Visceral leishmaniasis in Iran: Review of the Epidemiological and Clinical Features
Abstract
leishmaniasis (VL) is a life-threatening vector-borne parasitic disease is distribut-ed in some parts of the new world and old world. The disease is endemic in different parts of Iran. This review article has been focused on major topics of epidemiological aspects and clinical features of VL in Iran for the period of 2002 through 2012. For the detection of VL in humans as well as animal reservoir hosts, anti-Leishmania antibodies were detected using direct agglutination test (DAT) as a validated serological test. Parasi-tological examinations were performed on suspected VL patients as well as canines and rodents. Different molecular methods were used for identification of species and geno-type/ or strain of Leishmania spp. isolated from infected humans, animal reservoir hosts and vectors. Altogether, 1698 out of 36081 (4.7%) human serum samples collected from 5 distinct geographical zones showed anti-Leishmania antibodies at titers≥1:3200 using DAT. The majority of VL cases in the endemic areas were found among children up to 12 years old. Almost 75% of DAT-positive cases (≥1:3200) in endemic areas showed clinical signs and symptoms. Predominant signs and symptoms in 217 hospitalized pa-tients with DAT positive (≥1:3200) results included paleness (99.5%), fever (96.9%), splenomegaly (91.5%), hepatomegaly (53.6%) and lymphadenopathy (21.1%). Integrated VL surveillance system in primary care using DAT, could decrease mortality and morbidi-ty of the disease in the VL endemic areas of the northwestern Iran. Out of 7204 serum samples collected from domestic dogs in various geographical locations of Iran, 879 (12.2%) were DAT sero-positive at titers≥1:320. L. infantum as the principal causative agent of the disease was isolated from infected humans, domestic and wild canines and rodents. The principal animal reservoir hosts of the infection are domestic and wild ca-nines. Ph. kandelakii, Ph. perfiliewi transcaucasicus, Ph. tobbi in northwestern Iran; Ph. major s.l. (=Ph. neglectus), Ph. keshishiani, and Ph. alexandri in southern parts of Iran were molecularly and/or parasitologically positive for L. infantum infections. The zoonotic form of VL (ZVL) caused by L. infantum occurs sporadically in all geographical zones of Iran but in northwestern and southern parts of the country the disease is endemic. DAT as an ap-propriate and potential tool has been used for sero-diagnosis and sero- epidemiological of VL among humans as well as domestic and wild canines.
World Health Organization. Control of leishmaniases. Technical report series 793 of WHO Expert Committee, Geneva. 2010.
World Health Organization (WHO). Lei-shmaniasis and Leishmania/HIV coinfection, WHO/CDC/CSR/ISR. 2000.
Diseases Management Center, Ministry of Health, Treatment and Medical Education of Iran (2002–2010) Annual Communicable Dis-eases Report.
Edrissian Gh H, Nadim A, Alborzi AV, Ardehali S. Visceral leishmaniasis: the Iranian experiences. Arch Iranian Med. 1998; 1: 22-26.
Edrissian Gh H. Visceral leishmaniasis in Iran and the role of serological tests in diagnosis and epidemiological studies. In: Ozcel MA, Alkan MZ, editors. Parasitology for the 21st century. CAB International. 1996.
Mohebali M, Edrissian Gh H, Nadim A, Hajjaran H, Akhoundi B, B Hooshmand B. Zarei Z, Arshi Sh, Mirsamadi N, Manouchehri Naeini K, Mamishi S, Sanati AA , Moshfe AA , Charehdar S, Fakhar M. Application of direct agglutination test (DAT) for the diagnosis and seroepidemiological studies of visceral leis-hmaniasis in Iran. Iranian J Parasitol. 2006; 1: 15-25.
Mikaeili F, Fakhar M, Sarkari B, Motazedian MH, Hatam G. Comparison of serological methods (ELISA, DAT and IFA) for diagnosis of visceral leishmaniasis utilizing an endemic strain. Iran J Immunol. 2007; 4(2):116-121.
Harith A, Salappendel RJ, Reiter I, Knapen F, Korte P, et al. Application of a direct agglutina-tion test for detection of specific anti-Leishmania antibodies in the canine reservoir. J Clin Microbiol. 1989; 27: 2252–2257.
Davies CR, Mazloumi-Gavgani S. Age, acquired immunity and the risk of visceral leishmaniasis: a prospective study in Iran. Parasitol. 1999; 119: 247-257.
Soleimanzedeh G, Edrissian Gh H, Movahhed Danesh AM, Nadim A. Epidemiological aspects of kala-azar in Meshkin- Shahr, Iran: human in-fection. Bull World Health Org. 1993; 71: 759-762.
Edrissian Gh H, Hajjaran H., Mohebali M, Soleimanzadeh G, Bokaei S. Application and evaluation of direct agglutination test in sero-diagnosis of visceral leishmaniasis in man and canine reservoirs in Iran. Iranian J Med Sci. 1996; 21:119-124.
Bokai S, Mobedi I, Edrissian Gh H, Nadim A. Seroepidemiological study of canine visceral leishmaniasis in Meshkin-Shahr, northwest of Iran. Arch Inst Razi. 1998; 48-49:41-46.
Mohebali M, Hajjaran H, Hamzavi Y, Mobedi I, Arshi S, et al. Epidemiological aspects of canine visceral leishmaniasis in the Islamic Republic of Iran. Vet Parasitol. 2005; 129: 243-251.
Moshfe A, Mohebali M, Edrissian Gh H, Zarei Z, Akhoundi B, et al. Canine visceral leishmaniasis: asymptomatic infected dogs as a source of Leishmania infantum infection. Acta Trop. 2009; 112: 101-115.
Motazedian MH, Noyes HA, Maingon R. Leishmania and SauroLeishmania: the use of ran-dom amplified polymorphic DNA for the iden-tification of parasites from vertebrates and inver-tebrates. Exp Parasitol. 1996; 83: 150-154.
Mohebali M, Parsa B, Motazedian MH, Yaghoobi-Ershadi MR, Hajjaran H. Identifica-tion of Leishmania species from different parts of Iran using a random amplified polymorphism DNA in human, animal reservoirs and vectors. Med J Islamic Rep Iran. 2002; 15: 243-246.
Kazemi Rad E, Mohebali M, Hajjaran H, Rezaei S, Mamishi S. Diagnosis and characterization of Leishmania species in Giemsa-stained slides by PCR-RFLP. Iranian J Publ Health. 2008; 37: 54-60.
Oshaghi MA, Maleki Ravasan N, Hide M, Javadian E, Rassi Y, Sadraei J, Mohebali M, Sedaghat MM, Hajjaran H, Zarei Z, Mohtarami F. Phlebotomus perfiliewi transcaucasicus is circulating both Leishmania donovani and L. infantum in northwest Iran. Exp Parasitol. 2009; 123: 218-225.
Oshaghi M A, Maleki Ravasan N, Javadian E, Mohebali M, Hajjaran H, Zare Z, Mohtarami F, Rassi Y. Vector incrimination of sand flies in the most important visceral leishmaniasis focus in Iran. Am J Trop Med Hyg. 2009; 81(4): 572-577.
Rassi Y, Javadian E, Nadim A, Rafizadeh S, Zahirii A, et al. Phlebotomus perfiliewi Transcaucasicus, a vector of Leishmania infantum in northwestern Iran. J Med Entomol. 2009; 46: 1094-1098.
Sahabi Z, Seyedi Rashti MA, Nadim A, Javadian E, Kazemeini M, et al. A preliminary study on the natural leptomonad infection of Phlebotomus major in an endemic focus of visceral leishmaniasis in Fars Province, south of Iran. Iranian J Publ Health. 1992; 21: 87-93.
Azizi K, Rassi Y, Javadian E, Motazedian M H, Asgari Q, et al. First detection of Leishmania infantum in Phlebotomus (Larroussiuss) major (Diptera: Psychodidae) from Iran. J Med Entomol. 2008; 45: 726-731.
Seyedi Rashti M A, Sahabi Z. Phlebotomus (Larroussius) Keshishiani, Shchurenkova 1936, another vector of visceral leishmaniasis in Iran. Iranian J Publ Health. 1995; 24: 25-30.
Azizi K, Rassi Y, Javadian E, Motazedian MH, Rafizadeh S, et al. Phlebotomus (Paraphlebotomus) alexandri: a probable vector of Leishmania infantum in Iran. Ann Trop Med Parasitol. 2006; 100: 63-68.
Hajjaran H, Mohebali M, Zarei Z, Edrissian Gh H. Leishmania tropica: another etiological agent of canine visceral leishmaniasis in Iran. Iranian J Public Health. 2007; 36: 85-88.
Jafari S, Hajiabdolbaghi M, Mohebali M, Hajjaran H, Hashemian H. Disseminated leishmaniasis caused by Leishmania tropica in HIV-positive patients in the Islamic Republic of Iran. Eastern Mediterr Health J. 2010; 16: 340.
Alborzi A, Rasouli M, Shamsizadeh A. Leishmania tropica-isolated patient with visceral leishmaniasis in southern Iran. Am J Trop Med Hyg. 2006; 74: 306-307.
Yaghoobi-Ershadi MR, Hanafi AA, Javadian E, Jafari R, Mohebali M. A new focus of cutaneous leishmaniasis caused by Leishmania tropica. Saudi Med J. 2002; 24: 98-101.
Badirzadeh A, Mohebali M, Ghasemian M, Amini H, Zarei Z, Akhoundi B, Hajjaran H, Emdadi D, Molaei S, KushaA, Alizadeh S. Cu-taneous and post kala-azar dermal leishmaniasis caused by Leishmania infantum in endemic areas of visceral leishmaniasis, northwestern Iran 2002–2011: a case series. Pathogens Global Health. 2013; 107(4): 194-197.
Hatam GR, Hosseini SMH, Ardehali S. Isoenzyme studies in characterization of Leishmania isolated in Iran. Iran J Med Sci. 1999; 24 (1&2).
Pouya Y. Kala-azar in Iran. J Facult Med Tehran. 1949; 7: 115-121(in Persian).
Abass E, Mahamoud A, Mansour D, Mohebali M, Harith A. Validation of a β-ME ELISA for detection of anti Leishmania donovani antibodies in eastern Sudan. Iran J Immunol. 2011; 8:150-158.
Mohebali M, Edrissian Gh H , Shirzadi, MR, Hosseingholizadeh Gh, Pashaei MH, et al. Inte-grated visceral leishmaniasis surveillance system in primary care for children in Meshkin-Shahr district, north-western Islamic Republic of Iran. East Mediter Health J. 2010; 16: 1050-1054.
Rassi Y, Javadian E, Nadim A, Zahraeii AR, Vatandoost H. Phlebotomus (Larroussius) kandelakii, the principal and proven vector of visceral leishmaniasis in north west of Iran. Pak J Biol Sci. 2005; 80: 1-5.
Sanei Dehkordi A, Rassi Y, Oshaghi MA, Abaie MR, Rafizadeh S, et al. Molecular detection of Leishmania infantum in naturally infected Phlebotomus perfiliewi transcaucasicus in Bilesavar dis-trict, northwestern Iran. Iran J Arthropod-Borne Dis. 2011; 5: 20-27.
WHO, The World Health Report, Geneve. 2002; 192-197.
Sarkari B, Hatam G, Ghatee MA. Epidemiolog-ical features of visceral leishmaniasis in Fars province, southern Iran. Iranian J Publ Health. 2012; 41(4):94-99.
Mohebali M, Poormohammadi B, Kanani A, Hajjaran H, Edrissian Gh H. Rodents: another group of animal reservoir hosts of visceral leishmaniasis in Meshkin-Shahr district, the Is-lamic Republic of Iran. East Mediterr Health J. 1998; 4: 376-378.
Mohebali M, Javadian E, Yaghoobi-Ershadi E R, Akhavan A A, Hajjaran H, et al. Characteriza-tion of Leishmania infection in rodents from en-demic areas of the Islamic Republic of Iran. East Mediterr Health J. 2004; 10: 591-599.
Fallah E, Farshchian M, Mazlomi A, Majidi J, Kusha A, et al. Study on the prevalence of vis-ceral Leishmaniasis in rodent’s of Azarshahr dis-trict (new focus), northwest of Iran. Arch Razi Inst. 2006; 61: 27-33.
Gholami Sh, Shahabi S, Mobedi I. Prevalence of leishmaniasis in rodents’population in Jangle ar-ea of Semeskandeh district from Sari Township, Mazandaran Province. Proceeding of 8th Con-gress of Infectious and Tropical Diseases. 1999; Tehran, Iran.
Hatam G R, Adnani SJ, Asgari Q, Fallah E, Motazedian M H, Sadjjadi S M, etal. First report of natural infection in cats with Leishmania infantum in Iran. Vector-Borne Zoonotic Dis. 2010; 10(3): 313-316.
Sarkari B, Hatam GR, Adnani SJ, Asgari Q. Seroprevalence of feline leishmaniasis in areas of Iran where Leishmania infantum is endemic. Ann Trop Med Parasitol. 2009; 103(3):275-277.
Oshaghi MA, Rassi Y, Hazratian T, Fallah E, Rafizadeh S. Natural infection of wild caught Phlebotomus tobbi to Leishmania infantumin East Azerbaijan province, northwestern Iran. J Vec-tor Borne Dis. 2013;50: 24–29.
Javadian E, Mesghali A, Nadim A. Natural leptomonad infection of sandflies with its first occurrence in P. alexandri in Khuzistan Province, Iran. Ecologie de Leishmaniasis. Coll Int CNRS. 1977; 239: 203-205.
Nadim A, Javadian E, Tahvildar-Bidruni GH, Mottaghi M, Abaei M R. Epidemiological as-pects of kala-azar in Meshkin-Shahr, Iran: Inves-tigation on vectors.Iranian J Publ Health. 1992; 21: 61-72.
Parvizi P, Mazloumi-Gavgani A S, Davies C R, Courtenay O, Ready P D. Two Leishmania spe-cies circulating in the Kaleybar focus of infantile visceral leishmaniasis, northwest Iran: implica-tions for deltamethrin dog collar intervention. Trans Roy Soc Trop Med Hyg. 2008; 102: 891-897.
Yaghoobi-Ershadi M R. Phlebotomine sand flies (Diptera: Psychodidae) in Iran and their role on Leishmania transmission. J Arthropod-Borne Dis. 2012; 6(1): 1-17.
Alborzi A, Pouladfar GH, Aelami MH. Visceral leishmaniasis; literature review and Iranian expe-rience. Iran J Clin Infect Dis. 2007; 2: 99-108.
| Files | ||
| Issue | Vol 8 No 3 (2013) | |
| Section | Articles | |
| Keywords | ||
| Iran Kala-azar Visceral leishmaniasis | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
