Emerging Epidemics of Cutaneous Leishmaniasis in Iran: Operational Aspects, Management and Implemented Control Approaches

Sharifi, Iraj; Aflatoonian, Mohammad Reza; Babaei, Zahra; Sharifi, Farshad; Keyhani, Alireza; Salarkia, Ehsan; Khosravi, Ahmad; Khamesipour, Ali; Mohebali, Mehdi; Nadim, A; Bamorovat, Mehdi

doi:10.29252/jommid.7.3.52

Cited by 4 publications

(4 citation statements)

References 61 publications

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“…Over this period, the trend was somewhat sluggish, but more or less of fluctuating nature and steadily declined. This variation was mainly due to multiple risk factors, especially earthquakes, natural and anthropogenic environmental changes, population displacement, and drug unresponsiveness (50)(51)(52). The five provinces with the highest incidence were Ilam 143, Fars 75.3, Semnan 60.2, Isfahan 48.8, and Golestan 46 per 100,000 people.…”

Section: Demographic and Clinical Featuresmentioning

confidence: 99%

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Cutaneous leishmaniasis situation analysis in the Islamic Republic of Iran in preparation for an elimination plan

Sharifi

Khosravi

Aflatoonian

et al. 2023

Front. Public Health

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Iran has invariably been under the growing public health threat of cutaneous leishmaniasis (CL), a significant barrier to local development that hinders the prevention and control efforts toward eliminating the disease. So far, no comprehensive and in-depth epidemiological analysis of the CL situation has been carried out nationwide. This study aimed to employ advanced statistical models to analyze the data collected through the Center for Diseases Control and Prevention of Communicable Diseases during 1989–2020. However, we emphasized the current trends, 2013–2020, to study temporal and spatial CL patterns. In the country, the epidemiology of CL is incredibly intricate due to various factors. This fact indicates that the basic infrastructure, the preceding supports, and the implementation plan related to preventive and therapeutic measures need crucial support. The leishmaniasis situation analysis is consistent with desperate requirements for efficient information on the control program in the area. This review provides evidence of temporally regressive and spatially expanding incidence of CL with characteristic geographical patterns and disease hotspots, signifying an urgent need for comprehensive control strategies. This information could be a suitable model and practical experience in the Eastern Mediterranean Region, where over 80% of CL is reported.

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Section: Demographic and Clinical Featuresmentioning

confidence: 99%

“…or promptly abrupt into epidemic conditions(52,114,115). Iran is connected to Turkey, Azerbaijan, Armenia to the northwest, Afghanistan, and Pakistan to the east, Turkmenistan to the north, and Iraq to the west.…”

mentioning

confidence: 99%

Cutaneous leishmaniasis situation analysis in the Islamic Republic of Iran in preparation for an elimination plan

Sharifi

Khosravi

Aflatoonian

et al. 2023

Front. Public Health

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“…Some unusual clinical forms of CL are connected with various parasite species and the host's immunity. The usual stages of progress for the cutaneous lesion are papule, nodule, ulcer, and scar [120].…”

Section: Health Personnelmentioning

confidence: 99%

Mutual Role of Patients and the Healthcare System in the Control of Cutaneous Leishmaniasis

Bamorovat,

Sharifi,

Agha Kuchak Afshari

et al. 2023

Transboundary and Emerging Diseases

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Leishmaniasis is a neglected and old emerging/reemerging disease that has extremely increased and expanded in the different geographical areas. Cutaneous leishmaniasis (CL) is a common global public health concern in the tropics and subtropics reported from the Eastern Mediterranean Region, Africa, Latin America, and the Indian subcontinent. The presence of numerous epidemiological and clinical characteristics of the disease present a challenge in managing and controlling it. Despite wonderful efforts to control the disease in endemic areas, it appears that the burden of CL is still high. There is no comprehensive survey considering the interactive role of patients and medical services in the international CL control system. In the present study, the effective and mutual responsibility of the patients and the healthcare management in controlling the CL are reviewed, described, and discussed. Some patient-related factors that have a remarkable impact on the proper treatment and control strategies are low-socioeconomic condition, lack of sufficient knowledge about the disease, absence of personal protection, disregarding adherence to treatment, culture and incorrect beliefs about disease and therapy, depression, and lack of appropriate support from the family. On the other hand, some healthcare system-related factors that have an important effect on the suitable therapy and management of the disease are the economic burden of healthcare and drug preparation, unsuitable follow-up assessments, health education, early detection, and the right treatment, handling of unresponsive cases, active case detection, and monitoring/evaluation. Improving the socioeconomic conditions and living standards supports longstanding elimination approaches, and facilitates the wide-ranging control of the disease. Trained health staff and experienced clinicians should strengthen the building capacity for appropriate control programs throughout the healthcare system. These measures need sustained encouragement and appropriate multifunctional activities through all government segments including policymakers, the health system, clinical physicians, researchers, and also the private sector. In a suitable strategy, it is essential to understand precisely all the aspects of control strategies to respond correctly to the requests. Nevertheless, due to the complexity of the causative agent, major challenges/gaps remain, and vigorous conservative control plans should be continued until novel tools become available.

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“…Cutaneous and mucocutaneous forms of leishmaniases (CL and MCL) had the greatest DALY increase in the last 20 years [ 4 ], and the most CL cases have been detected in eco-epidemiological “hotspot” areas within the Eastern Mediterranean region [ 5 ]. In many of these areas, the outbreaks appear in 10-year intervals [ 6 ], but this trend is 1.5 times faster in some countries such as Iran [ 7 ]. Zoonotic cutaneous leishmaniasis (ZCL), the most predominant and widespread form of leishmaniasis in the country, is caused by Leishmania major and chiefly vectored by the sand fly Phlebotomus papatasi (Scopoli) (Diptera: Psychodidae) from gerbils to humans [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Characterization of bacteria expectorated during forced salivation of the Phlebotomus papatasi: A neglected component of sand fly infectious inoculums

Maleki-Ravasan,

Ghafari,

Najafzadeh

et al. 2024

PLoS Negl Trop Dis

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The infectious inoculum of a sand fly, apart from its metacyclic promastigotes, is composed of factors derived from both the parasite and the vector. Vector-derived factors, including salivary proteins and the gut microbiota, are essential for the establishment and enhancement of infection. However, the type and the number of bacteria egested during salivation is unclear. In the present study, sand flies of Phlebotomus papatasi were gathered from three locations in hyperendemic focus of zoonotic cutaneous leishmaniasis (ZCL) in Isfahan Province, Iran. By using the forced salivation assay and targeting the 16S rRNA barcode gene, egested bacteria were characterized in 99 (44%) out of 224 sand flies. Culture-dependent and culture-independent methods identified the members of Enterobacter cloacae and Spiroplasma species as dominant taxa, respectively. Ten top genera of Spiroplasma, Ralstonia, Acinetobacter, Reyranella, Undibacterium, Bryobacter, Corynebacterium, Cutibacterium, Psychrobacter, and Wolbachia constituted >80% of the saliva microbiome. Phylogenetic analysis displayed the presence of only one bacterial species for the Spiroplasma, Ralstonia, Reyranella, Bryobacter and Wolbachia, two distinct species for Cutibacterium, three for Undibacterium and Psychrobacter, 16 for Acinetobacter, and 27 for Corynebacterium, in the saliva. The abundance of microbes in P. papatasi saliva was determined by incorporating the data on the read counts and the copy number of 16S rRNA gene, about 9,000 bacterial cells, per sand fly. Both microbiological and metagenomic data indicate that bacteria are constant companions of Leishmania, from the intestine of the vector to the vertebrate host. This is the first forced salivation experiment in a sand fly, addressing key questions on infectious bite and competent vectors.

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Emerging Epidemics of Cutaneous Leishmaniasis in Iran: Operational Aspects, Management and Implemented Control Approaches

Cited by 4 publications

References 61 publications

Cutaneous leishmaniasis situation analysis in the Islamic Republic of Iran in preparation for an elimination plan

Cutaneous leishmaniasis situation analysis in the Islamic Republic of Iran in preparation for an elimination plan

Mutual Role of Patients and the Healthcare System in the Control of Cutaneous Leishmaniasis

Characterization of bacteria expectorated during forced salivation of the Phlebotomus papatasi: A neglected component of sand fly infectious inoculums

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