Visceral Leishmaniasis in Southeastern Iran: A Narrative Review
AbstractBackground: Visceral leishmaniasis (VL) has strong links with poverty, substantial medical and veterinary impacts. This review aimed to focus in studies published during 1994-2016 on VL in southeastern Iran.Methods: The present review is based on expert knowledge and historical studies published during the past 23 yr (1994-2016) on VL in southeastern Iran. In addition, related literature found in PubMed by using the keywords such as visceral leishmaniasis, kala-azar, and Leishmania infantum are included.Results: Overall, 118 children aged 4.2 yr were detected as infected with human VL (HVL). The majority of the cases were from Orzoieh district (37.1%) in southwest of Kerman Province, followed by Sirjan (15.7%), Jiroft (14.8%), Kahnuj (9.3%) and to lesser extent from other areas. The male to female ratio was 1.7. The three most frequent clinical features were represented by fever (100.0%), anemia (95.0%) and splenomegaly (91.5%). Altogether, 42.0% of the VL cases developed secondary bacterial infections, the overall case-fatality rate was 3.4%, and majorities (88.0%) of the VL patients were undernourished. Overall, 733 dogs and wild canines were examined by different techniques with various seroprevalence ranges.Conclusion: In southeastern Iran, VL is endemic in Orzoieh district in Kerman Province. While the dogs are implicated as the main domestic reservoir of VL, wide range of wild canines can serve as a secondary potential reservoir host.
Clinical and epidemiological data on the spatial distribution and prevalence of HVL and CVL are essential for planning and im-plementing appropriate control strategies.
VL in Orzoieh district is endemic, while it is sporadic to some extent in other districts in southeastern Iran.
Early detection of HVL cases, prompt treatment and integrated vector management by active and passive case detection approaches through an effective health surveillance system should receive high priority.
Since stray and feral dogs pose serious human and welfare problems, veterinary ser-vices should play a leading role in dog population control; to improve health and welfare of owned and stray dog population and to reduce numbers of stray dogs to an acceptable level.
A combination of applicable parasitological, serological and molecular methods are curtailed for the detection of the extent of infection in human and dogs in en-demic areas, particularly those with latent and/or apparent manifestations in order to understand their role in epidemiology of ZVL.
Detection and surveillance of VL status in immunocompromised patients should receive special attention in future planning.
The authors declare that there is no conflict of interests.
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