Downloaded from http://journals.tums.ac.ir/ on Tuesday, April 10, 2012

Tehran UivstyofMed Orignal Aticle

Keywords Province; hwr Conclusin: of 750bpand6bpfrgmets,croning thoseof jan showed Shar-e- Babk(l1cs)wrdtec Of 203identpas,lcBm(7 case),Krmn(32),Jioftl6d comn speciedtfed (2.7%),Sirjan16h-ebk5ndos30 Results: was perfomdtliyvbncg 208 and2010.Overl,3skincpngmwtfrohNd–PCR Methods: cies nndmdtrofKaPrv,uh-Ian of thewrldincugIa.Tpmyobjecvs Background: ABSTRAC F Sharifi Spatil DsrbuonndMecuIdeifictif 3 * Resarch CntofTopilndIectiouD,KemUveityMdalS Sciens Publato Corespnding auth:Tl: http:/ tums.acir 5 Distrc HealthCn,BmSyKeanUvsiofMdalceI 1 Bamwastheoinfecdrc(71.%),lbyK4),J5 2 Leishman RrcCt,KanUveyofMdlSceKeI Dept. ofParasitolgy,AhvzJundispuUnrsfMdcalSceazI 1 Thistudywacondebrndomplgss-econv , : Cutaneoslihm, 4 Provincal HealthCtr,KemUsityofMdSIan * L. tropica

I Sharifi L. tropica Cutaneoslihmcitjrpblioby

L. major i 1 cal or , MZarean Zahmtkesh isthemanpc(95.6%)caudACLnd emic areasofKn L.major Endemic FoifSuth-aserIr

+98341-226, (194 case,95.6%)while isprentlowv(4.%) Irani JPstol:V.7,N12012p45-52 (Recivd 27Ot011;acep3D) 2 . Charcteizonf , MHakimParzi 4 , Mashyekhi

Leishmania Irani JPsitol Open acsJourlt http:/ ija.tumscr L. tropica E-mail: 45

specie,IdntifcatoN-PCRra iraj.shf@yoocom 4 1 L.major , ARKermanizdeh , whereasinfctdubjBandSr- , MRAflatoonian Leishmania Leishman L. tropica wasfoundinly9cae(4.%) .

Leishmania specirultdngaon and kDNA. 3 L. tropica , MFasihHrndi Irani SocetyfPslgy L. major 5

Speciesfrom Leishman , respectivly. htp:// is.umacr was themo 3

spe- , R

Downloaded from http://journals.tums.ac.ir/ on Tuesday, April 10, 2012 voled infrt mic dstrwithn tify hecausav The mainobjctvfsudywn- (5-7, 9). clinical adepmoghractsti greate snitivyhaoumod reaction (PCR)saelbchnquw withou jsfcan(12).Plymer side–ffct anhhoulobgv antimol cpounds,hvedrb (11). Thecurnteamofhoi,aly ment ofavcirhusbeeg by astrongimun;hpefdvlp- recovey fmintsuallsscd aginst yformleh.Becu At presn,hiovacclb egy ainstlhm(8-10). used antilprofhcont- reason whypecifdticathoulb tures idoncessyandhvl on cliicalgroundadepmogfea- and lowseitvy(5-7).Hr,rce speci lv(4,5)andoftnwhrb but heydoniscrmag procedus fthadvngimly, cultre mthodistionng.Th thods arecinlyofvu,ltgh promastige ,ecvly.Bhe- preations f CL includertsmand The mostradinlfg pandig toewfc(2,3). Province withrasgdx- nias edmcyprtofK (ACL) dueto Leishmana jor in Ira;zotcCL(Z)usedby Both epidmlogcafrsCLn cial probemnyoutsudgI. leishman (CL)publictdo- able moriditynt(1).Cus L Introduci and sub-tropiclewithonr- chaleng i8ountrspca eishman rpublicealt

Sharif etl.:SpDsbutiondMcILhmia L. Leishmania tropica. andthroponticCL Leishmania Cutaneos lihma- amstigoend specin- 46 was ed.Ablin surveywacrrid Leishmania seri. Ft,podnfcati pling ascross-ectondevw This tudywaconduedbrndomm- Dat coletindsmpig humid. ) heweasamndlvy reas inthoudou(Bam perinc adymotl,whe- man, Shr-eBbkBaftndij)x- The nort,wsadclea(Kr- regions dpthlifla. other disc.Tlmavnf case arpotdolwxnfrm e- Babak,BftndSirjn)dspoc in sxdtrc(Bam,KeJofSh- main dstrcex,buCL 1% ofthealreacuny.T 1). Itishelargpovncndud and isloctednhufIr(Fg. This provnceovaf18174km , withpoulf2700. CL endmicstrwhProvof The samplwrtknfoubjci Study area Materils ndhod south –earnI. Leishmania tribuon admlecfon hensiv tudyrmofgogaphcals- To urKnowledg,thisfcmpe- and controlfhismpexd(13). standing ofhermssc resvoi hotandvcfbttundr- ried outnsuvyfoctica, regimns. Mov,thdcabcar- in selctonofopmahrpynd since pecdfrtatiouml ledg ofCLintcaonsvrymp, Kerman Povice,southeaI.now-

specie,thrnau s ofCL specinKrmaProvce,

… 2

Downloaded from http://journals.tums.ac.ir/ on Tuesday, April 10, 2012 struction. many), cordingtheufr’sn- PCR TemplaturifcaonK(Rch,Gr- traced bypoinasKughHP physiolgca lineuti.DNAwx- micro tubesandcenfugdhee Smear scpingwtnfdo1.5-l DNA waspredfomict. DNA extraction (Leishman bod). scope frnceamtigt Giemsa ndobrvunlghtco- slide, fixwthmanolnby phery ofactivlsn,mdg Skin scrapgwetfomhi- Sample rtion Province. regation fhlciltismK Rafsanj ditrcueomvg- sed. Noamplwrbntkf location ndnumberfsws- the infcdvualsgx, Clincal demogrphhtstif of neyearpitsamligwxclud. ling toherdmcaswpod distrc. CLpaenwithoyfvl- patiens rfdohlc Therfo, 203 by theKrmanPoviclHCe. wer lativybsdonhup ples fromndicatiwth Care (PHC)sytm,hpopoinfam- grams eintdoPryHlth the ProvincefKrmandconlpo- Since theCLsarpobldwit months, frMac2009July10. similar nneovpdfxtn graphic teswolldn ond, prsectivedanCLmo- rect smeapaionwlud.Sc- CL patiensrgdcofmbyi- from Mach2008tFebuy9.Al out inarespcvmfwy,

sample wrtknfoh Irani JPstol:V.7,N12012p45-52 47

Jiroft (16case)nd Shar-e-Babk cies nBam(107a), Kerman (32cas), (4.%) Of203identpatis,lle- while in KermaProvce(194cs,95.6%) comn speidtifbyt-PCR 0.2% each(Table1) Ganj(0.3%), KhnouZrnddBsi (1.%), Rodbar-eJnoob0Ghle- (1.6%), Shar-eBbk5Anbd (14.7%), Jiroft54Ba2),Sjan distrc (71.%),folwebyKman 208 and009.Bmwstheoinfcd Overal, mnuCLws2512cfo Results and demogrphicacts cant diferbwsbuon ware nd entrd ioacmpur,sgSPSft- proe mdicatinfhg.Dtw Al theCLpainswrfdocv Oral consetfhubjecwobid. Ethics andly bp and560,resectivly. tropica each roundofPCRandlctpsi. (MHO/Sudan58OD stri)we 64/ Nadim-1strn) positive cntrludng marke t260nwvlgh.Atid bridge UK),usna100-pDNAl agrose lctphi(Uvit,Cm- The PCRproductswviualizdby1.5% Leishmania used foramplicatnvbc TAG) andLiR(CGAACC)wer primes 13Z(ACTGTTAAAA- CG) andithesecop,wrlfc CSB2XF(ATTTTTGTAA (CGAGTACC) and first agewoxnlpmCSB1XR Nestd –PCRwaprfoml:inh Nestd –PCR L. major and

χ L.major kDNA. 2 – tesodrminaygfi- wasfoundioly9cae providefagmnts750 L . tropica L. major wasthemo L. tropica P (MRHO/ <0.5 L.

Downloaded from http://journals.tums.ac.ir/ on Tuesday, April 10, 2012 mean ubroflsionw1.5 (22.2% each)andfilygs1).T cated onhfrwmpls mostly nhead(4.5%),quo- in pateswh (5.2%) ontwrmelcaionsI, (35.5%), legs93andthrmin cated onhf(50%),lwbys due to tion oflesnarhowFg.2CL Distrbution f group ( lower than21-40yeas<0g 41 yearswa8.7%hicgnftl though eraofCLlsionnp> 75 years).Allageoupwinfctd;l- mean gws27.5year±SD81(,5- no sigfcatder(Tbl2).h buted amongflrs,with L. tropica and 6.7% cies ,(5.1%and36% jects inBafdSrhowhpe- tecd as rand Bsioech,we- Jonob (3case),Ghl-njKhnouZa- (1case) Anbrd4ca,Rod-e-

Table1: P L. tropica Spatildistribuionndmolecularentfcao <0.5) and L.tropica, L. major Total Bardsir Zarnd Kahnouj Ghal-e-nj Rodbar-eJonoob Anbard Shar-e-Bbk Sirjan Baft Jiroft Kerman Bam Distrct Sharif etl.:SpDsbutiondMcILhmia L. major Leishmania , lesionwrmayo- L. major , respctivly). wheras infctdub- L.tropica werqualydisti- specibyloa- , lesionwr and3.% Mean nul 2512(100.0) 1787(71.) 369(14.7) 136(5.4) No. (%) 24(1.0) 27(1.) 38(1.5) 41(1.6) 67(2.7) 5(0.2) 5(0.2) 6(0.2) 7(0.3) case L. tro- eastrn Irabydistic 48 tively (Fg.3) to hsef played frgmntof560b,crsoni of a750bpDNAnd9ties(4.%)s- 194 case(95.6%),rultdinthgon toplas mincrefca parsite ecbynd-PCR,ugke- Furthe caizationfsv ( nifcat dermonghwsp pica 194(10.) P pica L. tropica distrcts, KermanProvieouh-eaIra 107(5.2) Fig. 1: 32(16.5) No. (%) <0.1) 1(5.7) 10(5.) 16(8.2) Leishmania 1(0.5) 1(0.5) 1(0.5) 1(0.5) 3(1.6) 4(2.1) 7(3.6) and2.8for ( Specialdistrbuonf ) and Nestd-PCR L. tropica Leishmana jor speci,KrmanPovinceuth- L. major L. major 9(100.0) No. (%) 6(.7) 3(.) and 0() 0() 0() 0() 0() 0() 0() 0() 0() 0() , indcatingasg- L. major

… Leishmania ( ) inedmc , respc-

tro-

Downloaded from http://journals.tums.ac.ir/ on Tuesday, April 10, 2012

is mportanfoe t modaliyncn- (1). Identificatoff ernt speciofCL public healtrobemnIandwd Cutaneos lihmcjr Discuson 6, 7 tive conrl;a3, Fig. 3: Fig. 2: Table 2: L. tropica Agaroselctrphif Molecularidntfcao Molecuaridntifio isolatesobindfrmklionfhp,Krm an Provice,suth-rIr Face(2.%) Leishman jorantpc Hands(44.5%) Total L. major L. tropica sex L. tropica

(positiveconrl750bp);a4, Irani JPstol:V.7,N12012p45-52 Legs (1.%) 107(00.0) 102(95.3) Leishmania No. (%) Femal 5(4.7) ≥ 2 locations Leishmania (2.%) Leishmania

specie,KermanProvicuth-Ibylcaion of lesins speci,KrmanPovinuth-eaIrabyx isolates. Ln1,DNAsizmarkr00bp;2ga- 49

96(100.0) 92(95.8) No. (%) and biolgcachrte stic ofh–para- sic fatoruhlinca l, epidmoogca vious dfferntiatwbonxn- trol saegi(8,124).Mofhpe- 4(.2) Male

L. major Face(50% ) ≥ 2 locations (positiveconrl560b);as, (5.2%) 203(100.0) 194(95.6) No. (%) 9(4.) Total

Legs (9.3%) Hands(35.5%)

Downloaded from http://journals.tums.ac.ir/ on Tuesday, April 10, 2012 siten whHajr l. (19)inMashd, ares ofBatdic(2). Our esltacon- tive agnofZCLpdmchsur viously benrptdhcaa- as compredt presnt, bu evr, inBaftandSrj,bohspc in Bamsevrltud(4,1718).How- tropica Bardsi. ThepdomnacofACLut Jonob, Ghal-enjKnouZrdnd Jiroft,Sha-e BbkAnd,Rode- Kerman PoviclyBa, identif thsudymco L. tropica agnosi (16). specimn, othrwailyleadi- in thelsondrecmau caustive gn.Thcaryofm prime potancsecfdtioh phenomno, PCRtdculbf asi recdvn(lupofm)on ince wherclafomsui- In ACLedmicfowithKraPrv- (5, 67101). nomic dfertia this mehodalobnufrxo- adition thgsevitypecfc, for manyestudilh.I and powerfulmtho,hicsonb anlysi of evn straichzo.TPCR ing PCRandspecfrmo used mthoiDNA-bacnq,s- Among thes,curly precis dntfcaono intrsc fao,hvebdlp nolgica admecurths,bon Atpresnaviyofbchmcal,mmu- parsite (4,5). for deinitvticasthua insufcet adomjrl epidmolgca frs,thbv various clnmfetonddff parsite ecfcitynvlond site fatur.Dolckivecr- haslredybnconfim wasthemocnpi Leishmania L. major Sharif etl.:SpDsbutiondMcILhmia L. tropica isnhgerpopoton speciar Leishmania Leishmania . L. major speci. has pre- speci L. 50 wher 94.2%ofislat inters. authors declhinofli healt cnrsfoikdss.T personnl ofKmaovicdt would iketxprsssncha Medical Sns(projt.88/72)W celor fRsah,KmnUivty This tudywaupporedbVce–Cn- Acknowledgmnts grams. for staegicplnngduono- cies prnt.Thmodalo ties whrmoan ment rgis,pcallyolxi- tol insectifopmahrpyndeat- (4.%) Nestd–PCRcoulbav howevr ACL inendmcarsofKPrvce, pica The findngotsudywa (23). around thecouy(5,7921)globll viously reptdfmBa(18),Ba2 siten whofACLadZpre- sion andthemnubrfcn- major The CLcartisof vious fndgfrmBa(3,4). simlary. Theutconnwpe- groups. CLwaevlntibohx, >41 yearsacompedthwg fernce ispobalydutwx than oergups.Tfucdif- showed aignfctlyrCLon In thisudy,endval>41ear and provinces ofIaemxdwth major Shus, KhuzetanProviceIwe et al.(6)whoindcd90%ofsn while contrayspdbMg L. major wastheminpc(95.6%)ud caseintrmofhlcatie- . Ontheorad,mjityf L. major (9,20). isprentlowv L.tropica Leishmania

… L. tropica L. tropica and L. tro- spe- L. L. ,

Downloaded from http://journals.tums.ac.ir/ on Tuesday, April 10, 2012 Referncs 2. 1. 3. 8. 7. 6. 5. 4.

Iranin JEpidemiol.2008;4(1):53-8 ince anditsprobblcaustiviskfto. manisis inBftdisrcinKeProv- AR. nepidmicofutaouslsh- Sharif I,ZemanFAltoMRkr crobiol InfetDis.2004;27:35–18 and ewprsctiv.ComImmunolMi- Desjux P.Lishmaniis:crrntsiton Sharif I,PoursmaelinAltMR Hyg of Par,Brazil.TnsRScpMed ziliensis M, AmatoVS. AC, QuirogaMMMschettiBoul Floetr-Winr LM,OlivaJNicdm Bach HA,TuonFZmpierR 10.102/jcla0377 Clin LabAnl.2011;5():2-4doi: leishmani ptnugPCR-RFL.J materils puncturedfroous diagnos of Rezai S,MmshiChard.Dirct Hajrn ,VsigheFMohbl Iran. IrniJPasitol207; PCR) inShushcity,KzesanProvine nestd polymerachairion(Nstd- tion ofcutaneuslihmisgtsby Ghasemin M,VazrzadeB. Marghi S,mbfZdeASarlkAA Res. 208;13(5):119-6 with eparsiologcalmehods.Praol of cutaneouslihmnisis:parison PCR assyindigosisdidetfction bali M,AdRZare.Evutionof Shahbazi F,bKzemBMoe- Iranin JMedSci.1997;22(3,4):82- school ildrenBam,outerIr. racterizaion of toonian MR.Ideifcondha- Sharif I,ArdealiMotzanHla- Med IntHealth.2011;6(4):510-3 Bam districfetheahquk,Iran.Top Leishman tropca throponoic uaneslmnisisd MF.Emergnc ofawusn- Khamesipour A,HkiiParzMrandi Ardakni RF,Mizaee . 201;05(3):7-8. identifcatiobyPCRinhs Leishmania Leishmania (Vn)bra- Leishmania inrualcommnitiesf Irani JPstol:V.7,N12012p45-52 specionrty isolatein 2(3): 1-15.

Identifica-

51

13. 12. 11. 10. 9. 18. 17. 16. 15. 14.

201; 36():S58-6. presnt adfu.IJAtimicobAgnts 30(2): 09-18. cies. EurJClinMobiolInftDis2011; detction ofalOldWor G.Universal PCRyforthedini Büscher P,DujardinJCVandAuw Maes I,LaurntTElSfiMbchi Braz JInfectDis.2011; praisl ofcutneousishmI. of adignosticepidmiolorp- Naeim S,FrznhjdZ.Aovvw Diag MicrobiolInfeDis.206;5:75–79 rential digosisf rect spi-fPCRayode- Schönian G,LukesJ.Dvlopmetfdi- Jirku M,ZemanovEAl-vdbhA Rev sitance lhmni.ClinMrobiol Croft SL,undarFairlmbAH.Duge- Modaber F.Lishmnivcn:pt, Odiwuor SO,aadAADeonck Farhmnd M,NeviHShizHA 201; 49(5):7-6. South-eas Irn,194206.IntJDrmaol cidvans monghoolhildreinBa, Nadim A,ModberF.Lishnisise- Khamesipour A,MhboudiFDwltiY 205; ():19-6. clinica peomrhis.InftGEvol antige- polymorphs,xd JC.American tegumarylshis: AL, DeDonckrSLRayujdi Bermudez H,LlanosArevoJBñs manisi. Adv in theramndcoolflish- Iranin JPublHeth.2011; 40(2): 49-56. and post-erhqukyear(199208). in Bam:Acopartivevluionf- pour A,Nadim.Cutneslishmai H, ShirzadMRGooyaMMKhamesi- Hakimi PrzM,FekARSafdh Sharif I,NakeAltooninMR Iran. IraiJPublHeth195;24:- cutaneous lishmiB,t Nadim A,fltooniMR.hropc Sharif I,FekrARlatonM Garci AL,KndtAQuispe-TintyW Alvar J,CoftSOliarP.hempy . 2006;19():-2.

Parasitol Leishmani tropica .

2006;61:23-74. 15(): 7-2. Leishmania spe- . Downloaded from http://journals.tums.ac.ir/ on Tuesday, April 10, 2012

19. 20. 21.

Iranin JPublHeth.204;3():8-15 plifed polymorhicDNA(RAPD-PC). cutaneous lihmis,usigrdom- Leishmania J, HooshmandB.Ietifcion zaei S,KazemBEdrissnGHMojtbvi Hajrn ,MohebliRazviMRRe- Ebrahimi B,Vfe-NzhdRHnafi- MR, Zahrei-RamzniAVAbMR 200; 8(-3):4. public ofIran.EstMedierHlhJ isolated frmProvincsthIiRe- Characteizion of Motazedian H,NomprBAehlS. Yaghobi-Ersdi MR,AkvnAA Sharif etl.:SpDsbutiondMcILhmia specisolatdfromhun Leishman parasite 52 23. 22.

2():126-30. infections). CurOpItDis leishmanis A(focutus Meditr HalthJ.204;10(-5):68 in theIslamicRpublofIrn.Es in anewfocustouslihm Bojd A,JafariR.Epidemiologicalstudy Katkur .Molecarpidmigyf neous lishmaidut hebali M,Hjrn.Emergcofuta- Soleiman H,Zhr-RazniARMo- sib F,JafrRAdoliHrandiM Akhavn AA,Yghoobi-ErsdMRHa- J Arthopd-BneDis jor inanewfocussutherIra.Irni . 207;1():-8.

… Leishmania a- . 2009;