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Situation Analysis of Cutaneous Leishmaniasis in An APJTM382_proof ■ 31 December 2016 ■ 1/6 Asian Pacific Journal of Tropical Medicine 2017; ▪(▪): 1–6 1 56 HOSTED BY Contents lists available at ScienceDirect 57 58 Asian Pacific Journal of Tropical Medicine 59 60 journal homepage: http://ees.elsevier.com/apjtm 61 62 1 63 2 Original research http://dx.doi.org/10.1016/j.apjtm.2016.12.001 64 3 65 4 Situation analysis of cutaneous leishmaniasis in an endemic area, south of Iran 66 5 67 1 2 3 4 2✉ 6 Q3 Mansour Nazari , Saman Nazari , Ahmad Ali Hanafi-Bojd , Ali Najafi , Sasan Nazari 68 7 1Department of Medical Entomology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran 69 8 70 2Students Research Center, Hamadan University of Medical Sciences, Hamadan, Iran 9 71 3 10 Department of Medical Entomology and Vector Control, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran 72 11 4Medical Entomology, Health Center of Kazerun City, Iran 73 12 74 13 ARTICLE INFO ABSTRACT 75 14 76 15 Article history: Objective: To update current situation of the cutaneous leishmaniasis (CL) in Kazerun 77 16 Received 10 Aug 2016 County, southwest of Iran and to analyse the epidemiological aspects of the disease 78 17 Received in revised form 26 Nov during 2005–2015. 79 18 2016 Methods: Data on CL were obtained from the Health Center of Kazerun County, and 80 19 Available online xxx then were analysed and mapped using SPSS and Arc GIS 10.3. 81 20 Results: A total of 700 cases of CL were recorded during the study period with an 82 21 overall decreasing trend from 2005 to 2015. More than 60% of the patients were in- Keywords: 83 22 habitants of rural areas and males were infected more than females. Although there was 84 Cutaneous leishmaniasis fi 23 not a signi cant difference between gender, job categories, residence and CL infection 85 Epidemiological study > fi < 24 (P 0.05), age groups were signi cantly different (P 0.05). But there was no sig- 86 Southern Iran fi 25 ni cant correlation between monthly cases of the disease with average temperature 87 > 26 (P 0.05). Most of the acute lesions were found to be present on the hand, leg and face, 88 respectively. The average CL incidence in the study area was calculated as 24.9/100000 27 89 population. A hot spot for the disease was found in southern part of the area (P < 0.05). 28 90 Conclusions: This study revealed that CL is present in Kazerun country. Thus, effective 29 91 monitoring and sustained surveillance system is crucial in counteracting the disease, and 30 92 if possible, to eliminate it. 31 93 32 94 33 1. Introduction the 22 countries of EMR region [2]. These countries include 95 34 Afghanistan, Egypt, Iran, Iraq, Jordan, Libyan Arab 96 35 Jamahiriya, Morocco, Pakistan, Saudi Arabia, Somalia, Sudan, 97 36 Leishmaniasis is an arthropod-borne disease caused by over Leishmania Syrian Arab Republic, Tunisia and Yemen. Many of the 98 37 20 protozoan species belonging to the genus . The above-mentioned countries have experiences in the potential 99 38 Eastern Mediterranean region (EMR) of the World Health Or- occurrence of the disease nearly an interval of ten years. Reports 100 39 ganization (WHO) faces a major public health problem with [1] from WHO in 2008 confirmed that over 100000 new cases have 101 40 regards to Leishmaniasis . Four forms of the disease occur; occurred in 12 countries in the EMR [2,3]. 102 41 Zoonotic Cutaneous Leishmaniasis (ZCL), Anthroponotic Epidemiologically, CL is presently endemic in 98 countries 103 42 Cutaneous Leishmaniasis (ACL), Zoonotic Visceral worldwide, including Iran [4]. It is estimated that between 104 43 Leishmaniasis (ZVL) and Anthroponotic Visceral 500000 and 1000000 new cases are reported annually in the 105 44 Leishmaniasis (AVL). Three forms of the diseases (ZCL, ACL world, however, due to under-reporting, only a smaller per- 106 45 and ZVL) either independently or concurrently exist in 14 of centage (19%–37%) is verily reported to health systems. Among 107 46 the reasons pertaining to CL under-reporting, the following three 108 47 First author: Mansour Nazari, Department of Medical Entomology, School of reasons are highlighted to play a key role. First, the refusal of 109 48 Medicine, Hamadan University of Medical Sciences, Hamadan, Iran. 110 E-mail: [email protected] patients to receive medical attention when the disease, presumed 49 ✉ Corresponding author: Sasan Nazari, Medical Student, Students Research to cure by itself. Second, socioeconomic restraints hamper pa- 111 50 Center, Hamadan University of Medical Sciences, Hamadan, Iran. tients from medical care. Third, leishmaniasis is not incorporated 112 51 Tel: +98 9183166540 in national policies as a serious public health problem [2]. 113 52 Fax: +98 8138380208 E-mail: [email protected] Both urban and rural settings can experience outbreak of CL. 114 53 Peer review under responsibility of Hainan Medical University. Potentially severe, disfiguring and debilitating, CL infections 115 54 Foundation Project: Supported by Hamadan University of Medical Sciences 116 (Project No. 941226132). exhibit lesions on infected individuals, especially on exposed 55 117 1995-7645/Copyright © 2016 Hainan Medical University. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/). Please cite this article in press as: Nazari M, et al., Situation analysis of cutaneous leishmaniasis in an endemic area, south of Iran, Asian Pacific Journal of Tropical Medicine (2017), http://dx.doi.org/10.1016/ j.apjtm.2016.12.001 APJTM382_proof ■ 31 December 2016 ■ 2/6 2 Mansour Nazari et al./Asian Pacific Journal of Tropical Medicine 2017; ▪(▪): 1–6 1 parts of the body including the face, neck, arms and legs. Province tend to be more prevalent in areas with higher 63 2 Poverty has been partly linked to CL, as sufficient financial temperature, lower relative humidity, lower total rainfall, 64 3 breakthrough is needed for treatment and case management [5]. higher evaporation and lower number of rainy days [14]. 65 4 In EMR countries, the causative agent of ZCL is the Leish- Another contributing factor in ZCL prevalence is age 66 5 mania major (L. major), and this is mainly transmitted by the dependency. A study conducted in Qom province portrayed 67 6 bite of a female sand fly Phlebotomus papatasi (P. papatasi) [6]. the most highly infected age group was 5–9 years old for 68 7 Several factors contribute to the transmission of this disease, and ulcers with a rate of 6.56% [15]. Another study has recognized 69 8 these include, but not limited to, population movements seasonal variations in ZCL incidence where the active season 70 9 (migration and the introduction of non-immunized individuals of P. papatasi extended from late April to early October in 71 10 into areas of previous transmission), socioeconomic factors indoor areas [16]. This species is dominant in plain areas and 72 11 (poverty, poor housing and reduced sanitation) and environ- lowlands [17–19]. A study conducted in Yazd Province, Central 73 12 mental risk factors (high density of rodents, deforestation in Iran, confirmed the rate of ulcers and scars among the 74 13 some cases, and rodents) [7]. The cutaneous form of the disease inhabitants to be 24.6% and 30.4%, respectively. In that 75 14 (CL) also occurs in Iran, and closely associated with human survey, endemic foci of CL has been detected in Yazd 76 15 environments. In the zoonotic forms of Leishmaniasis, Province and the most highly infected age group was 10–14 77 16 vertebrate animals, with the exception of man, serve as with a rate of 28.4% [20]. An epidemiological study in 78 17 reservoir hosts in which man is portrayed as the final host [5,8]. Ardestan town in central Iran has indicated the most highly 79 18 Contrary to the distribution of L. major, which necessarily infected age group was 10–14 with a rate of 2.74% [21]. 80 19 depends on the presence of appropriate reservoir host, P. papatasi A modelling of CL distribution in Iran showed that over 60% 81 20 is widely distributed in semi-arid regions and feeds on both probability of presence was considered as areas with high po- 82 21 mammals and birds. In north-eastern and central areas of Iran, the tential of CL transmission. These areas include arid and semiarid 83 22 great gerbil, Rhombomys opimus exhibits a host interaction with climates, mainly located in central part of the country [22]. 84 23 L. major, mostly active in semi-arid condition, and breeds mainly Fars Province has the highest incidence of CL after Ilam in Iran 85 24 in spring, exposing them sand fly infection much earlier. Leish- and there are different foci of both ZCL and ACL in this province 86 25 maniasis is transmitted almost always by the bite of an infected [10]. A nested-PCR epidemiological survey conducted in rural 87 26 sand fly, however other reports have revealed that the disease can regions of Marvdasht, has confirmed the isolation of L. major as 88 27 also be transmitted through skin contact especially in CL [9]. the agent and P. papatasi as the vector for leishmaniasis [23] 89 28 The annual incidence of CL in Iran is averaged at 32 in Another study in Karameh district is in agreement with the fact 90 29 100000 populations. It was reported in 2012 that the highest P. papatasi is a vector responsible for the transmission of 91 30 incidence was dominant in age groups of 1–4 and 5–9 years, leishmaniasis [24].
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