Cutaneous Leishmaniasis in Diyala Province from Eastern Part of Iraq during the Period of 2011 to 2021
,
Abstract
Background: Cutaneous leishmaniasis (CL) is a neglected tropical disease endemic in Iraq. However, epidemiological data from Diyala Province are limited. Diyala province is located in eastern of Iraq, on the border with Iran, and adjacent to Kermanshah Province, Iran. We investigated the prevalence and distribution of CL in Diyala Province from 2011-2021.
Methods: Anonymous patient records on 25,474 confirmed CL cases in Diyala during 2011-2021 were analyzed to determine demographic, temporal, and geographic distributions.
Results: Overall, 52% of cases occurred in females and 48% in males. The 5-14 yr age group had the highest burden (33%) while infants <1 year had the lowest (5%). Annual cases peaked at 4,425 in 2015 but declined to 2,158 by 2021. Among districts, Khanaqeen had the most cases (28%) while Mansouriyah had the least (10%). Monthly cases peaked in winter (November-February) and were lowest in summer (June-August).
Conclusion: A high burden of CL was observed in Diyala during 2011-2021, with the highest risk among children. Significant geographic and seasonal variations were also evident. These findings can inform prevention and control strategies. The prevalence in this province in 2019 was 126 per 100000.
1. Sasidharan S, Saudagar P. Leishmaniasis: where are we and where are we heading? Parasitol Res. 2021;120(5):1541-54.
2. Saini I, Joshi J, Kaur S. Unwelcome prevalence of leishmaniasis with several other infectious diseases. Int. Immunopharmacol. 2022; 110:109059.
3. Abadías-Granado I, Diago A, Cerro PA, Palma-Ruiz AM, Gilaberte YJ. Cutaneous and mucocutaneous leishmaniasis. Actas Dermosifiliogr (Engl Ed). 2021; S0001-7310(21)00108-3.
4. World Health Organization. Report of a meeting of the WHO Expert Committee on the Control of Leishmaniases, Geneva. 2010; 22-26.
5. de Vries HJ, Schallig HD. Cutaneous leishmaniasis: a 2022 updated narrative review into diagnosis and management developments. Am J Clin Dermatol. 2022 ;23(6):823-40.
6. Torres-Guerrero E, Quintanilla-Cedillo MR, Ruiz-Esmenjaud J, Arenas R. Leishmaniasis: a review. F1000Res. 2017; 6:750.
7. Moya-Salazar J, Pasco IA, Cañari B, Contreras-Pulache H. Cutaneous leishmaniasis associated with the level of poverty of the Andean rural population: A five-year single-center study. Electron J Gen Med. 2021; 18 (6): em335.
8. Ujiie H, Rosmarin D, Schön MP, Ständer S, Boch K, Metz M, Maurer M, Thaci D, Schmidt E, Cole C, Amber KT. Unmet medical needs in chronic, non-communicable inflammatory skin diseases. Front Med (Lausanne). 2022; 9:875492.
9. Abdul-Hussein A, Yousif A, Abed O, Jabbar A. Cutaneous leishmaniasis: A clinicoepidemiological study in Al-Muthanna Governorate, Iraq. Al- Anbar Med J. 2023; 19(1): 30−35.
10. Salam N, Al-Shaqha WM, Azzi A. Leishmaniasis in the middle East: prevalence and epidemiology. PLoS Negl Trop Dis. 2014; 8(10):e3208.
11. Rahi AA, Hashim ZK, Al-Jamea AM. Epidemiological Study of Cutaneous Leishmaniasis in Wasit Province. Indian J Forensic Med Toxicol. 2021; 15(4):526-529.
12. Singh V, Kumar A, editors. Visceral Leishmaniasis and Post-kala-azar Dermal Leishmaniasis: Pathogenesis, Treatment and Disease Control. 1st Ed. CRC Press; 2025.
13. Farooq I, Singh R, Selvapandiyan A, Ganguly NK. The Burden of Visceral Leishmaniasis: Need of Review, Innovations, and Solutions. In Challenges and Solutions Against Visceral Leishmaniasis. Singapore: Springer Nature Singapore. 2023. 28 (pp. 1-17).
14. Deb RM. Hurdles to achieving effective vector control for visceral leishmaniasis elimination in India. [PhD dissertation]. The University of Liverpool (United Kingdom); 2022.
15. Abid BK. Epidemiological study of the Kala azar cases in Iraq for years 1999-2003 . Iraqi J Vet Med. 2004; 28(1):168-180.
16. Ali MA, Khamesipour A, Rahi AA, Mohebali M, Akhavan AA. Epidemiological study of cutaneous leishmaniasis in some Iraqi provinces. Journal of Men's Health. 2018; 14(4):18-24.
17. AlSamarai AM, AlObaidi HS. Cutaneous leishmaniasis in Iraq. J Infect Dev Ctries. 2009; 3:123–129.
18. Alaa NH. Epidemiology of skin diseases in Tikrit and vicinity: a community based study. [MSc thesis] Tikrit University College of Medicine. 2002.
19. Murtada SJ. Epidemiology of skin diseases in Kirkuk. [MSc thesis], Tikrit University College of Medicine. 2001.
20. Alsamarai AGM. Prevalence of Skin Diseases in Samara, Iraq. Int J Dermatol. 2009; 48(7):734-9.
21. Faulde M, Schrader J, Heyl G, Amirih M. Differences in transmission seasons as an epidemiological tool for characterization of anthroponotic and zoonotic cutaneous leishmaniasis in northern Afghanistan. Acta Trop. 2008; 105:131-138.
22. Jorquera A, Ledezma E, Sousa L, et al. Epidemiologic characterization of American cutaneous leishmaniasis in an endemic region of Eastern Veezula. Am J Trop Med Hyg 1998; 58:589-593.
23. Akcali C, Culha G, Inaloz HS, Savaş N, Önlen Y, Savaş L, Kırtak N. Cutaneous leishmaniasis in Hatay. J Turk Acad Dermatol. 2007; 1:1.
24. Al-Cindan Y, Abdul-Aziz O, Kubba R. Cutaneous leishmaniasis in Al-Hassa, Saudi Arabia. Int J Dermatol. 1984; 23 (3):194–197.
25. Al-Taqi M, and Behbehani K. Cutaneous leishmaniasis in Kuwait. Ann Trop Med Parasitol. 1980; 74(5): 495–501.
26. Al-Tawfiq JA, AbuKhamsin A. Cutaneous leishmaniasis: a 46-year study of the epidemiology and clinical features in Saudi Arabia (1956–2002). Int J Infect Dis. 2004; 8(4): 244–250.
27. Al-Sabawi BH, Al-kallak SN, Al-Niaeemi BH. Cutaneous Leishmanasis and Health Awareness to Prevent its Spread in Nineveh Governorate, Iraq. Ann Rom Soc Cell Biol. 2021;25(4):10937-48.
28. Al-Naimy AF, Al-Waaly AB. Investigation of Cutaneous Leishmaniasis Cases in Baghdad province, Iraq. Medico Legal Update. 2021; 21(1):65-9.
29. Sanei-Dehkordi A, Soleimani-Ahmadi M, Zare M, Mirzaei H. Epidemiological features of cutaneous leishmaniasis and distribution of sand flies in an endemic area in southeast of Iran. Parasite Epidemiol Control. 2021; 14:e00220.
30. Talari SA, Shajari G, Talaei RClinical finding of cutaneous leishmaniasis as a new focus of Iran. Internet J Infect Dis. 2005; 5 (2):1-5.
31. Al Zadawi KA, Al-Nori TA, Ali BM, Al-Diwand JK. Knowledge about Cutaneous Leishmaniasis among the population in Baghdad Iraq, 2021. Iraqi New Medical Journal. 2024; 10(20): 82-88.
32. Wesołowska A. Sex—the most underappreciated variable in research: insights from helminth-infected hosts. Vet Res. 2022; 53(1):94.
33. Sellau J, Hansen CS, Gálvez RI, et al. Immunological clues to sex differences in parasitic diseases. Trends Parasitol. 2024; 40(11):1029-1041.
34. Bailey MS and Diana NJ. Cutaneous leishmaniasis. Clin Dermatol. 2007; 25: 203-211.
35. Fellah H, Rhajoui M, Ouahabi S, Belghiti D and Lyagoubi M.Occurrence of Human Cutaneous Leishmaniasis in Zouagha My Yacoub Province (Morocco). Int J Agri Biol. 2007; 9 (1):197-198.
36. Alzahrani MJ, Elfaki N, Abdalla YHA, et al. Cutaneous leishmaniasis: Associated risk factors and prevention in Hubuna, Najran, Saudi Arabia. Int J Gen Med. 2023; 16: 723–731.
37. Pearson R, and S. De Queiroz, “Leishmania Species: visceral (kala-azar), cutaneous, and mucosal leishmaniasis,” in Principles and Practice of Infectious Diseases, G. Mandell, J. Bennett, and R. Dolin, Eds., 4th ed.New York, NY: Churchill Livingstone, 1995, P. 2434.
38. Ramirez JR, Agudelo S, Muskus C, et al. Diagnosis of cutaneous leishmaniasis in Colombia: the sampling site within lesions influences the sensitivity of parasitologic diagnosis. J Clin Microbiol. 2000; 38:3768-3773.
39. Courtenay O, Peters NC, Rogers ME, Bern C. Combining epidemiology with basic biology of sand flies, parasites, and hosts to inform leishmaniasis transmission dynamics and control. PLoS Pathog. 2017; 13(10):e1006571.
40. Githeko AK, Lindsay SW, Confalonieri UE, Patz JA. Climate change and vector-borne diseases: A regional analysis. Bull World Health Organ. 2000; 78(9):1136-47.
41. Darkaoui N, Idrisi AJ, Talbi FZ, et al. Seasonal dynamics of sand flies (Diptera, Pshycodidae), vectors of cutaneous leishmaniasis, in the City of Fez, Northern Morocco. ScientificWorldJournal. 2022; 2022:4095129.
42. Asadi A, Moradinazar M, Marzbani B, et al. Epidemiological Study of Cutaneous Leishmaniasis in Kermanshah Province, 2011-2019. J Mazandaran Univ Med Sci. 2022; 32 (212): 155-162.
2. Saini I, Joshi J, Kaur S. Unwelcome prevalence of leishmaniasis with several other infectious diseases. Int. Immunopharmacol. 2022; 110:109059.
3. Abadías-Granado I, Diago A, Cerro PA, Palma-Ruiz AM, Gilaberte YJ. Cutaneous and mucocutaneous leishmaniasis. Actas Dermosifiliogr (Engl Ed). 2021; S0001-7310(21)00108-3.
4. World Health Organization. Report of a meeting of the WHO Expert Committee on the Control of Leishmaniases, Geneva. 2010; 22-26.
5. de Vries HJ, Schallig HD. Cutaneous leishmaniasis: a 2022 updated narrative review into diagnosis and management developments. Am J Clin Dermatol. 2022 ;23(6):823-40.
6. Torres-Guerrero E, Quintanilla-Cedillo MR, Ruiz-Esmenjaud J, Arenas R. Leishmaniasis: a review. F1000Res. 2017; 6:750.
7. Moya-Salazar J, Pasco IA, Cañari B, Contreras-Pulache H. Cutaneous leishmaniasis associated with the level of poverty of the Andean rural population: A five-year single-center study. Electron J Gen Med. 2021; 18 (6): em335.
8. Ujiie H, Rosmarin D, Schön MP, Ständer S, Boch K, Metz M, Maurer M, Thaci D, Schmidt E, Cole C, Amber KT. Unmet medical needs in chronic, non-communicable inflammatory skin diseases. Front Med (Lausanne). 2022; 9:875492.
9. Abdul-Hussein A, Yousif A, Abed O, Jabbar A. Cutaneous leishmaniasis: A clinicoepidemiological study in Al-Muthanna Governorate, Iraq. Al- Anbar Med J. 2023; 19(1): 30−35.
10. Salam N, Al-Shaqha WM, Azzi A. Leishmaniasis in the middle East: prevalence and epidemiology. PLoS Negl Trop Dis. 2014; 8(10):e3208.
11. Rahi AA, Hashim ZK, Al-Jamea AM. Epidemiological Study of Cutaneous Leishmaniasis in Wasit Province. Indian J Forensic Med Toxicol. 2021; 15(4):526-529.
12. Singh V, Kumar A, editors. Visceral Leishmaniasis and Post-kala-azar Dermal Leishmaniasis: Pathogenesis, Treatment and Disease Control. 1st Ed. CRC Press; 2025.
13. Farooq I, Singh R, Selvapandiyan A, Ganguly NK. The Burden of Visceral Leishmaniasis: Need of Review, Innovations, and Solutions. In Challenges and Solutions Against Visceral Leishmaniasis. Singapore: Springer Nature Singapore. 2023. 28 (pp. 1-17).
14. Deb RM. Hurdles to achieving effective vector control for visceral leishmaniasis elimination in India. [PhD dissertation]. The University of Liverpool (United Kingdom); 2022.
15. Abid BK. Epidemiological study of the Kala azar cases in Iraq for years 1999-2003 . Iraqi J Vet Med. 2004; 28(1):168-180.
16. Ali MA, Khamesipour A, Rahi AA, Mohebali M, Akhavan AA. Epidemiological study of cutaneous leishmaniasis in some Iraqi provinces. Journal of Men's Health. 2018; 14(4):18-24.
17. AlSamarai AM, AlObaidi HS. Cutaneous leishmaniasis in Iraq. J Infect Dev Ctries. 2009; 3:123–129.
18. Alaa NH. Epidemiology of skin diseases in Tikrit and vicinity: a community based study. [MSc thesis] Tikrit University College of Medicine. 2002.
19. Murtada SJ. Epidemiology of skin diseases in Kirkuk. [MSc thesis], Tikrit University College of Medicine. 2001.
20. Alsamarai AGM. Prevalence of Skin Diseases in Samara, Iraq. Int J Dermatol. 2009; 48(7):734-9.
21. Faulde M, Schrader J, Heyl G, Amirih M. Differences in transmission seasons as an epidemiological tool for characterization of anthroponotic and zoonotic cutaneous leishmaniasis in northern Afghanistan. Acta Trop. 2008; 105:131-138.
22. Jorquera A, Ledezma E, Sousa L, et al. Epidemiologic characterization of American cutaneous leishmaniasis in an endemic region of Eastern Veezula. Am J Trop Med Hyg 1998; 58:589-593.
23. Akcali C, Culha G, Inaloz HS, Savaş N, Önlen Y, Savaş L, Kırtak N. Cutaneous leishmaniasis in Hatay. J Turk Acad Dermatol. 2007; 1:1.
24. Al-Cindan Y, Abdul-Aziz O, Kubba R. Cutaneous leishmaniasis in Al-Hassa, Saudi Arabia. Int J Dermatol. 1984; 23 (3):194–197.
25. Al-Taqi M, and Behbehani K. Cutaneous leishmaniasis in Kuwait. Ann Trop Med Parasitol. 1980; 74(5): 495–501.
26. Al-Tawfiq JA, AbuKhamsin A. Cutaneous leishmaniasis: a 46-year study of the epidemiology and clinical features in Saudi Arabia (1956–2002). Int J Infect Dis. 2004; 8(4): 244–250.
27. Al-Sabawi BH, Al-kallak SN, Al-Niaeemi BH. Cutaneous Leishmanasis and Health Awareness to Prevent its Spread in Nineveh Governorate, Iraq. Ann Rom Soc Cell Biol. 2021;25(4):10937-48.
28. Al-Naimy AF, Al-Waaly AB. Investigation of Cutaneous Leishmaniasis Cases in Baghdad province, Iraq. Medico Legal Update. 2021; 21(1):65-9.
29. Sanei-Dehkordi A, Soleimani-Ahmadi M, Zare M, Mirzaei H. Epidemiological features of cutaneous leishmaniasis and distribution of sand flies in an endemic area in southeast of Iran. Parasite Epidemiol Control. 2021; 14:e00220.
30. Talari SA, Shajari G, Talaei RClinical finding of cutaneous leishmaniasis as a new focus of Iran. Internet J Infect Dis. 2005; 5 (2):1-5.
31. Al Zadawi KA, Al-Nori TA, Ali BM, Al-Diwand JK. Knowledge about Cutaneous Leishmaniasis among the population in Baghdad Iraq, 2021. Iraqi New Medical Journal. 2024; 10(20): 82-88.
32. Wesołowska A. Sex—the most underappreciated variable in research: insights from helminth-infected hosts. Vet Res. 2022; 53(1):94.
33. Sellau J, Hansen CS, Gálvez RI, et al. Immunological clues to sex differences in parasitic diseases. Trends Parasitol. 2024; 40(11):1029-1041.
34. Bailey MS and Diana NJ. Cutaneous leishmaniasis. Clin Dermatol. 2007; 25: 203-211.
35. Fellah H, Rhajoui M, Ouahabi S, Belghiti D and Lyagoubi M.Occurrence of Human Cutaneous Leishmaniasis in Zouagha My Yacoub Province (Morocco). Int J Agri Biol. 2007; 9 (1):197-198.
36. Alzahrani MJ, Elfaki N, Abdalla YHA, et al. Cutaneous leishmaniasis: Associated risk factors and prevention in Hubuna, Najran, Saudi Arabia. Int J Gen Med. 2023; 16: 723–731.
37. Pearson R, and S. De Queiroz, “Leishmania Species: visceral (kala-azar), cutaneous, and mucosal leishmaniasis,” in Principles and Practice of Infectious Diseases, G. Mandell, J. Bennett, and R. Dolin, Eds., 4th ed.New York, NY: Churchill Livingstone, 1995, P. 2434.
38. Ramirez JR, Agudelo S, Muskus C, et al. Diagnosis of cutaneous leishmaniasis in Colombia: the sampling site within lesions influences the sensitivity of parasitologic diagnosis. J Clin Microbiol. 2000; 38:3768-3773.
39. Courtenay O, Peters NC, Rogers ME, Bern C. Combining epidemiology with basic biology of sand flies, parasites, and hosts to inform leishmaniasis transmission dynamics and control. PLoS Pathog. 2017; 13(10):e1006571.
40. Githeko AK, Lindsay SW, Confalonieri UE, Patz JA. Climate change and vector-borne diseases: A regional analysis. Bull World Health Organ. 2000; 78(9):1136-47.
41. Darkaoui N, Idrisi AJ, Talbi FZ, et al. Seasonal dynamics of sand flies (Diptera, Pshycodidae), vectors of cutaneous leishmaniasis, in the City of Fez, Northern Morocco. ScientificWorldJournal. 2022; 2022:4095129.
42. Asadi A, Moradinazar M, Marzbani B, et al. Epidemiological Study of Cutaneous Leishmaniasis in Kermanshah Province, 2011-2019. J Mazandaran Univ Med Sci. 2022; 32 (212): 155-162.
| Files | ||
| Issue | Vol 20 No 3 (2025) | |
| Section | Original Article(s) | |
| Keywords | ||
| Cutaneous leishmaniasis Prevalence Parasitology Iraq | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Mahdi Hamad E, Ghaffarifar F, Dalimi A. Cutaneous Leishmaniasis in Diyala Province from Eastern Part of Iraq during the Period of 2011 to 2021. Iran J Parasitol. 2025;20(3):400-407.
