A long-lasting emerging epidemic of anthroponotic cutaneous leishmaniasis in southeastern Iran: population movement and peri-urban settlements as a major risk factor

Abstract

Background Epidemics of cutaneous leishmaniasis (CL) are occurring more frequently and spreading faster and farther than before in many areas of the world. The present study aimed to assess a long-lasting emerging epidemic (2005–2019) of 5532 cases with anthroponotic CL (ACL) in peri-urban areas of Kerman city in southeastern Iran. Methods This descriptive-analytical study was carried out for 15 years in Kerman province, southeastern Iran. The data were passively obtained through the health surveillance system and the Kerman Leishmaniasis Research Center. Every subject was diagnosed using direct smear microscopy. The representative causative agent was further examined by ITS1-PCR, PCR-RFLP, 7SL RNA gene sequencing and phylogenetic analyses. For each subject, a case report form designating demographic and clinical data was recorded. Results A different pattern of ACL incidence was found in peri-urban areas compared to that in the city of Kerman. The incidence rate of ACL cases has significantly increased (P < 0.001) from 2005 to 2016 in new settlements with a gradual decline after that. The overall average risk of contracting the disease was 7.6 times higher in peri-urban areas compared to Kerman city, an old endemic focus. All isolates consisting of six variants were confirmed to be Leishmania tropica. The overall pattern of the ACL infection indicates that the etiological agent of ACL is propagated and transmitted by the bite of female Phlebotomus sergenti sandflies from person to person from dissimilar clones as reflected by the complexity of the migrants’ backgrounds in the province. Conclusions The movement of populations and establishment of new settlements in peri-urban areas close to endemic areas are major risk factors for and are directly linked to CL. The underlying factors of this emerging ACL epidemic caused by L. tropica were disasters and droughts, among others. A robust commitment to a multilateral approach is crucial to make improvements in this area. This will require decisive coordinated actions through all governmental factions and non-governmental organizations. Furthermore, active and passive case detection strategies, early diagnosis, and effective treatment could help control the disease.

The Geographical Distribution of Human Cutaneous and Visceral Leishmania Species Identified by Molecular Methods in Iran: A Systematic Review With Meta-Analysis

“…The findings of this study demonstrated that the main causative agent of ZCL cases in the 14 provinces is L. major and the main causative agent of ACL cases in the five provinces is L. tropica (Figure 2). Although L. tropica was formerly common in many large urban areas, it has also been observed in rural areas and small cities in Iran (169). According to the findings of the two studies, four isolates of L. turanica were found in CL patients in the Gonbad-Kavous and Turkmen Sahara districts of Golestan province, which are the known oldest ZCL foci (90,121).…”

Determinants of Unresponsiveness to Treatment in Cutaneous Leishmaniasis: A Focus on Anthroponotic Form Due to Leishmania tropica

“…The disease affects a number of the poorest people in the world and is linked with population movement, poor housing conditions, deficient immune systems, and lack of monetary resources. Rural-urban labor migration, civil unrest, and climate change remain significant additional risk factors for ACL (Desjeux, 2001;Karimi et al, 2021). Leishmaniasis is also related to environmental modifications, including deforestation, dam building, urbanization, and irrigation schemes (WHO, 2017).…”

Role of Leishmanin Skin Test (LST) as Epidemiological Indicators for Cutaneous Leishmaniasis in Al-tragma Village, River Nile State, Sudan

“…As shown in table (5), the domestic and pets animals found in and around the houses, dogs found in four houses, all the people found in these houses were positive, three houses having cats and dogs two were positive and one negative. The result showed there was a significant difference between them (P-value = 0.013).…”

“…Cutaneous Leishmaniasis (CL) is a common health problem in the world, it is divided into Zoonotic Cutaneous Leishmaniasis (ZCL) and Anthroponotic Cutaneous Leishmaniasis (ACL) [5]. ZCL was reported in Sudan and has been considered to be the second parasitic health problem after malaria.…”