Visceral Leishmaniasis in Southeastern Iran: A Narrative Review

Background: 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.

Acknowledgements

The authors declare that there is no conflict of interests.

References

Desjeux P. Leishmaniasis: current situation and new perspectives. Comp Immunol Microbiol Infect Dis. 2004; 27(5):305–18.

Postigo JA. Leishmaniasis in the World Health Organization Eastern Mediterranean Region. Int J Antimi-crob Agents. 2010; 36 Suppl 1:S62-5.

World Health Organization (WHO) (2010). Control of the leishmaniases. Report of a meeting of the WHO Ex-pert Committee on the Control of Leishmaniases, WHO Technical Re-port Series 949, Geneva, pp 1–187.

Alvar J, Velez ID, Bern C, Herrero M, Desjeux Ph, Cano J, Jannin J, den Boer M. WHO Leishmaniasis Control Team. Leishmaniasis worldwide and global estimates of its incidence. PLoS One. 2012; 7(5):e35671.

Alvar J, Yactayo S, Bern C. Leishmaniasis and poverty. Trends Parasitol. 2006; 22(12):552-7.

Chappuis F, Sundar S, Hailu A, Ghalib H, Rijal S, et al. Visceral leishmaniasis: what are the needs for diagnosis, treatment and control? Nat Rev Microbiol. 20007; 5(11):873-82.

Desjeux P. The increase of risk factors for leishmaniasis worldwide. Trans R Soc Trop Med Hyg. 2001; 95(3):239–43.

Bañuls AL, Hide M, Prugnolle F. Leishmania and the leishmaniases: a parasite genetic update and advances in taxonomy, epidemiology and path-ogenicity in humans. Adv Parasitol. 2007; 64:1-109.

Paul D Ready. Epidemiology of visceral leish-maniasis. Clin Epidemiol. 2014; 6: 147–154.

Bokai S, Mobedi I, Edrissian GH, Nadim A. Seroepidemiological study of canine visceral leishmaniasis in Meshkin Shahr, northwest of Iran. Arch Inst Razi.1998; 41(6):48–9.

Edrissian Gh H, Nadim A, Alborzi AV, Ardehali S. Visceral leishmaniasis: the Iranian experiences. Arch Iran Med. 1998; 1:22–6.

Fakhar M, Rahmati B, Gohardehi S, Mohebali M, Akhoundi B, Sharif M, Ali Mahdavi S. Molecular and seroepidemiological survey of visceral leishmaniasis among humans and domestic dogs in Mazandaran Province, north of Iran. Iran J Parasitol. 2011; 6(4):51-59.

Fakhar M, Asadi Kia A, Gohardehi S, Sharif M, Mohebali M, Akhoundi B, Pagheh A, Dadi-moghadam Y, Cheraghali F. Emergence of a new focus of visceral leishmaniasis due to Leishmania infantum in Golestan Province, north-eastern of Iran. J Parasit Dis. 2014:38 (3); 255-9.

Mohebali M, Edrissian GH, Shirzadi MR et al. An observational study on the current distribution of visceral leishmaniasis in different geographical zones of Iran and implication to health policy. Travel Med Infect Dis. 2011; 9(2):67–74.

Mohebali M. Visceral leishmaniasis in Iran: review of the epidemiological and clinical features. Iran J Parasitol. 2013; 8(3):348-58.

Mahmoudvand H, Mohebali M, Shariﬁ I, Keshavarz H, Hajjaran H, Akhoundi B, Jahan-bakhsh S, Zarean M, Javadi A. Epidemiological aspects of visceral leishmaniasis in Baft district, Kerman province, Southeast of Iran. Iran J Par-asitol. 2011; 6(1):1–11.

Mohammadi M, Sharifi I, Keshavarz H. Seroep-idemiology of visceral leishmaniasis in children under 12 years of age in nomads of Jiroft district using indirect immunoabsorbent assay, 2001. 4th National Iranian Congress of Parasitology and Parasitic Diseases. Oct 13-16, 2003 Mashhad, Iran.

Rakhshanpour A, Mohebali M, Akhondi B, Rahimi MT, Rokni MB. Serological survey and associated risk factors of visceral leishmaniasis in Qom Province, Central Iran. Iran J Public Health. 2014; 43(1):50-55.

Sarkari B, Pedram N, Mohebali M, Moshfe AA, Zargar MA, Akhoundi B, Shirzadi MR. Seroepi-demiological study of visceral leishmaniasis in Booyerahmad district, south-west Islamic Republic of Iran. East Mediterr Health J. 2010; 16(11):1133–6.

Desjeux P, Ghosh RS, Dhalaria P, Strub-Wourgaft N, Zijlstra EE. Report of the post kala-azar dermal leishmaniasis (PKDL), Consortium Meeting, New Delhi, India, 27–29 June 2012. Parasit Vectors. 2013; 6:196.

Aflatoonian MR, Akhtardanesh B, Sharifi I, Mo-stafavi M, Aflatoonian B, Khalili M, Ghanbarpour R, Baniaasadi M. Seroepidemiology of canine visceral leishmaniasis in Kerman city,2011. J Kerman Univ Med Sci. 2012; 19(6):531-539.

Bamorovat M, Sharifi I, Mohammadi MA et al. Canine visceral leishmaniasis in Kerman, southeast of Iran: a seroepidemiological, histo-pathological and molecular study. Iran J Parasitol. 2014; 9(3):342-9.

Kamiabi IT, Sharifi I, Daneshvar H, Mohammodi Z. Comparative study for diagnosis of canine visceral leishmaniasis using IFA and nested PCR in the endemic area of Iran. Proceedings of 2nd International and 9th National Congress of Parasitology and Parasitic Diseases of Iran (NICOPA9). Iran J Parasitol, 2015; 10(1): 192.

Gavgani AS, Mohite H, Edrissian GH, Mohebali M, Davies CR. Domestic dog ownership in Iran is a risk factor for human infection with Leishmania infantum. Am J Trop Med Hyg. 2002; 67(5): 511-5.

Mohebali M, Hajjaran H, Hamzavi Y, Mobedi I, Arshi S, Zarei Z, Akhoundi B , Naeini KM, Avizeh R, Fakhar M. Epidemiological aspects of canine visceral leishmaniasis in the Islamic Republic of Iran. Vet Parasitol. 2005; 129(3-4):243-251.

Mahshid M, Baharak A, Iraj S, Sina K, Javad K, Mehdi B. Seroprevalence of canine visceral leishmaniasis in southeast of Iran. J Parasit Dis. 2014; 38(2):218–22.

Naderi A, Sharifi I, Babaei Z, Dabiri S, Mashayekhi J, Bamorovat M, Mostafavi M. Epidemiology and clinical manifestations of visceral leishmaniasis and species identity in domestic digs using ELISA, nested- PCR and histopatological techniques in southeastern districts of Kerman province, Iran in 2013. Proceedings of 2nd International and 9th National Congress of Parasitology and Parasitic Diseases of Iran (NICOPA9). Iran J Parasitol. 2015; 10(1): 178.

Andrade TM. Carvalho EM, Rocha H. Bacterial infections in patients with visceral leishmaniasis. J Infect Dis. 1999; 162(6): 1354-9.

Barati M, Daie Parizi HM, Shariﬁ I. Epidemiological and clinical aspects of kala-azar in hospitalized children of Kerman province, during 1991–2006. J Kerman Univ Med Sci. 2008; 15(2):148–155.

McGwire BS, Satoskar AR. Leishmaniasis: clinical syndromes and treatment. QJM. 2014; 107(1):7-14.

Riera C, Fisa R, Udina M, Gállego M, Portus M. Detection of Leishmania infantum cryptic infection in asymptomatic blood donors living in an endemic area (Eivissa, Balearic Islands, Spain) by different diagnostic meth-ods. Trans R Soc Trop Med Hyg. 2004; 98(2):102-10.

Niknafs P, Daie Parizi M, Ahmadi A. Report of 40 cases of Kala-azar from Kerman province. J Kerman Univ of Med Sci. 1994; 1:30-37.

Harith A el, Slappendel RJ, Reiter I, van Knapen F, de Korte P, Huigen E, Kolk AH. Application of a direct agglutination test for detection of specific anti-Leishmania antibodies in the canine reservoir. J Clin Microbiol. 1989; 27(10):2252-2257.

Keshavarz H, Zangiabadi M, Mamishi S. Epi-demiology of visceral leishmaniasis in children under 12 years old in Baft district by indirect immunofluorescent antibody test (IFAT), 1994. 2nd National Congress of Parasitic Diseases. Oct 19-22, 1997 Tehran, Iran, P88.

Mohammadiha A, Haghighi A, Mohebali M et al. Canine visceral leishmaniasis: a comparative study of real-time PCR, conventional PCR, and direct agglutination on sera for the detection of Leishmania infantum infection. Vet Parasitol. 2013; 192(1-3):83-90.

Solano-Gallego L, Morell P, Arboix M, Alberola J, Ferrer L. Prevalence of Leishmania infantum infection in dogs living in an area of canine leishmaniasis endemicity using PCR on several tissues and serology. J Clin Microbiol. 2001; 39(2):560-3.

Aghaei Afshar A, Rasi Y, Ebaei MR, Aghaei Afshar M. Determination of fauna and monthly activity of sandflies in the south of Baft district, Kerman province in 2004. J Kerman Univ of Med Sci. 2005; 12(2):136-41.

Guan LR, Xu YX, Li BS, Dong J. The role of Phlebotomus alexandri Sinton, 1928 in the transmission of kala-azar. Bull World Health Organ. 1986; 64(1): 107–112.

Freitas-Junior LH, Chatelain E, Kim HA, Siqueira-Neto JL. Visceral leishmaniasis treatment: what do we have, what do we need and how to deliver it? Int J Parasitol Drugs Drug Resist. 2012; 2:11–19.

Tofighi Naeem A, Mahmoudi S, Sabouni F, Hajjaran H, Pourakbari B, Mohebali M, Zarkesh MR, Mamishi S. Clinical features and laboratory findings of visceral leishmaniasis in children re-ferred to Children Medical Center Hospital, Tehran, Iran during 2004-2011. Iran J Parasitol. 2014; 9(1): 1-5.

Barati M, Sharifi I, Daie Parizi M, Fasihi Harandi M. Bacterial infections in children with visceral leishmaniasis: observations made in Kerman province, southern Iran, between 1997 and 2007. Ann Trop Med Parasitol. 2008; 102(7):635-41.

Maia-Elkhoury AN, Carmo EH, Sousa-Gomes ML, Mota E. Analysis of visceral leishmaniasis reports by the capture-recapture method. Rev Saude Publica. 2007; 41(6): 931–7.

Singh VP, Ranjan A, Topno RK et al. Estimation of under-reporting of visceral leishmaniasis cases in Bihar, India. Am J Trop Med Hyg. 2010; 82(1): 9–11.

Hosseininasab A, Sharifi I, Daei MH et al. Causes of pediatric visceral leishmaniasis in southeastern Iran. Iran J Parasitol. 2014; 9(4):584-587.

Bamorovat M, Sharifi I, Dabiri SH et al. Leishmania tropica in stray dogs in southeast Iran. Iran J Public Health. 2015; 44(10): 1359-1366.

Shariﬁ I, Daneshvar H. The prevalence of visceral leishmaniasis in sus-pected canine reservoirs in southeast-ern Iran. Iran J Med Sci. 1998; 21(3):130–4.

Magill AJ, Grogl M, Gasser RAJr, Sun W, Oster CN. Visceral infection caused by Leishmania tropica in veterans of Operation Desert Storm. N Engl J Med. 1993;328(19):1383-7.

Costa CH, Stewar JM, Gomes RB, Garcez LM, Ramos PK, et al. Asymptomatic carriers of Leishmania chagasi. Am J Trop Med Hyg. 2002; 66(4): 334-7.

Fakhar M, Motazedian MH, Hatam GR, Asgari Q, Kalantari M, Mohebali M. Asymptomatic human carriers of Leishmania infantum: possible reservoirs for Mediterranean visceral leishmaniasis in southern Iran. Ann Trop Med Parasitol. 2008; 102(7):577-83.

Moreno J, Alvar J. Canine leishmaniasis: epide-miological risk and the experimental model.Trends Parasitol. 2002; 18(9):399-405.

Moshfe A, Mohebali M, Edrissian G, Zarei Z, Akhoundi B, Kazemi B, Jam-shidi S, Mahmoodi M. Canine visceral leishmaniasis: asymptomatic infected dogs as a source of L. infantum infection. Acta Trop. 2009; 112(2):101-5.

Molina R, Amela C, Nieto J, San-Andrés M, González F, Castillo JA, Lucientes J, Alvar J. In-fectivity of dogs naturally infected with Leishmania infantum to colonized Phlebotomus perniciosus. Trans R Soc Trop Med Hyg. 1994; 88(4):491-3.

Millán J, Ferroglio E, Solano-Gallego L. Role of wildlife in the epidemiology of Leishmania infantum infection in Europe. Parasitol Res. 2014; 113(6):2005-14.

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Issue	Vol 12 No 1 (2017)
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Keywords
Visceral leishmaniasis Kala-azar Leishmania infantum Iran

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SHARIFI I, AFLATOONIAN MR, DAEI PARIZI MH, HOSSEININASAB A, MOSTAFAVI M, BAMOROVAT M, AGHAEI AFSHAR A, MOHEBALI M, KESHAVARZ H, DANESHVAR H, BABAEI Z, MAHMOUDVAND H, MOHAMMADI MA, SHARIFI F, BARATI M, KAMIABI H, KHALEGHI T. Visceral Leishmaniasis in Southeastern Iran: A Narrative Review. Iran J Parasitol. 2017;12(1):1-11.

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