Taiebeh Karimi1, Iraj Sharifi2, Mohammad Reza Aflatoonian3, Behnaz Aflatoonian4, Mohammad Ali Mohammadi5, Ehsan Salarkia6, Zahra Babaei6, Farzaneh Zarinkar1, Fatemeh Sharifi7, Nima Hatami8, Ahmad Khosravi6, Arsalan Eskandari9, Elyas Solimani10, Mehdi Shafiee10, Masoumeh Mozaffari10, Amireh Heshmatkhah11, Rezvan Amiri12, Saeideh Farajzadeh12, Alireza Kyhani6, Abbas Aghaei Afshar6, Abdollah Jafarzadeh6, Mehdi Bamorovat6. 1. Department of Medical Parasitology and Mycology, Kerman University of Medical Sciences, Kerman, Iran. 2. Leishmaniasis Research Center, Kerman University of Medical Sciences, Kerman, Iran. Iraj.sharifi@yahoo.com. 3. Research Center for Tropical and Infectious Diseases, Kerman University of Medical Sciences, Kerman, Iran. mraflatoonian@gmail.com. 4. Research Center for Tropical and Infectious Diseases, Kerman University of Medical Sciences, Kerman, Iran. 5. Research Center for Hydatid Disease in Iran, Kerman University of Medical Sciences, Kerman, Iran. 6. Leishmaniasis Research Center, Kerman University of Medical Sciences, Kerman, Iran. 7. Pharmaceutics Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran. 8. Department of Endodontic, Faculty of Dentistry, Kerman University of Medical Sciences, Kerman, Iran. 9. County Health System Services, Kerman University of Medical Sciences, Kerman, Iran. 10. Provincial Health System Services, Kerman University of Medical Sciences, Kerman, Iran. 11. Shahid Dadbin Clinic, Kerman University of Medical Sciences, Kerman, Iran. 12. Department of Dermatology, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran.
Abstract
BACKGROUND: Epidemics of cutaneous leishmaniasis (CL) are occurring more frequently and spreading faster and farther than before in many areas of the world. The present study aimed to assess a long-lasting emerging epidemic (2005-2019) of 5532 cases with anthroponotic CL (ACL) in peri-urban areas of Kerman city in southeastern Iran. METHODS: This descriptive-analytical study was carried out for 15 years in Kerman province, southeastern Iran. The data were passively obtained through the health surveillance system and the Kerman Leishmaniasis Research Center. Every subject was diagnosed using direct smear microscopy. The representative causative agent was further examined by ITS1-PCR, PCR-RFLP, 7SL RNA gene sequencing and phylogenetic analyses. For each subject, a case report form designating demographic and clinical data was recorded. RESULTS: A different pattern of ACL incidence was found in peri-urban areas compared to that in the city of Kerman. The incidence rate of ACL cases has significantly increased (P < 0.001) from 2005 to 2016 in new settlements with a gradual decline after that. The overall average risk of contracting the disease was 7.6 times higher in peri-urban areas compared to Kerman city, an old endemic focus. All isolates consisting of six variants were confirmed to be Leishmania tropica. The overall pattern of the ACL infection indicates that the etiological agent of ACL is propagated and transmitted by the bite of female Phlebotomus sergenti sandflies from person to person from dissimilar clones as reflected by the complexity of the migrants' backgrounds in the province. CONCLUSIONS: The movement of populations and establishment of new settlements in peri-urban areas close to endemic areas are major risk factors for and are directly linked to CL. The underlying factors of this emerging ACL epidemic caused by L. tropica were disasters and droughts, among others. A robust commitment to a multilateral approach is crucial to make improvements in this area. This will require decisive coordinated actions through all governmental factions and non-governmental organizations. Furthermore, active and passive case detection strategies, early diagnosis, and effective treatment could help control the disease.
BACKGROUND: Epidemics of cutaneous leishmaniasis (CL) are occurring more frequently and spreading faster and farther than before in many areas of the world. The present study aimed to assess a long-lasting emerging epidemic (2005-2019) of 5532 cases with anthroponotic CL (ACL) in peri-urban areas of Kerman city in southeastern Iran. METHODS: This descriptive-analytical study was carried out for 15 years in Kerman province, southeastern Iran. The data were passively obtained through the health surveillance system and the Kerman Leishmaniasis Research Center. Every subject was diagnosed using direct smear microscopy. The representative causative agent was further examined by ITS1-PCR, PCR-RFLP, 7SL RNA gene sequencing and phylogenetic analyses. For each subject, a case report form designating demographic and clinical data was recorded. RESULTS: A different pattern of ACL incidence was found in peri-urban areas compared to that in the city of Kerman. The incidence rate of ACL cases has significantly increased (P < 0.001) from 2005 to 2016 in new settlements with a gradual decline after that. The overall average risk of contracting the disease was 7.6 times higher in peri-urban areas compared to Kerman city, an old endemic focus. All isolates consisting of six variants were confirmed to be Leishmania tropica. The overall pattern of the ACL infection indicates that the etiological agent of ACL is propagated and transmitted by the bite of female Phlebotomus sergentisandflies from person to person from dissimilar clones as reflected by the complexity of the migrants' backgrounds in the province. CONCLUSIONS: The movement of populations and establishment of new settlements in peri-urban areas close to endemic areas are major risk factors for and are directly linked to CL. The underlying factors of this emerging ACL epidemic caused by L. tropica were disasters and droughts, among others. A robust commitment to a multilateral approach is crucial to make improvements in this area. This will require decisive coordinated actions through all governmental factions and non-governmental organizations. Furthermore, active and passive case detection strategies, early diagnosis, and effective treatment could help control the disease.
Entities:
Keywords:
Cutaneous leishmaniasis epidemic; Iran; PCR-RFLP; Phylogenetic analysis; Population movement
Authors: Freddie Bailey; Karina Mondragon-Shem; Peter Hotez; José Antonio Ruiz-Postigo; Waleed Al-Salem; Álvaro Acosta-Serrano; David H Molyneux Journal: PLoS Negl Trop Dis Date: 2017-08-10
Authors: Freddie Bailey; Karina Mondragon-Shem; Lee Rafuse Haines; Amina Olabi; Ahmed Alorfi; José Antonio Ruiz-Postigo; Jorge Alvar; Peter Hotez; Emily R Adams; Iván D Vélez; Waleed Al-Salem; Julian Eaton; Álvaro Acosta-Serrano; David H Molyneux Journal: PLoS Negl Trop Dis Date: 2019-02-25