first epidemic and new-emerging human fascioliasis in Kermanshah [western Iran] and a ten-year follow up, 1998-2008

Fascioliasis is one of the most common zoonotic diseases in Iran and other parts of the world. Although the largest epidemic of this disease has occurred in northern provinces of Iran [Guilan] during the past two decades and a few cases have also been reported in Tehran and the other provinces, there has been no evidence of its' occurrence in western provinces of Iran such as Kermanshah before the outbreak which is being reported. The study was conducted by teamwork of infectious disease specialist, parasitologist, general practitioner, entomologist, and laboratory technician. It is an "epidemic investigation" and a cross sectional descriptive one. Clinical data and para-clinical changes are recorded considering all of the population of a village in Kangavar, one of the suburbs of Kermanshah [western Iran]. The mean age was 21.65, [SD=12.44]. Fifty three percent were female, and all of them were farmers. Eighty two percent had a history of watercress ingestion in a period of 1-2 months before the admission and 18% consumed other vegetables. The average of eosinophils was 32.35% [SD=26]. The patients' Enzyme Linked Immunosorbent Assay [ELISA] and Counter Current Immuno-electrophoresis [CCIE] serological tests were reported positive by the department of parasitology, Pasteur Institute of Iran. Treatment response to triclabendazole was excellent. A ten-year clinical and laboratory follow-up revealed no evidence of abnormality in treated patients. It was the first case of human fascioliasis in west Iran and was a real epidemic and an emerging infectious disease for this area at that time. The clinical symptoms were less severe compared with other reports. Health education to inhabitants and health care workers can lead to rapid detection of such outbreaks

[Isolation and serotyping of endemic leptospires of eastern part of flat area of Guilan province, Iran]

Leptospirosis is a zoonosis that is more common in tropical and semitropical regions and is endemic in Guilan province. In endemic region, only a limited number of pathogenic serovars are common, characterization of them is very important step in detecting the main reservoir [s] of the disease. This study was performed to isolate leptospires from rice farms, irrigation canals and rivers of eastern part of flat area of Guilan province to detect main endemic serotypes of leptospirosis. In this descriptive and cross - sectional study samples were taken from 8 cities of the area of Guilan province, Noth of Iran between May to September of 2007. Two ml of any processed water sample was inoculated in liquid EMJH medium with 200 micro g/ml 5-flurouracil after filtration, were incubated in 30°C for 3 monthes, and were checked by darkfiel microscopy every two weeks. All positive samples were serotyped by using 30 type antisera which were main representative of serogroups. 47 of 320 specimens were positive and 273 samples were negative. One saprophytic specie [Biflexa] including two serogroups [Andamana, and Semaranga] and three pathogenic species [Interrogans, Kireshnerii, and Boirgpetersenii] including 6 serogroups were detected Icterohaemorrhagiae, Pomona, and canicola of interrogans, Hardjobovis and Sejroea of Borgpeterseni pecie, Grippotyphosa of KircshnerL Non-pathogenic serogroups were found from surface water, but the pathogenic serogroup were detected only from rice farm water. The high incidence of leptospirosis in rual area concide with seasonal rice cultivation, which can be due to trafic of domestic animal in rice farms and elevation temprature, and activity of rice farm water with subsequent presence of pathogenic type and serotypes in rice farm

[Evaluation an in-house IgM-ELISA for the diagnosis of human leptospirosis]

Leptospirosisis a very common zoonosis in the world. Culture is low sensitive with high rate false negative. So, serological assays are best alternative way for its diagnosis. Microscopic agglutination test [MAT] is gold standard but performing it requires a panel of some standard strains and need periodic subculturing of them, and also requires double sera with at least two weeks interval to investigate seroconversion. Furthermore, other serological methods should be investigated. The aim of this study was to evaluate an in-house IgM-ELISA developed by using antigen extracted from endemic isolates. 14 endemic isolates belonged to the serogroups: Icterohaemorrahgia, Pomona, Hardjo, and Gripotyphosa, were inoculated in EMJH to take well grown cultures. Whole antigen was extracted from each culture by Freezing-Thawing method in distilled water. Same amount of extraction of each culture with same OD number in 550nm were mixed together and were used for coating Elisa plates. Antihuman IgM conjugated with alkaline phosphatase were used in this assay. We used a commercial quantitative IgM-ELISA [SERION ELISA classic] for cut off determination. MAT was used for confirmation positive and negative cases. Sera with titer >/= 1:100 in MAT and positive criteria in commercial quantitative IgM-ELISA were considered as positive cases. 98 positive cases and 54 negative cases were chosen by screening 200 sera of patients suspected to leptospirosis by using MAT and commercial quantitative IgM-ELISA. We also used 30 sera of patients affected by hepatitis B, salmonelosis, and brucellosis as control cases. 88 of 98 positive cases were positive [false negative=10], 1 of 54 negative and all control case were negative [false positive =1] in the test. Sensitivity, specificity, PPV, NPV, and accuracy of the test were evaluated :99.0%, 89.1%, 90.75, 98.8%, and 94.25, respectively. ELISA for measuring specific IgM to leptospires antigen[s] could be a good alternative to MAT, which is not a routine diagnostic assay to perform in clinical diagnostic laboratories and only is reliable when there is paired sera. Sensitivity and specificity of the assay is dependent to several factors, especially to the type of antigen coated on plates, quality of assay materials, and also to the time of sampling. Sera of days >/= 6 of the disease has enough antibodies to measure and a common antigen extracted from several common pathogenic leptospires, especially from endemic isolates, could be more helpful to increase accuracy of the assay