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Khodabandeh M, Moradian E, Sarvari M, Khiabani MS. Visceral Leishmaniasis (VL) Clinical Presentation, Laboratory Findings, Treatment Options and Outcome. IRANIAN JOURNAL OF PARASITOLOGY 2024; 19:28-37. [PMID: 38654944 PMCID: PMC11033536 DOI: 10.18502/ijpa.v19i1.15190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 11/14/2023] [Indexed: 04/26/2024]
Abstract
Background Black disease, also known as visceral leishmaniasis (VL), is a parasitic illness caused by various Leishmania species. The risk of morbidity and mortality increases with delayed diagnosis and treatment. Early VL diagnosis and fast appropriate treatment are critical issues in endemic areas. Methods This study was a retrospective cross-sectional study to investigate the diagnostic and therapeutic course of patients admitted with the diagnosis of VL in the Children's Medical Center (CMC) Hospital, Tehran, Iran. All cases of VL in patients under the age of 18 hospitalized between the years 2012 to 2022 were enrolled. Results Twenty-seven patients were enrolled with an average age of 28.13 months with the majority of females (51.8%). Common clinical signs were fever (96.2%) and splenomegaly (92.59%). However, lymphadenopathy was rare. The largest number of patients was from Tehran Province, followed by Ardabil, Khuzestan, Gilan, and Alborz provinces. The most common hematological abnormalities were anemia (85.1%) and thrombocytopenia (44.4%). In accordance with the treatment strategy, liposomal amphotericin B and amphotericin B deoxycholate were given to 11 and 5 patients, respectively. Eleven of them received glucantime. The average length of hospitalization for liposomal amphotericin B was 15.36 ± 12.49 days. In comparison with glucantime (18.38 ±10.26 days) and amphotericin B deoxycholate (20.20± 6.18 days), liposomal amphotericin B group hospitalization was shorter than others were. Conclusion VL should be included in the differential diagnosis of any child who presents with fever, splenomegaly, and anemia. Concerning the treatment strategy in this study, liposomal amphotericin B had more efficiency and shorter hospitalization duration.
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Affiliation(s)
- Mahmoud Khodabandeh
- Department of Infectious Diseases, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Children's Medical Center, Pediatrics Center of Excellence, Tehran, Iran
- Department of Pediatrics, Children's Medical Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Moradian
- Children's Medical Center, Pediatrics Center of Excellence, Tehran, Iran
| | - Maedeh Sarvari
- School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Mahsa Soti Khiabani
- Children's Medical Center, Pediatrics Center of Excellence, Tehran, Iran
- Department of Pediatrics, Children's Medical Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Mohebali M, Edrissian G, Akhoundi B, Shirzadi M, Hassanpour G, Behkar A, Rassi Y, Hajjaran H, Keshavarz H, Gouya MM, Arshi S, Zeinali M, Zarei Z, Sharifi I, Kakooei Z. Visceral Leishmaniasis in Iran: An Update on Epidemiological Features from 2013 to 2022. IRANIAN JOURNAL OF PARASITOLOGY 2023; 18:279-293. [PMID: 37886254 PMCID: PMC10597876 DOI: 10.18502/ijpa.v18i3.13751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 06/11/2023] [Indexed: 10/28/2023]
Abstract
Background Visceral leishmaniasis (VL) is one of the most important neglected tropical diseases. The zoonotic form of VL is endemic in some areas of Iran. We aimed to determine the status of VL identified in humans and canines in different parts of Iran from 2013 to 2022. Method A national representative cross-sectional study was conducted in 10 provinces of Iran, including the national leishmaniasis reference lab. We employed the direct agglutination test (DAT) as a reliable serological method to detect anti-Leishmania infantum antibodies in humans and animal reservoir hosts. Additionally, a narrative literature review was conducted to identify relevant studies on VL seroprevalence in Iran from 2013 to 2023. Results The results of 21281 human and 5610 canine serum samples from 2013 to 2022 are reported. Altogether, 448 (2.1%, 95%CI: 2.0-2.3) human serum samples showed anti-L. infantum antibody levels of ≥1:3200. Of these samples, 13716 (64.5%) were collected actively, which showed a seroprevalence of 0.6% (95% CI: 0.5-0.8) and 7565 (35.5%) were collected passively, which showed a seroprevalence of 4.8% (95%CI: 4.3-5.3). Overall, 1035 (20.1%, 95%CI: 19.0-21.2) of 5160 domestic dogs (Canis familiaris) samples showed anti-L. infantum antibody levels of ≥1:320. Northwest (2.8%) and northeast (0.96%) regions had the highest human VL seroprevalence, while northwest (21.5%) and south (14.4%) regions had the highest canine VL seroprevalence. Conclusion Zoonotic VL, an endemic parasitic disease, is still present in several different distinct areas across Iran. While human VL cases have shown a declining trend over the last decade, the prevalence of canine VL remains significant.
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Affiliation(s)
- Mehdi Mohebali
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Center for Research of Endemic Parasites of Iran (CREPI), Tehran University of Medical Sciences, Tehran, Iran
| | - Gholamhossein Edrissian
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Behnaz Akhoundi
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammedreza Shirzadi
- Center for Research of Endemic Parasites of Iran (CREPI), Tehran University of Medical Sciences, Tehran, Iran
- Center for Communicable Diseases Management, Ministry of Health Treatment and Medical Education, Tehran, Iran
| | - Gholamreza Hassanpour
- Center for Research of Endemic Parasites of Iran (CREPI), Tehran University of Medical Sciences, Tehran, Iran
| | - Atefeh Behkar
- Center for Research of Endemic Parasites of Iran (CREPI), Tehran University of Medical Sciences, Tehran, Iran
| | - Yavar Rassi
- Department of Vector Biology and Control of Diseases, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Homa Hajjaran
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Keshavarz
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Center for Research of Endemic Parasites of Iran (CREPI), Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mehdi Gouya
- Center for Communicable Diseases Management, Ministry of Health Treatment and Medical Education, Tehran, Iran
| | - Shahnam Arshi
- Center for Communicable Diseases Management, Ministry of Health Treatment and Medical Education, Tehran, Iran
| | - Mohammad Zeinali
- Center for Communicable Diseases Management, Ministry of Health Treatment and Medical Education, Tehran, Iran
| | - Zabihollah Zarei
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Meshkin-Shahr Health Station from the School of Public Health, Tehran University of Medical Sciences, Ardebil, Iran
| | - Iraj Sharifi
- Leishmaniasis Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Zahra Kakooei
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Sheikhi S, Heidari A, Mohebali M, Keshavarz H, Heidari A, Sezavar M, Akhoundi B, Bairami A. Molecular Identification of Cutaneous Leishmaniasis Species in the Northcentral Iranian Province of Alborz: Is There a New Focus on Cutaneous Leishmaniasis in the Province? IRANIAN JOURNAL OF PARASITOLOGY 2023; 18:244-250. [PMID: 37583638 PMCID: PMC10423915 DOI: 10.18502/ijpa.v18i2.13191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 06/12/2022] [Indexed: 08/17/2023]
Abstract
Background Cutaneous leishmaniasis (CL) is an endemic infection in the Middle East, including Iran that is also spreading to new foci. We aimed to determine the leishmaniasis species causing CL in Alborz province. Methods Overall, out of 55-suspected CL patients referred to health centers in Alborz Province, north central Iran in 2019, 40 patients had positive smear for CL based on optical microscopy. The internal transcribed spacer 1 (ITS1) of nuclear ribosomal DNA (rDNA) was amplified by PCR. Leishmania species were identified by PCR-restriction fragment length polymorphism (PCR-RFLP) using BshF I (Hae III) enzyme. Results Out of the 40 positive patients with CL, 34 cases (85%) had been caused by Leishmania (L) major and six (15%) by L. tropica. Fifteen patients had no history of traveling to the disease endemic areas, of which nine were Iranians. Skin lesions and scars caused by CL were mostly observed on the hands and face. Moreover, more than two skin lesions were observed in 22 cases (55%), all of which were infected with L. major. A single skin ulcer was seen in 18 (45%) of the CL patients. Conclusion Climate change, reduced rainfall, and demographic changes such as migration into Alborz Province and the increasing marginalization of the population and their entry to settle in new areas might have caused natural transmission of both L. tropica and L. major in this province.
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Affiliation(s)
- Susan Sheikhi
- Department of Medical Parasitology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Aliehsan Heidari
- Department of Medical Parasitology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Mehdi Mohebali
- Center for Research of Endemic Parasites of Iran (CREPI), Tehran University of Medical Sciences, Tehran, Iran
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Iran
| | - Hossein Keshavarz
- Center for Research of Endemic Parasites of Iran (CREPI), Tehran University of Medical Sciences, Tehran, Iran
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Iran
| | - Amir Heidari
- Department of Cardiovascular, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Monireh Sezavar
- Department of Experimental Sciences, School of Allied Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Behnaz Akhoundi
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Iran
| | - Amir Bairami
- Department of Medical Parasitology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
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Sedaghatmanesh K, Khazan H, Akhoundi B, Khazaei S, Kakooei Z, Mohebali M. Seroprevalence of Visceral Leishmaniasis in Children Up To 12 Years Old of Rural Areas from Kermanshah Province, Western Part of Iran. IRANIAN JOURNAL OF PARASITOLOGY 2023; 18:85-92. [PMID: 37197081 PMCID: PMC10183451 DOI: 10.18502/ijpa.v18i1.12384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/19/2022] [Indexed: 05/19/2023]
Abstract
Background After the earthquake in 2017 a few new cases of visceral leishmaniasis (VL) were reported from SarPol-e-Zahab district of Kermanshah Province, western part of Iran. This study was conducted to determine the seroprevalence in Kermanshah Province. Methods This descriptive cross-sectional study was conducted on children up to 12 years of age from SarPol-e-Zahab County, Kermanshah Province, western part of Iran in 2021. For each individual, a questionnaire including age, sex, clinical features, history of the disease, and contact with canines as reservoir hosts of VL were completed, separately. To determine VL seroprevalence, blood samples were collected from the children and after centrifugation, the sera samples were separated and tested using Direct Agglutination Test (DAT) for detection of anti-L. infantum antibodies. Statistical analyses were performed using SPSS16. Results Totally, 13 persons were seropositive; 7 samples with titer 1:800, 3 samples had 1:1600, 2 samples had 1:3200 and 1 sample had 1:6400. None of the seropositive cases had a history of kala-azar. There was no significant difference between males and females at titers of anti-Leishmania specific antibodies. Conclusion L. infantum infection is being circulated with low prevalence in children up to 12 years old from SarPol-e-Zahab County but it is necessary that the surveillance system is regularly monitored among physicians and public health managers in the studied areas.
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Affiliation(s)
- Kaveh Sedaghatmanesh
- Department of Medical Parasitology and Mycology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hooshang Khazan
- Department of Medical Parasitology and Mycology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behnaz Akhoundi
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Sasan Khazaei
- Department of Parasitology and Entomology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Zahra Kakooei
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Mohebali
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Zoonosis Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Center for Research of Endemic Parasites of Iran (CREPI), Tehran University of Medical Sciences, Tehran, Iran
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Alizadeh Z, Omidnia P, Altalbawy FMA, Gabr GA, Obaid RF, Rostami N, Aslani S, Heidari A, Mohammadi H. Unraveling the role of natural killer cells in leishmaniasis. Int Immunopharmacol 2023; 114:109596. [PMID: 36700775 DOI: 10.1016/j.intimp.2022.109596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/07/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022]
Abstract
NK cells are known as frontline responders that are efficient in combating several maladies as well as leishmaniasis caused by Leishmania spp. As such they are being investigated to be used for adoptive transfer therapy and vaccine. In spite of the lack of antigen-specific receptors at their surface, NK cells can selectively recognize pathogens, accomplished by the activation of the receptors on the NK cell surface and also as the result of their effector functions. Activation of NK cells can occur through interaction between TLR-2 expressed on NK cells and. LPG of Leishmania parasites. In addition, NK cell activation can occur by cytokines (e.g., IFN-γ and IL-12) that also lead to producing cytokines and chemokines and lysis of target cells. This review summarizes several evidences that support NK cells activation for controlling leishmaniasis and the potentially lucrative roles of NK cells during leishmaniasis. Furthermore, we discuss strategies of Leishmania parasites in inhibiting NK cell functions. Leishmania LPG can utilizes TLR2 to evade host-immune responses. Also, Leishmania GP63 can directly binds to NK cells and modulates NK cell phenotype. Finally, this review analyzes the potentialities to harness NK cells effectiveness in therapy regimens and vaccinations.
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Affiliation(s)
- Zahra Alizadeh
- Department of Parasitology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Farag M A Altalbawy
- National Institute of Laser Enhanced Sciences (NILES), University of Cairo, Giza 12613, Egypt; Department of Chemistry, University College of Duba, University of Tabuk, Duba 71911, Saudi Arabia
| | - Gamal A Gabr
- Department of Pharmacology and Toxicology, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia; Agricultural Genetic Engineering Research Institute (AGERI), Agricultural Research Center, Giza, Egypt
| | - Rasha Fadhel Obaid
- Department of Biomedical Engineering, Al-Mustaqbal University College, Babylon, Iraq
| | - Narges Rostami
- Department of Immunology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saeed Aslani
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Aliehsan Heidari
- Department of Parasitology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran.
| | - Hamed Mohammadi
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran; Department of Immunology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran.
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Amir Niaye Shad I, Mahmoudi MR, Mohebali M, Atrkar Roshan Z, Ashrafi K, Akhoundi B, Majidi Shad B. Seroepidemiological Study of Visceral Leishmaniasis (Kala-Azar) in Children under 12 Years Old in North of Iran: An Observational Study in 2019-2020. IRANIAN JOURNAL OF PARASITOLOGY 2022; 17:317-324. [PMID: 36466030 PMCID: PMC9682385 DOI: 10.18502/ijpa.v17i3.10621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 10/14/2021] [Indexed: 06/17/2023]
Abstract
BACKGROUND Visceral leishmaniasis (VL) caused by the Leishmania donovani complex that is transmitted by the bites of female sandflies. Mediterranean type of VL caused by L. infantum. While, Roudbar County of Guilan Province has been introduced as a suspected cutaneous leishmaniasis focus; there are no published data on the seroprevalence of VL in Guilan Province. We aimed to investigate the sero-prevalence of this disease in Roudbar County. METHODS This descriptive cross-sectional study was carried out in 2019-2020 among children less than 12 years of age to determine the seroprevalence of VL by direct agglutination test (DAT). Blood samples were randomly collected from 918 children under 12 years of age refers to the public health center in the clusters. RESULTS Out of 918 children, 14 (1.52%) showed anti-Leishmania antibodies, with 4 (0.43%), 2 (0.21%), 8 (0.87%) anti-L. infantum antibodies at titers 1:800, 1:1600 and ≥1: 3200 respectively. All children with anti-Leishmania antibody titers of ≥1:800 were evaluated by a physician. Clinical manifestation of VL including fever, anemia and hepatosplenomegaly observed in a 6-year-old boy from Defraz village with anti-Leishmania antibody of titers ≥102400.This patient was admitted to the pediatric hospital in Rasht, capital of Guilan province, Iran and was successfully treated. CONCLUSION VL is being circulated with low prevalence in children up to 12 years old in Roudbar, northern part of Iran. Accordingly, it is critical to improve the awareness of physicians and public health supervisors about the importance of this fatal disease in Guilan province and especially in Roudbar area.
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Affiliation(s)
- Iraj Amir Niaye Shad
- Department of Medical Parasitology and Mycology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammad Reza Mahmoudi
- Department of Medical Parasitology and Mycology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Mehdi Mohebali
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Center for Research of Endemic Parasites of Iran (CREPI), Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Atrkar Roshan
- Department of Medical Parasitology and Mycology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Keyhan Ashrafi
- Department of Medical Parasitology and Mycology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Behnaz Akhoundi
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Bijan Majidi Shad
- Department of Medical Parasitology and Mycology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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Akhtardanesh B, Mostafavi M, Khedri J, Fakhri A, Sharifi I, Shahraki MK. Seroepidemiology of visceral leishmaniasis among free-roaming dogs and children in Zahedan city, southeast of Iran, 2018-2020. Microb Pathog 2021; 161:105234. [PMID: 34653543 DOI: 10.1016/j.micpath.2021.105234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 09/15/2021] [Accepted: 10/06/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Mediterranean visceral leishmaniasis (VL) or kala-azar is an endemic zoonotic disease in Iran. Domestic dogs are the primary reservoir host and source of VL infection. The high-risk populations are children and immune-deficient adults. OBJECTIVE Based on the lack of published reports about the VL in Sistan and Baluchestan province in the southeast of Iran, this study aimed to assess the seroprevalence of diseae in free-roaming dogs and children under 12 years old using indirect fluorescent antibody (IFA) test. METHODS This cross-sectional study was performed between 2018 and 2020 in Zahedan city, Sistan, and Baluchestan province. Blood samples were taken from 400 children under 12 years old with a fever history accompanied by at least another specific clinical presentation. In the same period, blood samples were collected from 150 stray dogs. Demographic characteristics and clinical manifestations in both humans and dogs were recorded. The IFA test examined all blood samples for the detection of anti-Leishmania infantum antibodies. RESULTS Overall, the IFA test results were positive in 8 dogs (5.33%). Only two seropositive dogs (25%) showed obvious clinical symptoms. There was a significant correlation between the positive cases, clinical signs (P = 0.046), and age (P = 0.037) in infected dogs. None of the collected sera from 400 febrile children were positive. CONCLUSION According to the present finding, it seems that VL is not endemic in Zahedan city, Sistan, and Baluchestan province, but the domestic cycle of L. infantum has been established in this area. Further investigations would be needed to estimate the status of VL infection in wild canines as a secondary potential reservoir host. Furthermore, periodic monitoring of disease must not be neglected.
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Affiliation(s)
- Baharak Akhtardanesh
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Shahid Bahonar University of Kerman, Kerman, Iran; Leishmaniasis Research Center, Kerman University of Medical Sciences, Kerman, Iran.
| | - Mahshid Mostafavi
- Leishmaniasis Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Javad Khedri
- Department of Pathobiology, Faculty of Veterinary Medicine, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Ayoob Fakhri
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Shahid Bahonar University of Kerman, Kerman, Iran
| | - Iraj Sharifi
- Leishmaniasis Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Mehdi Khoshsima Shahraki
- Department of Parasitology and Mycology, School of Medicine, Zabol University of Medical Science, Zabol, Iran
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Rostamian M, Bashiri H, Yousefinejad V, Bozorgomid A, Sohrabi N, Raeghi S, Khodayari MT, Ghadiri K, Rezaeian S. Prevalence of human visceral leishmaniasis in Iran: A systematic review and meta-analysis. Comp Immunol Microbiol Infect Dis 2020; 75:101604. [PMID: 33388595 DOI: 10.1016/j.cimid.2020.101604] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 12/03/2020] [Accepted: 12/10/2020] [Indexed: 01/08/2023]
Abstract
Leishmania infantum is the main cause of human visceral leishmaniasis (HVL; also known as kala-azar) in the Middle East and may be fatal if left untreated. This disease was first reported in 1949 in Iran. Despite marked improvements in hygiene and sanitation conditions, the disease is still endemic in some parts of Iran. It is difficult to determine the current prevalence of HVL in Iran due to the scarcity of comprehensive studies in this regard. In response to this gap, a systematic review and meta-analysis was conducted to gain better understanding of HVL epidemiology in the general population of Iran. English and Persian databases were searched for studies reporting the prevalence and risk factors associated with HVL in the Iranian people from January 1995 to December 2019. The reported data were selected according to inclusion and exclusion criteria. The pooled prevalence of HVL infection and its 95 % confidence intervals were calculated. Quality assessment, heterogeneity testing and publication bias assessment were also done. Literature search revealed 3634 studies, of which 35 studies met our eligibility criteria, with a total of 50,716 individuals. The meta-analysis was performed on 31 out of 35 included studies. The estimated pooled prevalence of HVL infection according to seropositivity was 2% (95 % CI: 1-2%) in the general population of Iran in which western and northern provinces had the lowest and the highest prevalence, 0.5 % (95 %CI, 0.2-0.7%) and 3% (95 %CI, 1-5 %), respectively. The seroprevalence of HVL among females (2%; 95 %CI, 1-2 %) was more than males (1%; 95 %CI, 1-2 %). The ≤10 and >10 years age groups had similar seroprevalence rates (1%, 95 %CI, 1-2 % versus 1%, 95 %CI, 0-1 %, respectively). There was no significant difference in terms of geographic area, age and sex. Of 31 studies included in the meta-analysis, the most common diagnostic test was the direct agglutination test (96.77 %). To the best of our knowledge, this is the first systematic review of the prevalence of HVL in Iran. The results showed a low seroprevalence of HVL infection. However, the lack of published reports of HVL in an area does not exclusively mean the absence of the disease or carrier. We therefore recommend further studies in this regard.
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Affiliation(s)
- Mosayeb Rostamian
- Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Homayoon Bashiri
- Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Vahid Yousefinejad
- Liver and Digestive Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Arezoo Bozorgomid
- Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Nasrollah Sohrabi
- Department of Medical Laboratory Sciences, School of Paramedical, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Saber Raeghi
- Department of Laboratory Sciences, Maragheh University of Medical Sciences, Maragheh, Iran
| | | | - Keyghobad Ghadiri
- Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shahab Rezaeian
- Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Heidari A, Mohebali M, Vahed M, Kabir K, Zarei Z, Akhoundi B, Elikaee S, Barati H, Sezavar M, Keshavarz H, Kakooei Z, Hajjaran H. Molecular and Seroepidemiological Survey of Visceral Leishmaniasis in Owned Dogs ( Canis familiaris) in New Foci of Rural Areas of Alborz Province, Central Part of Iran: A Cross-Sectional Study in 2017. J Arthropod Borne Dis 2020; 14:38-46. [PMID: 32766347 PMCID: PMC7382694 DOI: 10.18502/jad.v14i1.2702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 03/12/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Mediterranean form of visceral leishmaniasis (VL) is endemic among some provinces of Iran. The present study was designed to determine the prevalence of canine visceral leishmaniasis (CVL) in the owned dogs of the rural areas of Alborz Province near Tehran as the capital of Iran. Methods: This study conducted on 303 owned dogs that selected using a stratified random sampling method. The direct agglutination test (DAT) was used to determine the frequency of Vl. The spleen biopsy was taken from the serology-positive dogs for the confirmation of CVL in the suspected dogs. Nested PCR and sequencing methods were used to determine the type of Leishmania species in the dogs which were parasitological positive. Results: Overall, the DAT results of 9 dogs (2.97%, CI: 1.57–5.55) showed anti Leishmania antibodies at titers ≥ 1:320 indicating VL infection. One dog (0.33%, CI 95%: 0.06–1.85) showed clinical signs and symptoms of VL. There was a significant correlation between the positive cases of CVL and rural area (p< 0.001). The Leishmania was observed in the impression smears that were prepared from spleen biopsy of five the studied dogs. Leishmania infantum were confirmed in all them using nested–PCR assay. The sequence analysis of all five isolates was 95% similar to L. infantum. Conclusion: This study shows that domestic cycle of L. infantum has been established in rural areas of Alborz province where located near Tehran as capital city of Iran. It is necessary to increase the awareness and monitoring of the disease periodically.
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Affiliation(s)
- Aliehsan Heidari
- Department of Parasitology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Mehdi Mohebali
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,Center for Research of Endemic Parasites of Iran (CREPI), Tehran University of Medical Sciences, Tehran, Iran
| | - Mozhgan Vahed
- Center for Research of Endemic Parasites of Iran (CREPI), Tehran University of Medical Sciences, Tehran, Iran
| | - Kourosh Kabir
- Social Determinant of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Zabihollah Zarei
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Behnaz Akhoundi
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Samira Elikaee
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hojatallah Barati
- Center of Against Infectious Diseases, Health Depatment, Alborz University of Medical Sciences, Karaj, Iran
| | - Monireh Sezavar
- Department of Experimental Sciences, Faculty of Allied medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Hossein Keshavarz
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,Center for Research of Endemic Parasites of Iran (CREPI), Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Kakooei
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Homa Hajjaran
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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10
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Nourian M, Heidari A, Tajali S, Ghasemi E, Mohebali M, Heidari A. Paediatric visceral leishmaniasis: a retrospective study on clinical manifestations, demographic features and laboratory findings of hospitalised cases in Iran between 2006 and 2016. Trop Doct 2018; 49:59-61. [PMID: 30453836 DOI: 10.1177/0049475518811513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Visceral leishmaniasis (VL) is a neglected disease. Our retrospective study describes 38 clinical and epidemiological characteristics of VL in patients admitted to a paediatric hospital in Tehran, Iran, who came from different geographical regions, indicating that the disease has spread to most parts of the country. Some 76.3% of the children documented suffered with symptoms of the disease for two months before admission.
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Affiliation(s)
- Manijeh Nourian
- 1 Department of Pediatric Nursing, School of Nursing and midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Aliehsan Heidari
- 2 Department of Medical Parasitology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Saleheh Tajali
- 3 Neonatal Health Research Center, Mofid Pediatric Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Erfan Ghasemi
- 4 Department of Biostatistics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Mohebali
- 5 Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Heidari
- 6 Department of Internal Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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11
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Zanjirani Farahani L, Mohebali M, Akhoundi B, Saghafipour A, Kakooei Z. Seroepidemiological study on visceral leishmaniasis in an endemic focus of central Iran during 2017. J Parasit Dis 2018; 43:22-27. [PMID: 30956441 DOI: 10.1007/s12639-018-1049-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 10/24/2018] [Indexed: 11/28/2022] Open
Abstract
Visceral leishmaniasis (VL) is a serious parasitic disease that occurs in some areas of Iran as endemic and sporadic forms. Qom province in central Iran is one of the endemic foci of VL, which is an important issue due to existence of local population density, foreign travelers and resided migrants. This descriptive cross-sectional study that was conducted with the aim of evaluating seroprevalence of VL in the studied area. The research considers various risk factors like immigration and tourism for planning prevention and disease control programs. Random cluster sample selection applied and 960 blood samples collected from children up to 12 years of age. The samples were taken from 22 villages in four clusters, during 2017. A questionnaire was given to each individual after obtaining parental consent. All collected sera assessed by Direct Agglutination Test to detect anti-Leishmania infantum antibodies. The antibody titers of ≥ 1:3200, accompanied by clinical symptoms, considered as VL disease. Eventually, 3 (0.3%) cases showed anti-L. infantum antibodies with titers of ≥ 1:1600, while 2 of them (0.2%) had antibody titers of 1:3200 with no clinical manifestations. In order to investigate the increase of antibody, resampling performed after 2-3 weeks in which no antibody rising observed. The findings indicate that distribution pattern of VL is changing from endemic to sporadic form in rural areas of Qom province. Therefore, it is necessary to continue the surveillance by public health centers besides conducting further studies on VL reservoirs and vectors with the aim of VL control in the area.
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Affiliation(s)
- Leyli Zanjirani Farahani
- 1Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Mohebali
- 1Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Behnaz Akhoundi
- 1Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Abedin Saghafipour
- 2Department of Public Health, Faculty of Health, Qom University of Medical Sciences, Qom, Iran
| | - Zahra Kakooei
- 1Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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12
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Ghatee MA, Mirhendi H, Karamian M, Taylor WR, Sharifi I, Hosseinzadeh M, Kanannejad Z. Population structures of Leishmania infantum and Leishmania tropica the causative agents of kala-azar in Southwest Iran. Parasitol Res 2018; 117:3447-3458. [PMID: 30105405 DOI: 10.1007/s00436-018-6041-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 08/02/2018] [Indexed: 10/28/2022]
Abstract
Visceral leishmaniasis (VL) is endemic in Iran and is caused predominantly by Leishmania infantum, but L. tropica is emerging as an important cause. We studied the intra-species population structure of Leishmania spp. causing VL in southwest Iran by sequence analysis of the internal transcribed spacer (ITS) 1 of DNA samples from 29 bone marrow aspiration smears. L. infantum (n = 25) and L. tropica (n = 4) were identified, consisting of 10 and three ITS1 sequence types (STs), respectively. Compared to GenBank ITS1 STs, our L. infantum parasites displayed high heterogeneity but less heterogeneity compared than northwest Iranian isolates. VL affects mostly nomadic populations in southwest Iran, and their mobility may explain partly the L. infantum heterogeneity. The VL causing L. tropica was also genetically heterogeneous but genetically indistinguishable from L. tropica strains causing anthroponotic cutaneous leishmaniasis from southwest Iran.
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Affiliation(s)
- Mohammad Amin Ghatee
- Cellular and Molecular Research Center, Yasuj University of Medical Sciences, Yasuj, Iran. .,Department of Parasitology, School of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran.
| | - Hossein Mirhendi
- Department of Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehdi Karamian
- Cellular and Molecular Research Center, Birjand University of Medical Sciences, Birjand, Iran.,Infectious Diseases Research Centre, Birjand University of Medical Sciences, Birjand, Iran
| | - Walter R Taylor
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Iraj Sharifi
- Leishmaniasis Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Massood Hosseinzadeh
- Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Kanannejad
- Department of Immunology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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13
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Nourizadeh E, Zargar SJ, Alimohammadian MH, Ajdary S, Mahdavi M. Development of monoclonal antibodies against axenic amastigotes of Leishmania infantum strain in Iran: implication for diagnosis of Kala-azar. IRANIAN JOURNAL OF BASIC MEDICAL SCIENCES 2018; 21:388-394. [PMID: 29796222 PMCID: PMC5960755 DOI: 10.22038/ijbms.2018.25355.6264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 09/28/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Leishmaniasis is endemic in 88 countries. Amastigote forms of Leishmania are experts at exploiting host cell processes to establish infection. Monoclonal antibodies are key reagents used in the diagnosis of infectious and non-infectious diseases. The aim of this study was to produce monoclonal antibodies against axenic amastigotes of the Leishmaniainfantum strain in Iran. MATERIALS AND METHODS First, standard strains were cultured and axenic amastigote antigens of L. infantum were obtained. Since then, BALB/c smice were immunized and antibody titers were determined. For hybridoma cell formation, lymphocytes isolated from spleen of immunized mice and myeloma cells were fused at a ratio of 10 to 1 in the presence of polyethylene glycol, followed by limiting dilution for the isolation of monoclones. Subsequently, antibody isotypes were determined by using the isotyping kit. The best clone was injected intraperitoneally to pristane-primed mice for large scale production of monoclonal antibodies. The specificity of antibody was determined with Western blotting. RESULTS Approximately 25 positive monoclones were obtained, of which four hybrids producing anti-amastigotes L. infantum monoclonal antibodies with high optical density (OD), selected and designated as 8D2 FVI6, 8D2 FVI3, 6G2 FV4 and 6G2 FV3. Results from isotype determination showed the IgG2b sub-class in 6G2FV2 and 8D2FVI6 monoclones. CONCLUSION This study produced monoclonal antibody against amastigotes of Iranian strain of L. infantum for the first time. These antibodies have reactivity against Iranian strain of L. infantum and can be used in the diagnosis of Kala-azar.
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Affiliation(s)
- Ezzat Nourizadeh
- School of Biology, College of Science, University of Tehran, Tehran, Iran
- Faculty of Biology, College of Science, University of Mohaghegh Ardabili, Ardabil, Iran
| | - Seyed Jalal Zargar
- School of Biology, College of Science, University of Tehran, Tehran, Iran
| | | | - Soheila Ajdary
- Department of Immunology, Pasteur Institute of Iran, Tehran, Iran
| | - Mahdi Mahdavi
- Department of Immunology, Pasteur Institute of Iran, Tehran, Iran
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14
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Autoantibodies in a Three-Year-Old Girl with Visceral Leishmaniasis: A Potential Diagnostic Pitfall. Case Rep Infect Dis 2016; 2016:2081616. [PMID: 27418985 PMCID: PMC4935904 DOI: 10.1155/2016/2081616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 05/23/2016] [Indexed: 11/30/2022] Open
Abstract
Visceral leishmaniasis (VL), a life-threatening parasitic infection, is endemic in the Mediterranean region. Diagnosis of VL is based on epidemiologic, clinical, and laboratory findings. However, sometimes, clinical features and laboratory findings overlap with those of autoimmune diseases. In some cases, autoantibodies are detected in patients with VL and this could be a potential diagnostic pitfall. In this study, we have reported on a three-year-old girl from a VL-endemic area in Iran, who presented with prolonged fever and splenomegaly. Bone marrow examination, serologic tests, and the molecular PCR assay were performed; however, results were inconclusive. The levels of anti-double stranded DNA, cytoplasmic antineutrophil cytoplasmic autoantibody, and perinuclear antineutrophil cytoplasmic autoantibody were elevated and, at the end, splenic biopsy was performed. The splenic tissue PCR test detected the DNA of Leishmania infantum. The patient's condition improved with anti-Leishmania therapy, and the autoantibodies disappeared within the following four months. Clinical presentations and laboratory findings of VL and autoimmune diseases may overlap in some patients.
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