Virus Type A in the Endemic Area of Iran within 2014-2015.

The foot-and-mouth disease virus (FMDV) with a wide variety of genomes and complicated biology is one of the infectious agents that put the lives of animals at risk. Therefore, to introduce suitable strains for vaccine production, it is essential to constantly evaluate genetic changes of circulating viruses in field. Within 2014-2015, a total of 126 clinical specimens consisting of epithelial tissue and vesicular fluid from tongue, dental pad, and hoofs suspected of FMD virus were submitted to the Reference Laboratory for FMD in Razi Vaccine and Serum Research Institute, and 86 of them were identified as FMD virus type A using sandwich Enzyme-Linked Immunosorbent Assay (ELISA). This virus was isolated from 42 samples from 16 provinces using cell culture. Firstly, the coding region that produces the main part of viral capsid was amplified by Polymerase chain reaction (PCR). This part of the genome by 800 bp length was related to the 1D gene that synthesizes the VP1 protein. The phylogenetic analysis of VP1 coding region determined two distinct genotypes with more than 15% nucleotide differences. The first cluster consisted of closely related viruses registered in the GeneBank of neighboring countries, including Afghanistan, Pakistan, and Turkey. All samples in Cluster1 were determined as relative viruses with genotype Iran-05. In-vitro serological examination indicated an antigenic relationship between Cluster 1 viruses and routine vaccine strain (A-IRN-2013). The second cluster with only two members was genetically far from earlier ones and could be considered a separate genotype. Furthermore, it was revealed that cluster 2 has not been previously reported in Iran. Genetic tracing indicated that these viruses might have been originated from circulating viruses from India. Antigenic evaluation exhibited that this group could not be cross-protected by the routine vaccinal strain (A-IRN-2013) used during the research period.

Designing and Evaluating Educational Intervention to Improve Preventive Behavior Against Cutaneous Leishmaniasis in Endemic Areas in Iran.

ObjectivesHealth education programs are one of the most important strategies for controlling cutaneous leishmaniasis (CL) in endemic areas such as Neshabur city. This study aimed to develop and evaluate a comprehensive health education program to improve preventive behaviors for CL.MethodsThis was an interventional study conducted on 136 high school students in Neishabur city. Data collection instruments included a demographic questionnaire and a researcher-made questionnaire based on the “Health Belief Model” and “Beliefs, Attitudes, Subjective Norms and Enabling Factors Model” constructs. The control and intervention groups completed the questionnaires before and 2 months after the intervention. The intervention was conducted in 6, 1-hour educational sessions for the intervention group students and 2, 1-hour sessions for school administrators, teachers, and students’ parents.ResultsThere was no significant difference between the 2 groups in the pre-intervention phase. However, in the post-intervention phase, there were significant differences between the 2 groups for mean scores of knowledge, perceived susceptibility, perceived severity, perceived benefits, cues to action, self-efficacy, attitude, subjective norms, behavioral intention, enabling factors, and behavior associated with CL.ConclusionHealth education program based on the “Health Belief Model” and the “Beliefs, Attitudes, Subjective Norms and Enabling Factors Model” model constructs may be a comprehensive and effective educational program to improve preventive behaviors against CL in students.

Species composition, seasonal abundance and distribution of potential anopheline vectors in a malaria endemic area of Iran: field assessment for malaria elimination

BackgroundDespite decreases in incidence, malaria remains a major public health challenge in south and southeast Iran, where vector control is considered one of the main strategies for elimination of the disease. The efficacy of this strategy depends on understanding malaria vector ecology, which varies by species. This study was conducted to determine the species composition, seasonal abundance and distribution of potential anopheline vectors in Bashagard County, one of the important malaria-endemic areas in south Iran.MethodsIn this cross-sectional study, four typical foothill and mountainous villages were selected by simple random sampling. Anopheline mosquitoes were collected by the standard dipping method for larvae and total catch for adults. Anopheline specimens were morphologically identified using taxonomic keys. Statistical analyses were performed using SPSS ver.20 software.ResultsIn total, 1211 anopheline specimens, including 1055 (87.12%) larvae and 156 (12.88%) adults, were collected and identified. They consisted of 9 species: Anopheles moghulensis (27.89%), Anopheles dthali (18.91%), Anopheles culicifacies (16.60%), Anopheles stephensi (15.38%), Anopheles turkhudi (9.83%), Anopheles superpictus (9.66%), Anopheles apoci (1.40%), Anopheles fluviatilis (0.17%), and Anopheles sergentii (0.08%). The most prevalent species in adult catches were An. culicifacies (44.23%), An. dthali (21.15%) and An. stephensi (16.03%), and the most prevalent species caught as larvae were An. moghulensis (31.94%), An. dthali (18.85%) and An. stephensi (15.26%). Most of the anopheline species were distributed in different topographical areas and two proven malaria vectors, An. culicifacies and An. superpictus, were significantly associated with altitude and collected more frequently in the foothill regions. Most of the anopheline species were present almost throughout the year with a major peak in April and a smaller peak in October.ConclusionThe results of this study revealed that there are five malaria vectors in Bashagard County and some of them are more abundant in areas with special topographic features and are reproductively active throughout the year. These findings can be applied to successful planning and providing effective control measures in problematic areas during the malaria elimination phase in Iran.

Evaluating the performance of IFAT, RDT, and semi-nested PCR for detection of Leishmania infantum infection on sera samples in symptomatic dogs

Zoonotic visceral leishmaniosis is caused by Leishmania infantum in the Mediterranean region and the Middle East, and dogs are the main reservoirs of the disease. The aim of this study was to estimate the diagnostic results of indirect immunofluorescent antibody test (IFAT), rapid diagnostic test (RDT), and semi-nested PCR to detect L. infantum infection on sera samples of symptomatic dogs in an endemic area of Iran. In this study, 23 clinically infected dogs and 75 clinically suspected dogs were selected for the study and sera samples were examined using IFAT, RDT, and semi-nested PCR. Among clinically suspected dogs, 72% (54/75), 26% (13/50), and 36% (27/75) of sera samples were positive for L. infantum by IFAT, semi-nested PCR, and RDT, respectively. A poor agreement was observed between IFAT and semi-nested PCR. A slight agreement was observed between IFAT with PCR and RT methods, and the worse agreement was observed between semi-nested PCR and RDT. The sensitivity and specificity of RDT and semi-nested PCR were calculated according the IFAT results on clinically suspected dogs. The RDT and semi-nested PCR showed a low sensitivity (35%, 38%), whereas the specificity was the highest (100%) in RDT and high (71%) in semi-nested PCR. The IFAT was shown the best results for the diagnoses of visceral leishmaniosis in symptomatic dogs. The RDT and semi-nested PCR had low sensitivity but high and moderate specificity were observed by RDT and semi-nested PCR, respectively. Based on the high-specificity results, RDT could be used as simple test for diagnoses of visceral leishmaniosis in symptomatic dogs.

Molecular identification and phylogenetic analysis of human Trichostrongylus species from an endemic area of Iran

Human infections with Trichostrongylus species have been reported in most parts of Iran. The aim of this study was the identification, molecular characterization and phylogenetic analysis of human Trichostrongylus species based on ITS2 region of ribosomal DNA from Guilan Province, northern Iran. Stool samples were collected from rural inhabitants and examined by formalin-ether concentration and agar plate culture techniques. After anthelmintic treatment, male adult worms were collected from five infected cases. Genomic DNA was extracted from one male worm of each species in every treated individual and one filariform larva isolated from each case. PCR amplification of ITS2-rDNA region was performed and the products were sequenced. Among 1508 individuals, 46 (3.05%) were found infected with Trichostrongylus species using parasitological methods. Male worms of T. colubriformis, T. vitrinus and T. longispicularis were expelled from five patients after treatment. Out of 41 filariform larvae, 40 were T. colubriformis, and the other one was T. axei. Phylogenetic analysis showed that each species was placed together with reference sequences submitted to GenBank database. Intra-species similarity for all species obtained in the current study was 100%. T. colubriformis was found to be probably the most common species in this region of Iran. For the first time, the authors of the present study report the occurrence of natural human infection by T. longispicularis in the world. Therefore, the number of Trichostrongylus species infecting human in Iran now increased to ten.

Environmental risk factors for the incidence of cutaneous leishmaniasis in an endemic area of Iran: A GIS-based approach

ObjectivesThis study was designed to determine the environmental factors associated with cutaneous leishmaniasis (CL) in Isfahan Province, using spatial analysis. MethodsData of monthly CL incidence from 2010 to 2013, climate and environmental factors including: temperature, humidity, rainfall, wind speed, normalized difference vegetation index (NDVI), altitude and population density across the Isfahan's cities was used to perform spatial analysis by ordinary least square (OLS) regression and geographically weighted regression (GWR). ResultsOLS revealed a significant correlation between CL incidence and five predictors including temperature, population density, wind speed, humidity and NDVI; which explained 28.6% of variation in CL incidence in the province. Considering AICc and adjusted R2, GWR provided a better fit to the data compared with OLS. ConclusionThere was a positive correlation between temperature and population density with CL incidence in both local (city) and global (province) level.

Predicting Malaria Transmission Risk in Endemic Areas of Iran: A Multilevel Modeling Using Climate and Socioeconomic Indicators

Background: Over the past years, the malaria elimination program has considerably decreased the malaria indigenous cases and confined their incidence to the southeastern areas of Iran encompassing 28 less developed counties with favorable transmission conditions. Objectives: The aim of the study was to investigate the effects of climatic and socioeconomic indicators on malaria transmission and to predict malaria transmission risk until 2025 for all the southeastern endemic counties in Iran. Methods: The aggregated data from indigenous malaria cases, as well as, climatic and socioeconomic indicators of malaria endemic areas were collected on the monthly basis from each county between 2005 and 2015. The collected variables were, then, estimated until 2025 using time series analysis. Considering the nature of these data, two different multilevel models were implemented for vivax and falciparum based on the socioeconomic variable that was used. Finally, applying two different models, two sets of estimates were obtained for malaria transmission risk in each county. Results: The annual decline of malaria transmission was estimated to be 17% based on model 1, and 25% based on the model 2 for vivax (P < 0.001). These estimates were 13% and 21% for falciparum (P < 0.001), respectively. For every increased unit in the wealth index, malaria transmission for vivax and falciparum decreased by 33% (P = 0.001) and 12% (P = 0.54), respectively. Also, for every increase in the mean years of schooling, the transmission decreased by 65% (P < 0.001) and 57% (P = 0.001) for vivax and falciparum. Conclusions: The results of this study, using climatic variables along with socioeconomic variables, indicated the obvious influence of socioeconomic status improvement on decreasing malaria transmission. According to the results, malaria transmission risk will considerably diminish in the next few years. The pattern of malaria transmission decline was consistent with the declining trend of malaria incidence which will move from the west to the east and from the north to the south in the years to come. The transmission risk for falciparum was considerably lower than that of vivax and the endemic areas of falciparum move towards 0 faster than vivax.

Seroprevalence and geographical distribution of human T-lymphotropic virus type 1 among volunteer blood donors in endemic areas of Iran

BackgroundHuman T-cell lymphotrophic virus type 1 (HTLV-1) has a worldwide distribution and it is endemic in some regions of Iran. One of the most important routes of HTLV-1 transmission is via transfusion of contaminated blood components. The risk of transmission through asymptomatic blood donors, particularly in endemic areas should be considered and appropriately managed. The main objective of this study was to determine the seroprevalence and description the geographic distribution of HTLV-1 among voluntary blood donors in Iran.MethodsThis retrospective study carried out using the data obtained from the main database of the seven blood transfusion centers of Iranian Blood Transfusion Organization between 2009 and 2013. The presence of anti-HTLV-1/2 antibodies were primarily assessed using Enzyme-linked Immunosorbent Assay. The Ab Kit assay, contain antigens for the screening of antibodies to HTLV type 1 and 2. So, it is expressed as HTLV 1/2 assay. Samples that were positive by the western blot confirmatory test were considered as definite positive HTLV-1 or HTLV-2 cases. The main socio-demographic variables were; age, gender, donation history and marital status. Descriptive and analytical statistics were used to summarize the gathered data. The chi-Square Statistical test was used to test the association between groups, P-value of less than 0.05 was considered significant.ResultsA total of 1864489 blood donations were evaluated. There were 1840 confirmed HTLV-1 positive donations (0.098%). None were positive for anti-HTLV-2. The overall HTLV-1 prevalence was 98.7 per 100,000 donations during the 5 year period. Seroprevalence was higher among females, married and older blood donors. The overall seropositivity among first time, regular and lapsed donors was, 0.29% (290/100000), 0.001% (1/100000) and 0.02% (20/100000) respectively. A significant difference was observed between regular and the first time (p <0.0001) and also between lapsed and regular blood donors (p <0.0001). Most of the HTLV-1 seropositive blood donors (175 per 100,000) were from northeastern regions. We observed a gradual decline in overall HTLV-1 prevalence during the course of the study, the prevalence rate decreased from 0.13% (130/100000) in 2009 to 0.07% (70/100000) in 2013.ConclusionsThe Seroprevalence of HTLV-1 among Iranian blood donors in the regions of our study still is considerable, but there is an obvious declining prevalence over the course of present study. Blood transfusion centers should continually evaluate the residual risk of infection in the country, especially in endemic areas.

Fasciola gigantica of Ruminants: The phylogenetic analysis based on COX1 sequences

BACKGROUND: Fasciola species are parasitic trematode with world wide distribution that infects wild and domesticated herbivores, particularly ruminants. The aim of the present study was to investigate the intra species variations of F. gigantica, from goats and buffalos isolates in two common geographic climates of Iran. METHODS: Fasciola species were collected from goat, buffalo, sheep, and cattle in different regions. Cytochrome c oxidase I (COX1) of mitochondrial DNA (mt-DNA) was amplified from individual trematodes by polymerase chain reaction (PCR), using universal primers, and the amplicons were consequently sequenced and sequencing data were analyzed, using Clutal W software against the GenBank database. RESULTS: A monomorphic DNA segment of approximately 499bp was seen in Fasciola isolates. The results of the amino acid sequence alignment defined strictly conserved amino acid residues in buffalo isolates of F. gigantica and partially conserved residues for goat isolates of F. gigantica. There are four tandem amino-acid replacements in the goat isolates at the position of 135-138, where Leucine (L), F (Phenylalanine), T (Threonine), and D (Aspartate) sequences changed into S (Serine), L (Leucine), H (Histidine), and L (Leucine), respectively. Furthermore, a replacement in the sequence of amino acid was found in isolates from buffalo at the position of 154, where Serine (S) was transformed into Leucine (L). CONCLOUSION: The findings our study indicate that the variants of goat and buffalo can be responsible for persistence of Fasciola infection in the endemic areas of Iran. It seems that biological differences could be occurred by considering a variety of F. gigantica-hosts in Iran. Thus, suitable approaches are required for effective treatments and useful control strategies.

Assessment of the impact of the malaria elimination programme on the burden of disease morbidity in endemic areas of Iran.

BackgroundControlling and preventive measures considerably reduced malaria incidence in Iran over the past few years, which confined the endemic areas to some regions in the southeastern Iran. The National Malaria Elimination Programme commenced in 2010. With regard to the presumption that the elimination programme interventions have accelerated the declining trend of malaria incidence across the endemic areas of Iran, the present study attempted to assess the effectiveness of the elimination programme by reviewing malaria incidence status, over a 14-year period, and comparing the trend of malaria incidence across malaria-endemic areas between the control and pre-elimination phase, and the elimination phase.MethodsA retrospective analysis of malaria surveillance data was conducted in a 14-year period (2001–2014), using multilevel Poisson regression. The epidemiological malaria maps and indicators also were developed and compared between the control and pre-elimination phase, and the elimination phase.ResultsThe mean of malaria incidence was 2.2 (1.7–2.7) for the entire study period. This rate was 3.4 (2.6–4.1) in the control and pre-elimination phase, and 0.41 (0.25–0.57) for the elimination phase. During the malaria elimination phase, the decline of annual malaria incidence had significantly accelerated and autochthonous cases had the greatest difference in malaria incidence decline (compared to the control and pre-elimination phase), whereas, falciparum cases had the lowest difference in malaria incidence decline, followed by non-Iranian and imported cases. Furthermore, there was a decline in Iranians to non-Iranians ratio and an increase in the ratios of over 15 to under 15, as well as male to female, in the elimination phase in comparison to the control and pre-elimination phase.ConclusionsIt seems that the decline of malaria transmission, which has been initiated over the past few years, has accelerated as a result of the elimination programme, and Iran is approaching the goals set regarding the elimination of this disease.

Soluble recombinant merozoite surface antigen-142 kDa of Plasmodium vivax: An improved diagnostic antigen for vivax malaria

Enzyme Linked Immunosorbent Assay (ELISA), as a serological test, can be a beneficial tool for epidemiological studies by screening blood donors and diagnosis of specific antibodies from Plasmodium vivax (P. vivax) infected cases. Since P. vivax cannot easily be acquired in vitro, ELISA assays using total or semi-purified antigens are seldom used. On the basis of this restriction, we examined whether recombinant protein 42kDa related to C-terminal region of the merozoite surface antigen-1 of P. vivax (MSA-142) could be suitable for serological detection of vivax malaria infection. Purified recombinant protein produced in Escherichia coli (E. coli) (GST-MSA-142) was examined for its ability to bind to IgG antibodies of individuals with patent P. vivax infection. The method was tested with 262 serum samples collected from individuals living in the south and southeastern regions of Iran where malaria is endemic. Samples exposed to Plasmodium falciparum (P. falciparum) infection and patients with other infectious disease (toxoplasmosis, Leishmania infantum infection, echinococcosis and FUO (fever with unknown origin)) except for P. falciparum were residing in non- malaria endemic areas in Iran. Generally, the sensitivity of ELISA evaluated with sera from naturally infected individuals was 86.9%. The specificity value of the ELISA determined with sera from healthy individuals and from individuals with other infectious diseases was 94.05%. The positive predictive value (PPV), negative predictive value (NPV) provided, and the diagnostic efficiency of anti-rPvMSA-142 antibody using indirect ELISA were determined 93.58, 87.77 and 91.06% respectively. Our study demonstrated that, because MSA-142kDa contains both the 33 and 19kDa fragments in its structure, it can serve as the basis for the development of a sensitive serological test which can be used for epidemiological studies, screening blood donors and diagnosis of P. vivax malaria.

Community knowledge and practices regarding malaria and long-lasting insecticidal nets during malaria elimination programme in an endemic area in Iran.

BackgroundSince malaria is one of the foremost public health problems in Iran, a malaria elimination phase has been initiated and application of long-lasting insecticidal nets (LLINs) is an important strategy for control. Success and effectiveness of this community based strategy largely dependent on proper use of LLINs. In this context, to determine the community’s knowledge and practices about malaria and LLINs, a study was conducted in Rudan County, one of the important malaria endemic areas in southeast of Iran.MethodsIn this cross-sectional study, 400 households in four villages were selected by cluster randomly sampling method. Community knowledge and practices about malaria and LLINs including symptoms and transmission of malaria and washing, drying and using of bed nets were investigated using pre-tested structured questionnaires. The data were analysed using SPSS.16 software.ResultsIn this study nearly 89% of the respondents knew at least one symptom of malaria and 86.8% considered malaria as an important disease. The majority of respondents (77.8%) believed that malaria transmits through mosquito bite and 72.5% mentioned stagnated water as a potential mosquito breeding place. About 46% of respondents mentioned the community health worker as the main source of their information about malaria. Approximately 44.8% of studied population washed the LLINs once in six months and 92% of them mentioned that they dry the bed nets in direct sunlight. While 94% of households reported they received one or more LLINs by government and 60.8% of respondents mentioned that LLINs were the main protective measure against malaria, only 18.5% of households slept under bed nets the night before the survey, this use rate is lower than the targeted coverage (80%) which is recommended by World Health Organization.ConclusionAlthough, majority of studied population were aware of the symptoms and cause of malaria, a majority had misconceptions about LLINs. Therefore, appropriate educational intervention by trained health workers should be developed for a behaviour change and motivating people to use LLINs which would improve malaria elimination programme.Electronic supplementary materialThe online version of this article (doi:10.1186/1475-2875-13-511) contains supplementary material, which is available to authorized users.

In vitro efficacy of ethanolic extract of Artemisia absinthium (Asteraceae) against Leishmania major L. using cell sensitivity and flow cytometry assays.

Leishmaniasis is one of the most neglected human diseases with an estimated global burden ranking second in mortality and fourth in morbidity among the tropical infections. Chemotherapy involving the use of drugs like glucantime is the mainstay treatment in endemic areas of Iran. Drug resistance is increasingly prevalent, so search for alternative therapy is gathering pace. Medicinal herbs, like wormwood Artemisia, have chemical compounds effective against a number of pathogens. In this study, the efficacy of ethanol extract from Artemisia absinthium (Asteraceae) against Leishmania major L. was investigated in vitro. The outcome of different effective doses (1-40mg/ml) of ethanol extracts from this medicinal herb, A. absinthium, on a standard Iranian parasite strain of L. major was examined. The L. major promastigote cell sensitivity and mortality or viability effects due to the addition of herbal extract were measured using the MTT assay and the flow cytometry technique, respectively. There was complete agreement between the two assays. The lethal concentration (LC50) was measured as 101mg/ml. Some contrasting relationships between the medicinal herb concentrations and the viability of parasites were observed; so that there was an increased multiplication of the parasite at low concentrations of the drug, but an anti-parasitic apoptotic effect was seen at high concentrations of A. absinthium. It was concluded that there might be one or more chemical constituents within the herbal extract of wormwood which at high concentration controlled cell division and affected the relevant activity within the only one giant mitochondrion in this flagellate parasite. At low doses, however, it showed the opposite effect of leading to mitotic cell divisions.