IAJPS 2017, 4 (11), 4252-4262 Hamid Kassiri et al ISSN 2349-7750 CODEN [USA]: IAJPBB ISSN: 2349-7750 INDO AMERICAN JOURNAL OF PHARMACEUTICAL SCIENCES http://doi.org/10.5281/zenodo.1056982 Available online at: http://www.iajps.com Research Article THE PREVALENCE OF CUTANEOUS LEISHMANIASIS IN EAST OF AHVAZ COUNTY, SOUTH-WESTERN IRAN Hamid Kassiri 1*, Atefe Ebrahimi 2, Masoud Lotfi 3 1 School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. 2 Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. 3 Abdanan Health Center, Ilam University of Medical Sciences, Ilam, Iran. School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Abstract: Objectives: Cutaneous Leishmaniasis (CL) is a zoonotic parasitological disease. This disease cause always important health challenges for the human communities. It is common in many parts of the globe. This research was designed to determine the epidemiology of CL in East of Ahvaz County during 2003- 2013. Methods: This was a descriptive cross-sectional study. The disease was diagnosed based on clinical examination and microscopic observation of the parasite in the ulcer site. The patient's Information such as age, gender, number and sites of ulcer (s) on the body, month and residence area were recorded. Data analysis was performed using SPSS software. Results: Totally, 2287 cases were detected during 2003 – 2013. About 53.4% patients were male and 46.4% female. The highest frequency infected age groups were observed in 10-19 years old (n=550 ,24%). Nearly 37 % of the patients had one and 38.1% had three ulcers. The most common location of ulcers were on hands (n=1022, 44.7%) and then on feet (n=501, 21.9%). Totally 1877 of the patients were infected in rural areas. Based on the appearance of the lesion it was found that 410 cases (17.9%) were of the dry type and 1877 cases (82.1%) were wet type. Concluaions: Such high prevalence and incidence rates are alarming and require control and prevention measures. Further epidemiological studies of CL are suggested. Key words: Epidemiology, Cutaneous Leishmaniasis, Iran. *Corresponding author: Hamid kassiri, QR code School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Email address: [email protected] Please cite this article in press as Hamid kassiri et al., The Prevalence of Cutaneous Leishmaniasis in East of Ahvaz County, South-Western Iran, Indo Am. J. P. Sci, 2017; 4(11). www.iajps.com Page 4252 IAJPS 2017, 4 (11), 4252-4262 Hamid Kassiri et al ISSN 2349-7750 INTRODUCTION: different regions of Iran. Given the proximity of According to the World Health Organization, Khuzestan Province with endemic foci of CL such as leishmaniasis is one of the nine most important Bushehr, Ilam, and Isfahan Provinces and the infectious diseases worldwide [1]. Socioeconomic emergence of new foci of CL in this province development and environmental changes have including Ahvaz County, the present study aims to increased the risk factors of this disease around the evaluate the epidemiological aspects of this disease world. Leishmaniasis is transmitted through the bite and further highlight the importance of controlling it of an infected female sand fly. More than 20 in the east of Ahvaz . Leishmania species are responsible for diseases in humans [2]. Leishmaniasis annually affects 1.5-2.5 MATERIALS AND METHODS: million people [3]. Cutaneous Leishmaniasis (CL) is The present research was a descriptive cross – the most common form of the disease, and 90% of sectional study which was conducted based on cases are related to eight countries of Afghanistan, information of patients with CL visited health centers Algeria, Brazil, Saudi Arabia, Syria, Iraq, and Iran in the east of Ahvaz from April 2003 to March 2013. [4]. After necessary examinations and confirmation of the disease (finding Leishman-Donovan body in the Cutaneous leishmaniasis occurs in two smears of the sore of the patients), their information epidemiological forms in Iran. The dry type was registered in special forms and then they had (anthroponotic or urban CL) have been reported from received proper treatments. The collected information Kerman, Bam, Mashhad, Nishapur, and Sabzevar. included age, gender, and nationality, place of The reservoir and vector of urban CL are human and residence, type and number of lesions which was Phlebotomus sergenti, respectively [5, 6]. Recently, statistically analyzed in SPSS. new foci of the disease have been found in Rafsanjan and Khomeyni Shahr [7, 8]. The wet type (zoonotic RESULTS: or rural CL) has been observed in Isfahan, Sarakhs, During the period 2003-2013, information of 2287 Lotfabad, Kashmar, Khuzestan, Ilam and Baft. The patients with CL visited health centers of the east reservoirs of the wet type are rodents and its vector is Ahvaz was registered in health centers in the east of Phlebotomus papatasi [9, 10]. Recently, new foci of Ahvaz .The incidence of this disease followed a this disease have been found in Shiraz and villages downward trend in this 11-year period, as it reduced around Kashan [11, 12]. Many reports indicate that from 856 registered cases in 2003 to only 61 cases in this disease is increasingly expanding in Iran and 2013 (Figure 1). In terms of gender, 53.4% of around the world, causing the waste of manpower patients were male and 46.6% of them were female and cost [3,13]. (Table 1). The highest incidence (n=550, 24%) was observed in the age group 10-19. Almost three- Although leishmaniasis control has always been quarters of patients aged under the age of thirty. considered in national plans and programs of Iran, Table 2 and Figure 2 shows the frequency and extensive efforts and national and international distribution of leishmaniasis in different age groups. investments have been made in this issue, not only In terms of lesion site on the body, the highest this disease has not been eradicated but also new foci frequency was related to hands with 1022 cases of it have been recently diagnosed around Iran [14]. (44.7%), legs with 501 cases (21.9%), and face with Leishmaniasis National Control Program emphasizes 369 cases (16.1%) (Table 3 and Figure 3). Study the the need for determine the epidemiological number of lesions on the body also showed that 651 characteristics of the leishmaniasis in the disease foci. (38.1%), 645 (37.0%) and 537 (24.9%) of patients In addition, in order to choose the right method to had three, one, and two lesions, respectively (Table combat disease and increase the success of control 4). Molecular survey of Leishmania parasite was not programs, it is necessary to determine conducted, but based on the appearance of the lesion epidemiological characteristics of diseases in their it was found that 410 cases (17.9%) were of the dry foci. Over the past few years, several studies have type and 1877 cases (82.1%) were wet type (Table 5). been conducted on the epidemiology of CL in www.iajps.com Page 4253 IAJPS 2017, 4 (11), 4252-4262 Hamid Kassiri et al ISSN 2349-7750 1000 856 800 600 Number of Cases Number of 400 354 234 229 200 141 156 72 63 62 59 61 0 2003 2004 2005 2006 2007 2008 2009 2010 2011 2013 2013Years Fig1: Trend of cutaneous leishmaniasis cases, east of Ahvaz County, Southwestern Iran (2003-2013). Table 1: Distribution of cutaneous leishmaniaisis cases according to the gender, East of Ahvaz County, Southwestern Iran (2003-2013). Gender Male Female Total Years No. (%) No. (%) No. (%) 2003 415(48.5) 441(51.5) 856(100) 2004 188(53.1) 166(46.9) 354(100) 2005 137 (58.5) 97(41.5) 234(100) 2006 71(50.3) 70(49.7) 141(100) 2007 47 (65.3) 25(34.7) 72(100) 2008 48 (77.4) 14(22.6) 62 (100) 2009 44 (69.8) 19(30.2) 63 (100) 2010 34 (57.6) 25(42.4) 59(100) 2011 118 (51.5) 111 (48.5) 229 (100) 2012 85 (54.5) 71 (45.5) 156 (100) 2013 33 (54.0) 28 (46.0) 61 (100) 1220 (53.4) 1067(46.6) 2287 (100) Total www.iajps.com Page 4254 IAJPS 2017, 4 (11), 4252-4262 Hamid Kassiri et al ISSN 2349-7750 Table 2: Frequency distribution of cutaneous leishmaniasis cases by the age groups (years) in East of Ahwaz County (2003-2013). Age <5 5-10 10-19 20-29 30-39 40-49 >50 Total groups No. (%) No. (%) No. (%) No. (%) No. (%) No (%) No (%) No. (%) Years 2003 79 (9.2) 144(16.8) 244(28.5) 156(18.2) 105(12.3) 68(8.0) 60(7.0) 856(100) 2004 46 (13.0) 49 (13.8) 98 (27.6) 66 (18.6) 33 (9.4) 31 (8.8) 31 (8.8) 354 (100) 2005 37(15.8) 24 (10.2) 60 (25.6) 44 (18.8) 33 (14.1) 17 (7.3) 19 (8.2) 234 (100 2006 14 (9.9) 17(12.0) 35 (24.8) 34 (24.1) 11(7.8) 18 (12.9) 12 (8.5) 141 (100) 2007 8 (11.1) 7 (9.7) 13 (18.0) 22( 30.5) 14 (19.5) 4 (5.6) 4 (5.6) 72 (100) 2008 7 (11.4) 4 (9.4) 13 (20.4) 27 (43.6) 2 (3.3) 3 (4.9) 6 (9.9) 62(100) 2009 5(7.9) 6( 9.5) 10 (15.9) 22 (35.0) 7 (11.1) 8 (12.6) 5(8.0) 63 (100) 2010 7(11.7) 6 (10.2) 9(15.3) 20(34.0) 10(17.0) 4(6.8) 3(5.0) 59(100) 2011 26(11.4) 28(12.2) 28(12.2) 59(25.8) 42(18.4) 22(9.5) 24(10.5) 229(100) 2012 18(11.5) 16(10.3) 28(17.9) 31 (19.9) 26(16.6) 18(11.5) 19(12.3) 156(100) 2013 6(9.8) 6(9.8) 12(19.7) 13(21.3) 13(21.3) 3(4.9) 8(13.2) 61(100) Total 253 (11.1) 307 (13.5) 550 (24.0) 494 (21.6) 296(13.0) 196 (8.5) 191 (8.3) 2287 (100) Figure 2: Frequency distribution of cutaneous leishmaniasis cases by the age groups in East of Ahwaz County (2003-2013).