Epidemiological survey on Cutaneous Leishmaniasis in southwestern Iran.

BACKGROUND & OBJECTIVES: Cutaneous leishmaniasis (CL) is still a public health threat in many rural areas of Iran. It causes considerable morbidity among a huge number of people in the endemic areas. Khuzestan is considered as a CL focus in Iran and recently several cases have been reported from Shush County. The aim of the current study was to determine different aspects of CL epidemiology in this County. METHODS: The study was conducted in four villages in the rural district of Shush County. In order to survey the scar and acute rate of the disease, 100 inhabitants were questioned in each village. In addition, to determine the reservoir host and vector of the disease, rodents were captured using Sherman traps, and sandflies were collected from around the rodent burrows using sticky paper traps. RESULTS: The scar and acute lesion rates were reported as 5.26 and 0.57% among inhabitants, respectively. Fifty-four rodents including Tatera indica (55.5%), Nesokia indica (33.3%), Mus musculus (9.3%) and Rattus norvegicus (1.9%) were captured and identified. Nested PCR showed 3 out of 54 rodents infected with Leishmania major. In total, 1122 sandflies were collected, and Leishmania major detected in Phlebotomus papatasi (4.35%), Sergentomyia dentata (23%), and Sergentomyia clydei (10%). INTERPRETATION & CONCLUSION: Zoonotic cutaneous leishmaniasis due to L. major prevailed in this area. The common and the main vector was Ph. papatasi and, T. indica seems to be the main while N. indica as a secondary reservoir host of the disease in this area.

The Potential Role of Humans in the Transmission Cycle of Leishmania major (Kinetoplastida: Trypanosomatidae), the Causative Agent of the Old World Zoonotic Cutaneous Leishmaniasis.

Zoonotic cutaneous leishmaniasis (ZCL) due to Leishmania major (Yakimoff and Schokhor, 1914) is known as a neglected tropical disease, transmitted by Phlebotomus papatasi (Scopoli, 1786) in North Africa and the Middle East. The main reservoirs of ZCL are desert gerbils and the role of humans as a reservoir host of the disease is not clearly defined and is therefore investigated in this study. In order to achieve this objective, Ph. papatasi sand flies were allowed to take blood through indirect blood sources (human, Rhombomys opimus (Lichtenstein, 1823) (great gerbil), and BALB/c mice) using artificial feeding or direct xenodiagnoses from ZCL patients. To detect Leishmania promastigotes inside digestive canal, blood-fed sand flies were dissected and examined under light microscope and then confirmed by nested-PCR. In indirect xenodiagnoses, promastigote forms of Leishmania parasite were observed in 7.1%, 12%, and 13.6% of sand flies which fed on Rh. opimus, BALB/c mice, or human blood sources, respectively. In direct xenodiagnoses, among 93 female lab-reared sand flies which fed on active L. major lesion(s), 2.1% Leishmania infection was subsequently observed in the sand flies. No infection was detected in those sand flies that fed on nonlesioned skin of CL patients. Humans can serve as a reservoir of ZCL since the data indicate that Ph. papatasi is able to acquire L. major parasites from an active lesion of ZCL patients and the parasites can complete metacyclogenesis in the sand fly.

Modeling the Distribution of Cutaneous Leishmaniasis Vectors (Psychodidae: Phlebotominae) in Iran: A Potential Transmission in Disease Prone Areas.

Cutaneous leishmaniasis (CL) is now the main vector-borne disease in Iran. Two forms of the disease exist in the country, transmitted by Phlebotomus papatasi and Phlebotomus sergenti s.l. Modeling distribution of the vector species is beneficial for preparedness and planning to interrupt the transmission cycle. Data on sand fly distribution during 1990-2013 were used to predict the niche suitability. MaxEnt algorithm model was used for prediction using bioclimatic and environmental variables (precipitation, temperature, altitude, slope, and aspect). Regularized training, area under the curve, and unregularized training gains were 0.916, 0.915, and 1.503, respectively, for Ph. papatasi. These values were calculated as 0.987, 0.923, and 1.588 for Ph. sergenti s.l. The jackknife test showed that the environmental variable with the highest gain when used in isolation has the mean temperature of the wettest quarter for both species, while slope decreases the gain the most when it is omitted from the model. Classification of probability of presence for two studied species was performed on five classes using equal intervals in ArcGIS. More than 60% probability of presence was considered as areas with high potential of CL transmission. These areas include arid and semiarid climates, mainly located in central part of the country. Mean of altitude, annual precipitation, and temperature in these areas were calculated 990 and 1,235 m, 273 and 226 mm, and 17.5 and 16.4°C for Ph. papatasi and Ph. sergenti s.l., respectively. These findings can be used in the prediction of CL transmission potential, as well as for planning the disease control interventions.

Diversity of sand flies (Diptera, Psychodidae) in southwest Iran with emphasis on synanthropy of Phlebotomus papatasi and Phlebotomus alexandri.

Zoonotic Cutaneous Leishmaniasis (ZCL) is still a serious health problem in Iran. The objective of the study was to determine the differences in sand fly biodiversity in Shush (plain) and Khorramshahr (littoral) Counties, Khuzestan Province, southwest Iran. Sand flies were collected using sticky paper traps from urban, semi urban, agricultural and natural ecotypes. Alpha and beta diversity were calculated using Shannon-Weiner index and Jaccard's and Sorensen's coefficients, respectively. Synanthropic index was determined for the first time for Phlebotomus papatasi and Phlebotomus alexandri in different land use categories in Iran. Totally 11213 specimens, 68.47% in Shush and 31.53% in Khorramshahr, were collected. Eleven species of sand flies including, 2 of genus Phlebotomus and 9 of genus Sergentomyia were identified. Sergentomyia christophersi was found as a new record. Dominant species were P. papatasi and Sergentomyia sintoni. Shannon-Weiner index, richness and evenness in semi urban area of Shush County were more than other habitats. The analysis of α biodiversity showed that agricultural ecosystem of Khorramshahr County had the highest diversity due to maximal richness and diversity and also relatively high evenness. Comparison of similarity of the sand flies population composition between Shush and Khorramshahr indicated the maximum similarity between the urban area of Shush and the semi urban area of Khorramshahr (Sj=75% and Ss=86%). Synanthropic index of P. papatasi and P. alexandri were calculated to be -83.34 and -91.18, respectively in Shush County. Estimated synanthropic indices for P. papatasi and P. alexandri in three habitats (natural, semi urban and urban) of Khorramshahr County were -69.84 and -85.89, in the same order. The factors for having high diversity of sand flies in the plain area studied may be due to higher annual precipitation, the related land use and land cover. The changes on the composition of sand flies are perhaps due to human intervention in their natural habitats.

Spatial and temporal distributions of phlebotomine sand flies (Diptera: Psychodidae), vectors of leishmaniasis, in Iran.

Leishmaniasis is a major vector-borne disease and health problem in Iran. Studies on sand flies, as the vectors of the disease, began in the Northern and Western parts of the country in 1930 and have been continued up to now. Concerning many published information in the field of sand flies, providing a digital database for the country will help the public health authorities to make more correct and prompt decisions for planning leishmaniasis control programs as well as modeling and forecasting of transmission potential across the country. All published data on phlebotomine sand flies of Iran were collected. A database was then designed in Excel format, including all available information regarding sand flies. The valid data were transferred to ArcGIS9.3 to prepare the first spatial database of sand flies of Iran. The IrSandflybase includes 131 papers, 2 abstracts and 71 PhD/MSc theses, reporting studies conducted during 1930-2012. This database contains different available data covering all aspects of ecology and biology of 50 sand fly species in two genera of Phlebotomus and Sergentomyia in the country. The temporal activity of sand flies is reported 9 months in warm regions of the southern part, while it may reduce to 7-8 months in central plateau or 4-5 months in cold areas of the northwest. Occasional studies reported rare species from the borderlines of Iran. It seems that changing the climate due to global warming may affect the spatial distribution of different species and expand it into the country, the issue that can be followed by an updated database.