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Original Article Seroprevalence of Visceral Leishmaniasis in Children

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Original Article Seroprevalence of Visceral Leishmaniasis in Children Medical Journal of Tabriz University of Medical Sciences Original Article Seroprevalence of visceral leishmaniasis in children living in rural areas of Ahar and Osku Counties in East Azarbaijan Province, North-west of Iran in 2018 1 1* 1 2 2 Amirhossein Maghsood , Mahdi Parsaei , Afshin Azimi , Mehdi Mohebali , Behnaz Akhoundi , Nazila Sarafraz3 , Mahdi Hasanzadeh4 , Saber Alizadeh4 , Ahad Shahnami4 1Department of Parasitology and Mycology, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran 2Department of Parasitology and Mycology, Faculty of Health, Tehran University of Medical Sciences, Tehran, Iran 3Department of Parasitology and Mycology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran 4Vice Chancellor for Health, Tabriz University of Medical Sciences, Tabriz, Iran *Corresponding author; E-mail: [email protected] Received: 11 May 2019 Accepted: 14 Jul 2019 First Published online: 17 April 2021 Med J Tabriz Uni Med Sciences. 2021;43(1):61-68 Abstract Background: Visceral leishmaniasis (VL) or Kala-azar is an endemic disease in some areas of Iran, including East Azarbaijan, Ardabil, Fars and Bushehr provinces. The disease is sporadic in other parts of the country. According to the reports of numerous cases of the disease from Ahar and Osku counties (cities), East Azarbaijan province and the lack of new study on the prevalence of the disease, this study was designed to determine the seroprevalence of VL in the children of Ahar and Osku counties, in East Azarbaijan Province. Methods: In this descriptive cross-sectional study, blood samples were collected in the test tube without anticoagulants, from children under 8 years from rural areas of Ahar and Osko, in 2018. The samples were evaluated using Direct Agglutination Test (DAT) to measure anti Leishmania infantum antibodies for titer up to 1:3200. Results: Out of 209 children <8 years in selected centers in Ahar and Osku, two cases (0.95%) revealed anti- Leishmania antibodies titer 1:3200. Initially, one of the two positive individuals in the study had a suspicious antibody titer of 1:1600, whose antibody titer increased to 1:3200 after 4 weeks. Conclusion: The Kala-azar, in spite of low endemicity, is one of the health problems in Ahar and Osku in East Azarbaijan Province. This study suggests the necessity of supplementary studies based on molecular approaches in the region and other parts of the province. Keywords: Leishmania infantum, Seroprevalence, Direct agglutination test, Kala-azar, Iran How to cite this article: Maghsood AH, Parsaei M, Azimi A, Mohebali M, Akhoundi B, Sarafraz N, Hasanzadeh M, Alizadeh S, Shahnami A. [Seroprevalence of visceral leishmaniasis in children living in rural areas of Ahar and Osku Counties in East Azerbaijan Province, North-west of Iran in 2018]. Med J Tabriz Uni Med Sciences. 2021;43(1):61-68. Persian. © 2021 The Author. This is an Open Access article published by Tabriz University of Medical Sciences under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 26 / مجله پزشکی دانشگاه علوم پزشکی تبریز دوره 34 شماره 1 فروردین و اردیبهشت 1311 مقاله پژوهشی شیوع سرمی لیشمانیوز احشایی در کودکان ساکن مناطق روستایی شهرستانهای اهر و اسکو استان آذربایجان شرقی در سال 1431 3 4 6 6 1 1 1 امیرحسین مقصود ، مهدی پارسایی* ،افشین عظیمی ، مهدی محبعلی ، بهناز آخوندی ، نازیﻻ سرفراز ، مهدی حسن زاده ، 3 3 صابر علیزاده ، احد شهنامی 1 گروه انگل شناسی و قارچ شناسی، دانشکده پزشکی، دانشگاه علوم پزشکی همدان، همدان، ایران 2 گروه انگل شناسی و قارچ شناسی، دانشکده بهداشت، دانشگاه علوم پزشکی تهران، تهران، ایران 3 گروه انگل شناسی و قارچ شناسی، دانشکده پزشکی، دانشگاه علوم پزشکی زنجان، زنجان، ایران 4 معاونت بهداشت دانشگاه علوم پزشکی تبریز، تبریز، ایران *نویسنده مسؤول؛ ایميل: [email protected] دریافت: 21/2/1331 پذیرش: 23/4/1331 انتشار برخط: 1411/1/21 مجله پزشکی دانشگاه علوم پزشکی تبریز. 1411؛43)1(:11-11 چکیده زمینه: لیشمانیوز احشایی یا کاﻻآزار در برخی مناطق ایران مانند استانهای آذربایجان شرقی، اردبیل، فارس و بوشهر به صورت بومی دیده می شود. این بیماری در سایر مناطق کشور به شکل پراکنده و تکگیر )اسپورادیک( گزارش شده است. با توجه به گزارش مواردی از بیماری کاﻻآزار از شهرستانهای اهر و اسکو استان آذربایجان شرقی در سالهای اخیر و نبود مطالعه جدید در مورد میزان شیوع آن، این بررسی با هدف تعیین وضعیت شیوع سرمی لیشمانیوز احشایی در کودکان شهرستانهای اهر و اسکو استان آذربایجان شرقی انجام شد. روش كار: در این مطالعه توصیفی مقطعی، نمونه خون از کودکان زیر 8 سال مناطق روستایی شهرستانهای اهر و اسکو در سال 7931 در لوله آزمایش بدون ماده ضدانعقاد جمعآوری شد. نمونه ها با روش سرولوژی آگلوتیناسیون مستقیم )DAT( برای اندازه گیری آنتی بادی ضد انگل لیشمانیا اینفانتوم ارزیابی شدند. يافته ها: از 903 نفر کودک زیر 8 سال نمونه گیری شده، میزان شیوع سرمی بیماری لیشمانیوز احشایی در مراکز نمونه گیری شده از شهرستانهای اهر و اسکو با تیتر آنتیبادی 709900، %39/0 تعیین شد. یکی از دو فرد مثبت این مطالعه در ابتدا تیتر آنتی بادی مشکوک 707:00 داشت که 4 هفته بعد نمونهگیری اولیه، تیتر آنتی بادی 709900 شد. نتیجهگیری0 طبق نتایج، بیماری کاﻻآزار با وجود شیوع بومی پایین، یکی از مشکﻻت بهداشتی شهرستانهای اهر و اسکو استان آذربایجانشرقی است. مطالعات تکمیلی بر پایه روشهای مولکولی در منطقه و سایر مراکز استان آذربایجان شرقی ﻻزم است. کلید واژه ها0 لیشمانیا اینفانتوم، شیوع سرمی، آگلوتیناسیون مستقیم، کاﻻآزار، انسان، ایران نحوه استناد به این مقاله: مقصود ا ح، پارسایی م، عظیمی ا ، محبعلی م، آخوندی ب، سرفراز ن، حسن زاده م، علیزاده ص، شهنامی ا. شیوع سرمی لیشمانیوز احشایی در کودکان ساکن مناطق روستایی شهرستان های اهر و اسکو استان آذربایجان شرقی در سال 7931. مجله پزشکی دانشگاه علوم پزشکی تبریز. 7011؛09)7(:16-17 حق تالیف برای مولف محفوظ است. این مقاله با دسترسی آزاد توسط دانشگاه علوم پزشکی تبریز تحت مجوز کرییتو کامنز )http://creativecommons.org/licenses/by/4.0( منتشر گردیده که طبق مفاد آن هرگونه استفاده تنها در صورتی مجاز است که به اثر اصلی به نحو مقتضی استناد و ارجاع داده شده باشد. شیوع سرمی لیشمانیوز احشایی در کودکان ساکن مناطق روستایی شهرستانهای اهر و اسکو استان آذربایجان شرقی در سال 1431 مقصود و همکاران / 24 مقدمه نکات کاربردی لیشمانیوز احشایی )کاﻻآزار( از بیماری های انگلی است که نتایج این مطالعه نشان می دهد، مخازن انگل )سگ و سگ اهمیت بهداشتی فراوانی دارد. در سال های اخیر توجه به لیشمانیوز به سانان( در شهرستان های تحت مطالعه وجود داشته و امکان عنوان یک مشکل بهداشت عمومی افزایش یافته است. اما بروز بیماری آلودگی موارد انسانی در شهرستان های اهر و اسکو و یا در افراد با در مناطق بومی و یا مسافران بازگشته از این مناطق نشان میدهد سابقه مسافرت به این مناطق وجود دارد. مطابق با نتیجه بدست فعالیتهای انجام شده برای کنترل بیماری کافی نیستند. به دلیل تنوع آمده در این مطالعه احتمال اینکه افراد با تیتر 707:00 مبتﻻ به زیاد انواع بالینی بیماری در مناطق مختلف جغرافیایی، مناطق بومی بیماری حاد شوند وجود دارد. لذا نیازمند پیگیری و انجام آزمایش بیماری به روشها و فرآیندهای کنترلی خاص خود نیاز دارد )7،9(. مجدد با تست DAT می باشند. لیشمانیوز از بیماریهای بومی ایران و بیش از 80 کشور جهان است)9(. کاﻻآزار ایران از نوع مدیترانهای، عامل آن انگل لیشمانیا جمعیت کل افراد زیر 8 سال براساس آمار خانه بهداشت مراکز اینفانتوم، ناقل آن گونههایی از پشه خاکی از جنس فلبوتوموس و مخزن مطالعه شده، 7947 نفر است. حجم نمونه با فرمول کوکران با میزان انگل، سگ و سگسانان وحشی است )9،4(. این بیماری در ایران در خطا 09/0% ، 939 نفر محاسبه شد. برخی مناطق استانهای اردبیل ):،9(، آذربایجان شرقی ):(، فارس )p=q= )1 0/9 و بوشهر )8( به شکل بومی و در سایر مناطق بهصورت =d تکگیر)اسپورادیک( گزارش شده است )9(. در استان اردبیل 0/09 حجم جامعه آماری =N شهرستانهای مشگینشهر و گرمی بیشترین موارد ابتﻻ به لیشمانیوز =z احشایی را دارند و بیماری بیشتر در کودکان 9 ساله و کمتر از آن دیده :7/3 میشود )3(. لیشمانیوز احشایی با آسپیراسیون نمونه مغز استخوان، روشهای سرولوژیک مختلف مانند ELISA ،DAT ،IFA، ﻻتکس Dipstick rK39 آگلوتیناسیون، تستهای تشخیصی سریع مانند و نمونهگیری بصورت تصادفی ساده و با مشارکت بهورزان خانههای روشهای مولکولی تشخیص داده میشود )70،77(. به دلیل راحتی و بهداشت مراکز و براساس لیست خانوار خانه بهداشت انجام شد. با آسیب کمتر به بیماران، روشهای سرولوژیک برای تشخیص وجود 939 نفر حجم نمونه تعیین شده، 903 کودک زیر 8 سال لیشمانیوز احشایی بیشتر مورد توجه است. بین روشهای داوطلبانه برای نمونهگیری و تهیه سرم به خانه بهداشت مراکز مراجعه DAT سرولوژیکی، روش )آگلوتیناسیون مستقیم( براساس مطالعات، کردند. تمام نمونههای گرفته شده به روش DAT )آگلوتیناسیون راحتی بیشتر )بدون نیاز به تجهیزات آزمایشگاهی پیچیده در مستقیم( در آزمایشگاه مرجع کشوری لیشمانیا در واحد آزمایشگاههای محیطی( و حساسیت تشخیص بیماری تا 39% دارد و تک یاختهشناسی دانشکده بهداشت دانشگاه علوم پزشکی تهران همراه در اکثر آزمایشگاههای محیطی مناطق بومی بیماری، یک ابزار سرم کنترلهای مثبت و منفی آن مرکز بررسی شدند. پس از کسب تشخیصی برای شناسایی بیماران مبتﻻ به لیشمانیوز احشایی است رضایت آگاهانه کتبی از یکی از والدین کودکان، پرسشنامه از قبل )79(. بیماری در مناطق بومی بیشتر در کودکان 9 ساله و کمتر از آن طراحی شده شامل اطﻻعات دموگرافیک، وجود عﻻیم بالینی مرتبط دیده میشود )79( که عﻻیمی مانند تب، بزرگی طحال، بزرگی کبد و کاهش تمام ردههای سلولهای خونی دارند و در صورت عدم درمان، با کاﻻآزار، نگهداری سگ در منزل و سابقه مسافرت به مناطق بومی موجب مرگ بیمار میشود )74(. محبعلی و همکاران )79( طی سال بیماری مانند اردیبل، فارس و بوشهر برای هر فرد تکمیل شد.
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