A long-lasting emerging epidemic of anthroponotic cutaneous leishmaniasis in southeastern Iran: population movement and peri-urban settlements as a major risk factor.

BACKGROUND: Epidemics of cutaneous leishmaniasis (CL) are occurring more frequently and spreading faster and farther than before in many areas of the world. The present study aimed to assess a long-lasting emerging epidemic (2005-2019) of 5532 cases with anthroponotic CL (ACL) in peri-urban areas of Kerman city in southeastern Iran. METHODS: This descriptive-analytical study was carried out for 15 years in Kerman province, southeastern Iran. The data were passively obtained through the health surveillance system and the Kerman Leishmaniasis Research Center. Every subject was diagnosed using direct smear microscopy. The representative causative agent was further examined by ITS1-PCR, PCR-RFLP, 7SL RNA gene sequencing and phylogenetic analyses. For each subject, a case report form designating demographic and clinical data was recorded. RESULTS: A different pattern of ACL incidence was found in peri-urban areas compared to that in the city of Kerman. The incidence rate of ACL cases has significantly increased (P < 0.001) from 2005 to 2016 in new settlements with a gradual decline after that. The overall average risk of contracting the disease was 7.6 times higher in peri-urban areas compared to Kerman city, an old endemic focus. All isolates consisting of six variants were confirmed to be Leishmania tropica. The overall pattern of the ACL infection indicates that the etiological agent of ACL is propagated and transmitted by the bite of female Phlebotomus sergenti sandflies from person to person from dissimilar clones as reflected by the complexity of the migrants' backgrounds in the province. CONCLUSIONS: The movement of populations and establishment of new settlements in peri-urban areas close to endemic areas are major risk factors for and are directly linked to CL. The underlying factors of this emerging ACL epidemic caused by L. tropica were disasters and droughts, among others. A robust commitment to a multilateral approach is crucial to make improvements in this area. This will require decisive coordinated actions through all governmental factions and non-governmental organizations. Furthermore, active and passive case detection strategies, early diagnosis, and effective treatment could help control the disease.

Associated-risk determinants for anthroponotic cutaneous leishmaniasis treated with meglumine antimoniate: A cohort study in Iran.

BACKGROUND: The control of cutaneous leishmaniasis (CL) is facilitated by knowledge of factors associated with the treatment failures in endemic countries. The aim of this evaluation was to identify the potential risk determinants which might affect the significance of demographic and clinical characteristics for the patients with anthroponotic CL (ACL) and the outcome of meglumine antimoniate (MA) (Glucantime) treatment. METHODOLOGY/PRINCIPAL FINDINGS: This current was executed as a cohort spanning over a period of 5 years which centered in southeastern part of Iran. Altogether, 2,422 participants were evaluated and 1,391 eligible volunteer patients with ACL caused by Leishmania tropica were included. Overall, 1,116 (80.2%) patients received MA intraleisionally (IL), once a week for 12 weeks along with biweekly cryotherapy, while 275 (19.8%) patients received MA alone (20 mg/kg/day for 3 weeks) (intramuscular, IM). The treatment failure rate in ACL patients was 11% using IL combined with cryotherapy plus IM alone, whilst 9% and 18.5% by IL along with cryotherapy or IM alone, respectively. Multivariate logistic regression model predicted 5 major associated-risk determinants including male (odds ratio (OR) = 1.54, confidence interval (CI) = 1.079-2.22, p = 0.018), lesion on face (OR = 1.574, CI = 1.075-2.303, p = 0.02), multiple lesions (OR = 1.446, CI = 1.008-2.075, p = 0.045), poor treatment adherence (OR = 2.041, CI = 1.204-3.46, p = 0.008) and disease duration > 4 months (OR = 2.739, CI = 1.906-3.936, p≤0.001). CONCLUSIONS/SIGNIFICANCE: The present study is the original and largest cohort of ACL patients who treated with MA. A comprehensive intervention and coordinated action by the health authorities and policy-makers are crucial to make sure that patients strictly follow medical instructions. Early detection and effective therapy < 4 months following the onset of the lesion is critical for successful treatment of the patients. Since a significant number of patients are still refractory to MA, reducing man-vector exposure and development of new effective alternative drugs are essential measures against ACL due to L. tropica.

Evaluation of serum iron and ferritin levels in alopecia areata.

Although immunologic processes and hereditary factors are suggested to play an important role in alopecia areata, the specific etiology is unclear. Iron deficiency has been suggested to play a role, but its effect is controversial. In our case control study, we found a higher mean level of serum iron and ferritin and a lower mean level of TIBC in patients compared to control subjects, but the differences did not reach significance.

Determination of survival and hazard functions for pemphigus patients in Kerman, a southern province of Iran.

BACKGROUND: Pemphigus has in the past been associated with a high mortality rate. However, with the discovery of corticosteroids, patient median survival has improved. Our purpose was to assess median survival after confirmed diagnosis of pemphigus in patients in Kerman, a southern province of Iran. METHODS: All patients who were either admitted to the hospital or treated as outpatients in Kerman from 22 September 1987 to 22 September 1999 and who had confirmed pemphigus were included in the study. Survival was estimated using the Kaplan-Meier method, and the following variables were evaluated in a univariate analysis for an association with survival: age, sex, type of pemphigus, and type of therapy. RESULTS: A total of 55 patients (38 female and 17 male) were identified. No significant differences were found between genders. The mean age at the time of diagnosis was 46.0 years. Older groups had a lower survival rate than younger groups (P < 0.001). The majority (82%) of cases were vulgaris/vegetans, and no significant differences were found in 10-year survival for type of pemphigus (P > 0.05). The patients who had been treated with corticosteroids alone had longer median survival times than those who had been treated with corticosteroids plus azathioprine (P < 0.001). A total of 11 patients died; the median follow-up time for those still alive was 5.9 years (range 2-12 years). Estimated survival at 2, 6 and 10 years was 92.7, 86.8 and 61.5%, respectively. CONCLUSION: Overall median survival rate in patients with pemphigus was 10 years, regardless of gender or subtype of pemphigus. Survival was adversely affected by late onset. Those patients treated with immunosuppressives and corticosteroids also appeared to have reduced survival times when compared to those treated with corticosteroids alone.