Visceral leishmaniasis (VL) is endemic in Northwest and southern Iran. Reports of cutaneous leishmaniasis (CL) in Northwest areas are rare, and its etiological agents are unknown. In the current study, we report six CL and two post kala-azar dermal leishmaniasis (PKDL) cases caused by Leishmania infantum from endemic areas of VL in the Northwest. Smears were made from skin lesions of 30 suspected patients in 2002-2011, and CL was determined by microscopy or culture. Leishmania spp. were identified by nested-PCR assay. The disease was confirmed in 20 out of 30 (66%) suspected patients by parasitological examinations. L. infantum was identified in eight and Leishmania major in 12 CL cases by nested-PCR. Cutaneous leishmaniasis patients infected with L. major had the history of travel to CL endemic areas. L. infantum antibodies were detected by direct agglutination test (DAT) at titers of 1:3200 in two cases with history of VL. Results of this study indicated that L. infantum is a causative agent of CL as well as PKDL in the VL endemic areas.

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The obtained results demonstrate that the LAMP technique has a greater sensitivity for detection of T. gondii. Furthermore, these findings indicate that primers based on the RE are more suitable than those based on the B1 gene. However, the B1-LAMP assay has potential as a diagnostic tool for detection of T. gondii.

In Iran, Leishmania major or L. tropica cause almost all of the human cutaneous leishmaniasis (CL). Unfortunately, the detection methods frequently used for CL (the microscopical examination of direct smears or the culture of biopsies) are not very sensitive and the Leishmania species causing each case of CL in Iran is usually only tentatively identified from extrinsic factors, such as the case's clinical manifestations and region of residence. Recently, however, a nested PCR that targets the parasites' kinetoplast DNA has been used in the city of Ahvaz (the capital of the province of Khouzestan, in south-western Iran) to confirm the microscopical diagnosis of CL and to identify the causative parasites, to species level. Smears from the lesions on 100 suspected cases of CL were fixed, stained with Wright's eosin-methylene blue, and checked for amastigotes under a light microscope. Scrapings from the same smears were then tested for leishmanial DNA, using a nested PCR that allows the DNA from L. tropica to be identified and distinguished from that of L. major. The 100 smears investigated were all found amastigote-positive by microscopy and PCR-positive for either L. major DNA (97 smears) or L. tropica DNA (three smears). The predominant species causing CL in Ahvaz is therefore L. major.

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Parasitological methods for the diagnosis of visceral leishmaniasis (VL) require invasive sampling procedures. The aim of this study was to detect Leishmania infantum (L. infantum) DNA by real time-PCR method in peripheral blood of symptomatic VL patient and compared its performance with nested PCR, an established molecular method with very high diagnostic indices. 47 parasitologically confirmed VL patients diagnosed by direct agglutination test (DAT [ 3200), bone marrow aspiration and presented characteristic clinical features (fever, hepatosplenomegaly, and anemia) and 40 controls (non-endemic healthy control-30, Malaria-2, Toxoplasma gondii-2, Mycobacterium tuberculosis-2, HBV-1, HCV-1, HSV-1 and CMV-1) were enrolled in this study. SYBR-green based real time-PCR and nested PCR was performed to amplify the Kinetoplast DNA minicircle gene using the DNA extracted from Buffy coat. From among 47 patients, 45 (95.7 %) were positive by both nested-PCR and real time-PCR. These results indicate that real time-PCR was not only as sensitive as a nested-PCR assay for detection of Leishmania kDNA in clinical sample, but also more rapid. The advantage of real time-PCR based methods over nested-PCR is simple to perform, more faster in which nested-PCR requires post-PCR processing and reducing contamination risk.

Background: The rapid increase in the spread of COVID-19 and the numbers of infected patients worldwide has highlighted the need for intensive care unit (ICU) beds and more advanced therapy. This need is more urgent in resource-constrained settings. The present study aimed to identify the predictors of ICU admission among hospitalized COVID-19 patients. Study design: The current study was conducted based on a retrospective cohort design. Methods: The participants included 665 definite cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) hospitalized in Imam Hossein Hospital from February 20 to May 14, 2020. The baseline characteristics of patients were assessed, and multivariate logistic regression analysis was utilized to determine the significant odds ratio (OR) for ICU admission. Results: Participants were aged 59.52±16.72 years, and the majority (55.6%) of them were male. Compared to non-ICU patients (n=547), the ICU patients (n=118) were older, had more baseline comorbidities, and presented more often with dyspnea, convulsion, loss of consciousness, tachycardia, tachypnea, and hypoxia, and less often with myalgia. Significant OR (95% CI) of ICU admission was observed for the 60-80 age group (2.42, 95%CI: 1.01; 5.79), ≥80 age group (3.73, 95%CI: 1.44; 9.42), ≥3 comorbidities (2.07, 95%CI: 1.31; 3.80), loss of consciousness (6.70, 95%CI: 2.94, 15.24), tachypnea (1.79, 95%CI: 1.03, 3.11), and SpO2<90 (5.83, 95%CI: 2.74; 12.4). Abnormal laboratory results were more common among ICU-admitted patients; in this regard, leukocytosis (4.45, 95%CI: 1.49, 13.31), lymphopenia (2.39, 95%CI: 1.30; 4.39), elevated creatine phosphokinase (CPK) (1.99, 95%CI: 1.04; 3.83), and increased aspartate aminotransferase (AST) (2.25, 95%CI: 1.18-4.30) had a significant OR of ICU admission. Chest computer tomography (CT) revealed that consolidation (1.82, 95%CI: 1.02, 3.24), pleural effusion (3.19, 95%CI: 1.71, 5.95), and crazy paving pattern (8.36, 95%CI: 1.92, 36.48) had a significant OR of ICU admission. Conclusion: As evidenced by the obtained results, the predictors of ICU admission were identified among epidemiological characteristics, presenting symptoms and signs, laboratory tests, and chest CT findings.

Background: Leishmaniasis is a protozoan disease caused by Leishmania genus and its most common form is cutaneous leishmaniasis. The number of reported cases of cutaneous leishmaniasis in Khuzestan, southwest Iran, continues to increase. Therefore, early, accurate diagnosis is crucial for successful therapy. Objectives: The Nested PCR is a molecular method with high sensitivity and specificity in detecting leishmaniasis, but this method requires advanced equipment and skilled labor. Therefore, developing a simple yet accurate technique to diagnose leishmaniasis is essential. This study was designed to evaluate the possibility of replacing Nested PCR with loop-mediated isothermal amplification (LAMP) method for diagnosis of cutaneous leishmaniasis. Methods: We obtained 75 clinical samples from cutaneous leishmaniasis patients whose infection had already been confirmed by microscopic examination. The LAMP assay with pre-added malachite green was performed using a set of four primers targeting conserved sequences of the18S ribosomal RNA gene. The nested PCR method was performed using specific kinetoplast minicircle DNA primers. Cultured promastigotes of Leishmania major (MHOM /IR/75/ER), L. tropica (MHOM/IR/02/Mash10), and the virulent RH strain of Toxoplasma gondii were used as controls. Results: Our results showed that LAMP was positive for 100% of microscopically positive samples, which was similar to Nested PCR. The detection of L. major was improved at 10 4 parasites/ml using the LAMP method. Conclusions: Our findings suggest that considering the simplicity, specificity, and sensitivity of LAMP, it would be a potentially useful method in the diagnosis of leishmaniasis and detection of its various strains/species. This cost and time-effective method can be used as a suitable alternative for surveillance of leishmaniasis, as well as in epidemiological studies.