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Cutaneous leishmaniasis (CL) is a neglected public health problem in developing countries including Iran. CL is caused by different species of Leishmania parasites and results in morbidity and complications in patients with active lesions. Since protozoa are intracellular parasites, cellular immunity plays an essential role in controlling the infection. Cellular immunity is induced immediately after the infection and persists for many years after recovery. Studies over the past decades have identified the important role of CD4+ T cells and their T-helper subtypes in the immune response to CL. Finding antigens capable of producing Th1-dominant immune responses can play an effective role in preventing CL. This study examines the protective role of phosphoenolpyruvate carboxykinase (PEPCK), a critical enzyme for protozoan survival and reproduction. The potential of targeting PEPCK for the development of novel prevention strategies against Chagas disease is explored. Detailed findings presented herein underscore the critical role of PEPCK as an immunogenic antigen in parasite metabolism, gluconeogenesis, and energy homeostasis. Notably, the elimination of PEPCK alters parasite metabolic activity and attenuates Leishmania pathogenicity. These results position PEPCK as a promising vaccine candidate and therapeutic target for CL, pending further validation. [ABSTRACT FROM AUTHOR]

Background and objectives: Leishmania is one of the indigenous diseases of Iran, which is endemic in 18 provinces of the country. It is necessary to carry out an educational intervention to promote the preventive behaviors of this disease in endemic areas. The present study was designed to determine the effect of educational intervention based on the Health Belief Model (HBM) on the preventive behaviors of cutaneous leishmaniasis in male students. Materials and Methods: This study was conducted using a randomized controlled trial on 80 male students of the First secondary level school in Shahin shahr in 2022. The students were randomly divided into two intervention and control groups. Data were collected based on a standard questionnaire based on the Health Belief Model. Questionnaire was completed before, immediately and three months after the intervention. The data were analyzed using SPSS 19 software and statistical tests of repeated analysis of variance, independent t-test and post hoc Ben Feroni. Significance level was considered at 0.05. Results: Before the educational intervention, the two groups were similar in terms of demographic information and the scores of the constructs of the HBM (p>0.05). Immediately and three months after the educational intervention, the mean scores of the constructs of knowledge, perceived susceptibility, perceived severity, self-efficacy, behavior and perceived benefits increased significantly in the intervention group (p>0.05), but there were not a statistically significant difference in the constructs of perceived barriers and cues to action (p>0/05). Conclusion: The results of the present study showed the effect of educational intervention based on the preventive behaviors of Cutaneous leishmaniasis in male students. Of course, due to the lack of impact of the intervention on the perceived barriers, it is necessary to pay attention to non-educational interventions such as allocating subsidies for the purchase of protective equipment, especially in deprived areas, in addition to educational interventions. [ABSTRACT FROM AUTHOR]

This study aimed to identify PGP and MRPA genes in clinical isolates of Leishmania. The genes of pgpa (MRPA) and mdr1 (PGP) are involved in the drug resistance, their products act as dependent transporters of ATP (ABC Transporter) in the reflux of drugs from the cytosol to the outer space of the cell. Hence, 40 volunteers with leishmaniasis were randomly selected. Firstly, Amastigotes were examined under a light microscope, then inoculated into NNN-specific biphasic culture medium. Deoxy ribonucleic acids were extracted by phenol-chloroform method and were determined by ITS-specific primers. Then the frequency of two pumps involved in "drug resistance" was investigated by PCR. In this study, the mdr1 gene, which had previously been shown to be present in the in vitro resistant strains, was shown to have a higher frequency of pgpas, which could be due to the presence of MDR. It transports the drug from the inner layers of the lipid bilayer membrane to the outer layers, reducing the concentration of the drug inside the cell and causing drug resistance, while the MRPA pump is in the membrane of the cell organelles.

Background: Leishmaniasis is one of the endemic diseases in Iran and Isfahan province. This study was conducted to investigate the trend of cutaneous leishmaniasis in 6 main centers of Isfahan province during the years 2007 to 2018. Methods: This research is a cross-sectional descriptive-analytical study that was conducted based on the data available in the Zoonosis Diseases Unit located in the Isfahan Health Vice-Chancellor. The data related to the new cases of cutaneous leishmaniasis that were reported by the detection laboratories as well as the data related to the control measures and the fight against the reservoir were collected. The trend of disease incidence was analyzed separately by foci, year and the relationship between disease incidence and control measures. Findings: The results showed that during this 11-year period, the incidence of leishmaniasis is decreasing, but some centers, such as the number 1 Isfahan region, have had severe fluctuations in some years. The relationship between the average incidence of the disease and the total number of poisons consumed using the Pearson Correlation statistical test was linear and significant. In other words, in the centers where the highest amount of poison has been consumed, the incidence rate of leishmaniasis is also reported to be higher. Conclusion: Considering the fluctuations of the disease in some years, and the number 1 Isfahan region has the highest rate of incidence despite the highest amount of poisons consumed compared to the Shahin-shahr region, the effectiveness of this type of intervention in the long term is doubtful.

Background and Objectives: Cutaneous leishmaniasis (CL) is a common zoonotic disease that is transmitted by sandflies. This disease has become endemic in different regions of Iran. This study aims to determine the epidemiological aspects of CL in Qom, Iran from 2016 to 2022. Methods: In this cross-sectional study, the data of all patients with CL referred to clinics in Qom city from March 2016 to February 2022 were evaluated. Independent t-test, Chi-square test, and Fisher’s exact test were used for data analysis. Results: Of 1084 participants, 719 had infection with CL, of whom 539 were male (75%) and 180 were female (25%). Most of patients had 20-30 years of age and 87.3% had a history of traveling to disease endemic areas. The prevalence of CL was higher in autumn. Moreover, 32.2% of the patients had three or more skin lesions, and in 49.3% of cases, the lesions were in the hand. Conclusion: Considering the prevalence of CL in Qom, it is necessary to take effective health measures to control and prevent CL in this re

Background and Objectives: Cutaneous leishmaniasis (CL) is a common parasitic disease in tropical and subtropical areas. This disease has become endemic in some parts of Qom province in central Iran. This study aims to determine the epidemiological characteristics and endemicity of zoonotic CL in Qom, Iran. Methods: In this cross-sectional study, out of 45 villages located in CL endemic areas in central and Kahak districts of Qom province, 8 villages were randomly selected. At the end of each season, the households were visited and their demographic information and history of infection with CL were recorded using standard forms. Results: Out of 4228 people living in 8 disease endemic villages, 1920(45.41%) had skin lesions and a history of infection with CL. We also found 165 new cases with active lesions. The prevalence of zoonotic CL was 71.49 per 1000 persons. Among patients, 13.33% were under 7 years of age and 67.87% aged >15 years old. Therefore, zoonotic CL in the study area had a hypoendemic focus. Conclusion: The focus of zoonotic CL in Qom province is hypoendemic. Therefore, personal protection methods against sandfly bites such as the use of mosquito nets (especially insecticide-treated mosquito nets), the nets for doors and windows in residential areas, and the insect repellent compounds are recommended to control the disease in Qom.

Background and purpose: World Health Organization recommends and supports studies about leishmaniasis as one of the six major tropical and subtropical diseases. Iran is one of countries with relatively high infection rate of cutaneous leishmaniasis, so, the purpose of this study was to investigate the epidemiological status of cutaneous leishmaniasis in Kermanshah province, western Iran. Materials and methods: In a cross-sectional study, we investigated the records of all patients with leishmaniasis positive smears between 2011 and 2019 in Kermanshah province. Annual rate of the disease was calculated according to the data obtained from Statistical Center of Iran. Results: There were 1946 patients with leishmaniasis, including 1477(75.9%) men. The prevalence of leishmaniasis in Kermanshah province was 15.4 in 100,000 people. The prevalence of the disease in men and women was 23.4 and 7.42, respectively. Annual pattern of infection showed that in men the incidence rate was higher between November and January and lower in June, but no specific seasonal pattern was seen in women. The most common lesions were observed in hands and then the foot with an upward trend in recent years (P

Background and Aim: Cutaneous leishmaniasis (CL) is an important health problem in Iran and one of the world ̛s neglected diseases which is caused by Leishmania spp. The aim of this study was to investigate the epidemiology of cutaneous leishmaniasis and its associated risk factors in an endemic center in Golestan Province. Materials and Methods: This descriptive cross-sectional study included patients with suspected CL who had been referring to the health centers of Gonbad–e Qabus town, between 2018 and 2020. Demographic and epidemiological data of CL patients were recorded and diagnosis of Leishmania spp. was made by Giemsa staining of direct smear. PCR was also used to determine and confirm the parasite species. Results: From 1979 suspected CL lesions, 1704(87.4%) had positive smears. 898 (52.7%) patients were male and 806 (47.3%) were female. The highest incidence rate was observed in the patients of less than 5 (25.93%) and those between 25 and 45 years of age (25.41%). In all samples in this study, Leishmania major was the only Leishmania spp detected by ITS-PCR. Also, Critidia fasciulata was identified in three patients. Conclusion: The study provided valuable data concerning the epidemiologic aspects of the CL in an old endemic focus in north of Iran, which can be used as the basis for planning future control strategies.

Background & aim: Cutaneous leishmaniasis or leishmaniasis in Iran is caused by two species of Leishmania parasites including: L. major and L. tropica. In recent years, the disease has been reported in different parts of Kohgiluyeh and Boyer-Ahmad Province. Due to the huge differences in the type of animal reservoirs and biological carriers, identifying the causative agent can be effective in the necessary planning to control the disease. Therefore, the aim of the present study was to determine the causative species of cutaneous leishmaniasis in Kohgiluyeh and Boyer Ahmad province, Iran, by molecular methods: a retrospective study. Methods: The present cross-sectional and retrospective descriptive study was conducted to determine the species of Leishmania, 52 samples of smears stained with Giemsa dye were collected from different laboratories in the cities of the province between 2013 and 2017 and were examined using light microscope for the presence of Leishman's body. After extracting the DNA present on the surface of slides, using specific primers LINR4 and LIN17, the species of Leishmania parasite was identified by PCR method. The data were analyzed using chi-score statistical test. Results: Out of 52 samples with cutaneous leishmaniasis lesions, 26 (50%) were male and 26 (50%) were female. The mean age of the participants in the study was 23.32 years (with a standard deviation of ±18.42). Out of 52 samples, parasitic amastigotes (Leishman's body) were observed in 36 cases (69.2%) by direct observation using a light microscope and 43 samples (82.7%) were positive for PCR. Infectious species in all residents of Dehdasht and Yasuj were L. major and L. tropica in Gachsaran. Conclusion: the results of the present study indicated that L.major and L.tropica species were the cause of cutaneous leishmaniasis in Dehdasht, Yasuj, and Gachsaran. Therefore, further studies are suggested to identify vectors and reservoirs of cutaneous leishmaniasis parasites in Kohgiluyeh and Boyer-Ahmad province, Iran.

Background & aim: Given that an effective vaccine is not available against leishmaniasis, along with the side effects of current drugs and the emergence of resistance to treatment, researchers are seeking more effective, safe and low-cost natural compounds. The aim of the present study was to evaluate the anti-leishmaniasis effect of aqueous and alcoholic extracts of opium with concentration 10% on lesion of Leismania major in BALB/c mice. Methods: In the present study, thirty male BALB/c mice, 6–8 weeks of age were injected subcutaneously in tail-base with Leismania major amastigotes. They were randomly divided into five groups (n=6 per group). Two groups (aqueous and alcoholic extracts of opium with the concentration of 10%) as experimental and three as control (Eucerin ointment, Glucantime and Control, which were infected but not treated). Treatment started when the CL lesions were appeared and continued for 14 days. The diameter of the lesion was measured and the differences in the mean lesion size were assayed by paired t-test, two-way ANOVA and tokay post-hoc tests. Findings: Statistical analysis indicated significant difference (P

Background: Leishmaniasis, a common parasitic disease between humans and animals, which is currently one of the major health problems in many parts of Iran. Therefore, this study aimed to investigate the prevalence of cutaneous leishmaniasis in Aran and Bidgol and the effects of climatic factors on that during 2016-2019. Methods: This cross-sectional study was performed by referring to the health records of 964 cutaneous leishmaniasis patients in Aran and Bidgol during 2016-2019 and epidemiological information was recorded. In addition, the climatic characteristics of the study area, including temperature, humidity, and precipitation were collected from the meteorological station of the study area. Then correlation analysis was performed between meteorological elements and the incidence of the disease. The data were analyzed using SPSS software version 16. Results: 60% of the patients were male. The age group of 0-10 years had the highest frequency (23.9%) among patients. Also, 47.7% of the patients had a history of traveling to endemic areas and the highest rate of leishmaniasis was related to urban residents. There was also a weak positive correlation between humidity and rainfall with leishmaniasis incidence (r = +0.55). A weak negative correlation was also observed between temperature of the environment and leishmaniasis incidence (r = -0.42). Conclusion: Due to the significant increase in cutaneous leishmaniasis in recent years in the area, as well as the appropriate ecological conditions of the area for sand fly activity, it is recommended to conduct the necessary training to observe health in hot seasons and field controls, such as baiting.

Background and purpose: Leishmaniasis is one of the most important infectious diseases caused by different species of the Leishmania, which is a public health problem worldwide. So far, no effective vaccine is introduced for this disease and drug therapy is associated with many side effects. Therefore, this study was designed to identify novel FDA-approved compounds with anti-leishmanial activity. Materials and methods: In this experimental study, proteomics, protein network analysis, and molecular docking were used. Protein profile was identified by LC-MS/MS and protein network analysis was performed using Cytoscape. Processing of the compound structure and molecular docking was performed by HyperChem and AutoDock Vina, respectively. Finally, docking results were interpreted by LigPlot+. Results: Based on proteomics and protein network analysis, glycosomal malate dehydrogenase was suggested as a potential drug target. Among the compounds, the best docking results were associated with Conivaptan and Avodart with a binding energy level of -10.5 and -10.2, respectively. Also, molecular docking studies showed that the most important bonds involved in drug-receptor binding were hydrogen and hydrophobic bonds. Conclusion: The current study demonstrated the importance of integrated proteomics, protein network and docking to identify novel compounds with anti-Leishmania properties. According to this study, Conivaptan and Avodart, also approved by the Food and Drug Administration, are effective inhibitors of glycosomal malate dehydrogenase in Leishmania major and Leishmania tropica which meanwhile require further in-vitro and in-vivo experiments.

Background and Objectives: Due to the importance of cutaneous leishmaniasis, the national leishmaniasis project began in 2007 in Iran. The aim of the present study was to evaluate community interventions in changes in the incidence of cutaneous leishmaniasis in Isfahan Province from 2002 to 2018: an Interrupted time series regression analysis. Materials and Methods: The present study was a repeated cross-sectional study. The incidence and 95% confidence interval were used to describe the disease trend. Data were entered into the Excel and analyzed using STATA14 software at a significance level of 5%. Intermittent time series regression analysis was used to evaluate community interventions in changes of leishmaniasis incidence. Results: from 2002 to 2018, the data of 43,904 patients with leishmaniasis was registered in Isfahan Health Centers. The mean (standard deviation) age of the patients was 23.99 (19.03) years. The incidence had a decreasing trend after the interventions in all affiliated cities and the whole province. Conclusion: The preventive intervention programs of the provincial health center have been rather successful and have reduced the incidence of the disease in the years after the intervention, so that despite the large number of confounding and influential factors regarding this disease, preventive intervention programs have led to disease control according to the reported annual incidence.

Introduction and purpose: Cutaneous leishmaniasis (CL) is one of the Zoonotic parasitic diseases caused by protozoa of the genus leishmania. This disease is prevalent in many parts of the world, particularly in Iran. The present study aimed to assess the trend of CL in Gerash, Iran, during 2007-2020. Methods: This study was conducted based on a secondary design. The following data were collected: patient’s age, gender, number and location of sores, disease type and reservoir, place of residence, and type of Construction. The obtained data were analyzed in SPSS software (version 24). Results: Out of 562 patients, 276 cases were male, and 286 subjects were female. Cutaneous Leishmaniasis was diagnosed clinically and based on laboratory tests in 48.6% and 51.4% of the cases, respectively. The highest and lowest prevalence rates were detected in the age groups of below 10, and over 61 years, respectively. The highest frequency of lesions was in patients with urban leishmaniasis and the most affected areas were hand and face (30.56%). Moreover, 66% and 34% of patients were infected with urban and rural types of disease, respectively. Furthermore, 61.21% of patients were living in newly-built houses, and the rest were residing in old buildings. In addition, 33% and 67% of them resided in rural and urban areas, respectively. Conclusion: Due to the high prevalence of CL in Gerash and its increase in 2017, there is a need for coherent planning and effective health measures by the officials of different organizations and public participation to prevent the spread of this disease

Leishmaniasis is a zoonotic disease and is known as a health problem in all of the world. The patient, a 47-year-old man car driver from the city of Bostan Abad, with a history of traveling to cutaneous leishmaniasis endemic provinces last year, was referred to the city health center with a 17 mm, no discharge and pus with a necrotic appearance skin lesion. Biochemical, hematological parameters and urine culture and analysis were normal. Three smears were prepared with sterile vaccinostyle from the margins of the wound and transferred to a specific medium in sterile conditions. After staining the prepared smears from the wound, amastigotes with a large nucleus and small kinetoplast in macrophages and active promastigotes in the liquid phase of the medium were observed. Polymerase chain reaction (PCR) was performed using ITS-1 by specific primers. In the PCR product electrophoresis was compared with the marker bands and 350 bp band weight determined. With electrophoretic patterns and comparison with positive control band, isolates parasites belonged to the Leishmania genus. In order to definitively diagnose the parasite species, a sequencing method was used. The results showed 99% homology with Leishmania major. Finally, the patient with a diagnosis of rural cutaneous leishmaniasis was induction with Glucantime drug. Diagnosis of suspected cases with cutaneous leishmaniasis is of major importance. If an infected patient is diagnosed in the early stages of the disease, the extension of the scar after recovery, as well as the possible complications of rural infection can be prevented

Background and purpose: World Health Organization recommends and supports studies about leishmaniasis as one of the six major tropical and subtropical diseases. Iran is one of countries with relatively high infection rate of cutaneous leishmaniasis, so, the purpose of this study was to investigate the epidemiological status of cutaneous leishmaniasis in Kermanshah province, western Iran. Materials and methods: In a cross-sectional study, we investigated the records of all patients with leishmaniasis positive smears between 2011 and 2019 in Kermanshah province. Annual rate of the disease was calculated according to the data obtained from Statistical Center of Iran. Results: There were 1946 patients with leishmaniasis, including 1477(75.9%) men. The prevalence of leishmaniasis in Kermanshah province was 15.4 in 100,000 people. The prevalence of the disease in men and women was 23.4 and 7.42, respectively. Annual pattern of infection showed that in men the incidence rate was higher between November and January and lower in June, but no specific seasonal pattern was seen in women. The most common lesions were observed in hands and then the foot with an upward trend in recent years (P<0.001). But the trends for number of lesions in the head and body remained unchanged (P=0.7). Conclusion: According to the seasonal pattern of cutaneous leishmaniasis especially in men and its relationship with their career, educational programs and trainings are recommended to prevent sand fly bites. [ABSTRACT FROM AUTHOR]

Background and Objectives: Environmental conditions in different geographical areas provide a basis for the spread of some diseases. Cutaneous leishmaniasis is a serious threat to public health and is one of the arthropod-borne diseases. The prevalence and distribution of this disease is affected by environmental and climatic factors. The aim of this study was to model the Spatio-temporal variations in the incidence rate of this disease based on environmental and ecological criteria. Methods: The northeast of Iran was selected as the study area. The data used in this study included vegetation, surface temperature, precipitation, evapotranspiration, soil moisture, digital elevation model and sunny hours. The artificial neural network method was used to model the spatio-temporal changes of cutaneous leishmaniasis. Results: Spatial variations in the incidence of the disease had a north-south trend and decreased from north to south. In addition, two foci were identified in the medium altitude areas in North and South Khorasan provinces. Temporal variations in the incidence of disease in the study period showed that the incidence rate decreased in the two identified foci from 2011 to 2016. Conclusion: The modeling results showed that the estimated regression coefficient was 0.92 for neural network based on all three types of data (training, validation, test) indicating good quality of constructed neural network. In addition, sensitivity analysis results showed that sunny hours and soil moisture were the most important factors in the model function.

Introduction: Cutaneous leishmaniasis is an endemic infectious disease in Iran. Failure to treat the disease requires the use of effective medicinal plants. Different species of Artemisia have anti leishmania activity. The aim of this study was to study effect of aqueous extract of Artemisia aucheri seed on Promastigote and Amastigote of leishmania major in vitro. Methods: In this study, the aqueous extract of Artemisia aucheri was prepared. The concentration of Artemisia aucheri was 25, 50, 100, 200 and 400 µg/ml to investigate on promastigote and amastigote of Leishmania major. The effects of concentrations on leishmania promastigotes, non-infected macrophages and amastigote-infected macrophages were investigated by MTT and flow cytometry tests. The effect of the extract on apoptosis in promastigotes was investigated by flow cytometry. Results: Data were analyzed using one-way ANOVA. Increasing the time and concentration of Artemisia aucheri significantly decreased the number of promastigotes of Leishmania major (P≤0.05). The growth of the parasite was completely stopped at a concentration of 400 and 200 µg / ml. Percentage of macrophages infected with amastigotes was 11.84% for the treated group at a concentration IC50 of extract was 37.5 µg /ml for promastigotes. At this concentration there was a 50% inhibition of growth. Conclusion: Aqueous extract of Artemisia aucheri seed had good activity in destroying Leishmania major promastigotes in culture and Leishmania major amastigotes in macrophages and the extract was able to induce apoptosis in 9.28% of promastigotes [ABSTRACT FROM AUTHOR]

Background and Objective: Cutaneous leishmaniasis is one of the endemic diseases in Iran and every year a large number of children under10years of age are infected with it. Therefore, the aim of this study was to investigate the preventive behavior of leishmaniasis based on the PRECEDE model in families with children under 10 years. Materials and Methods: The present study is a cross sectional study that was performed on240Families with children under 10 years old in the Sankhast ward of North Khorasan province. The data collection tool was a researcher questionnaire that included demographic questions and structures of the questionnaire model (knowledge, attitude, reinforcing factor, and enabling factor). Sampling was performed in several steps. Data was entered into SPSS16 software using Kolmogorov-Smirnov test, one-way analysis of variance, independent t-test, correlation coefficient, multiple linear regressions. Results: The highest mean a score was obtained by the reinforcing factor (24.3 ± 22.80) and the lowest mean a score was obtained in the performance section (48.46 ± 15.66). The results of the regression model showed that knowledge (0.28), attitude (0.16), and enabling factors (0.14) had the highest predictive power of mothers in controlling and preventing disease, respectively. Overall, the structures of the PRECEDE model predicted21%of the variance of the preventive behavior of cutaneous leishmaniasis. Conclusion: The PRECEDE model is a good theoretical framework for the prevention of leishmaniasis. Designing and implementing an educational program based on the PRECEDE model in the population at risk will be an effective step in controlling leishmaniasis. Because the prevalence of leishmaniasis is higher in rural areas, it is more important to consider the conditions of the rural people in order to implement the educational program. [ABSTRACT FROM AUTHOR]

Background and purpose: Leishmaniasis is one of the most important infectious diseases caused by different species of the Leishmania, which is a public health problem worldwide. So far, no effective vaccine is introduced for this disease and drug therapy is associated with many side effects. Therefore, this study was designed to identify novel FDA-approved compounds with anti-leishmanial activity. Materials and methods: In this experimental study, proteomics, protein network analysis, and molecular docking were used. Protein profile was identified by LC-MS/MS and protein network analysis was performed using Cytoscape. Processing of the compound structure and molecular docking was performed by HyperChem and AutoDock Vina, respectively. Finally, docking results were interpreted by LigPlot+. Results: Based on proteomics and protein network analysis, glycosomal malate dehydrogenase was suggested as a potential drug target. Among the compounds, the best docking results were associated with Conivaptan and Avodart with a binding energy level of -10.5 and -10.2, respectively. Also, molecular docking studies showed that the most important bonds involved in drug-receptor binding were hydrogen and hydrophobic bonds. Conclusion: The current study demonstrated the importance of integrated proteomics, protein network and docking to identify novel compounds with anti-Leishmania properties. According to this study, Conivaptan and Avodart, also approved by the Food and Drug Administration, are effective inhibitors of glycosomal malate dehydrogenase in Leishmania major and Leishmania tropica which meanwhile require further in-vitro and in-vivo experiments. [ABSTRACT FROM AUTHOR]

Introduction Phlebotomus papatasi, the main vector of cutaneous leishmaniasis with the agent of Leishmania major is in Iran that is widely distributed in the country. The purpose of this study was to determine the effect of climatic factors on the presence probability of a vector in some counties of Khuzestan Province. Materials and Methods In this cross-sectional study, sand flies were collected from 5 selected counties during two seasons. The climatic information of the study areas was obtained from the Meteorological Organization. Spearman correlation coefficient was used to investigate the presence probability of the main vector with environmental variables. The spatial distribution of the main vector was prepared in ArcGIS 10.5. Results Of the 884 collected sand flies, 506 of them were Ph. papatasi. The highest number of Ph. papatasi was observed in Ahvaz 151 (29.8%) and the lowest number was observed in Andimeshk 4 (0.79%). There was a significant difference between the geographical location and the probability of being the main vector of rural cutaneous leishmaniasis (P˂0.0001). The temperature was significantly different in the sampling areas (P= 0.024). With the influence of the temperature factor, the highest and lowest probability of vector was reported in Dasht-e-Azadegan (0.71 ± 0.05) and Andimeshk (0.01 ± 0.03), respectively. Conclusion In the present study, Ph. papatasi is a dominant species. By controlling the confounding effect of environmental factor, temperature, there was a significant difference between the presence probability of this species in Andimeshk county with other counties.

Background: Currently, cutaneous leishmaniasis (CL) as a parasitic disease is treated with Glucantime and Pentostam in most of the endemic countries. This study aimed to identify factors affecting the glucantime therapy duration rate in patients with CL using a survival analysis model. Methods: This retrospective descriptive-analytic study was conducted on 1017 CL patients that were referred to the urban and rural comprehensive health centers of Qom Province under the supervision of Qom University of Medical Sciences, Qom, Iran, from April 2014 to March 2019 through the census. The recovery time was measured by the Kaplan-Meier method, and then the survival function was plotted based on each variable. The Log-Rank test was applied to analyze the differences among variables, and after the evaluation of the PH assumption by Shoenfeld residuals, a stepwise forward Cox progressive regression was used to determine factors affecting intralesional or systematic treatment duration in the patients involved with cutaneous leishmaniasis. Results: The recovery rate of lesions in cutaneous leishmaniasis cases was found to be 96.7% by the intralesional treatment and 93% by the systematic one. The mean recovery time for cutaneous leishmaniasis patients was 8.00 weeks for the intralesional treatment and 18.00 days for the systematic treatment. The only significant variable in the intralesional treatment was observed on cases with thigh lesions, meaning that those patients who had CL lesions on their thighs experienced a significant reduction in their recovery time. Furthermore, the lesion variable was also significant (P=0.039) as the recovery chance of those patients who had four or more CL lesions was 30% less. Conclusion: The existence of lesions on CL patients’ thighs and a low number of lesions in CL patients can decrease the recovery time. The use of the Cox regression model in medical studies is more appropriate because not only does it consider the occurrence of the event but also it can reveal the occurrence time of the disease.

Background: Systemic or intralesional injection of Glucantime in treatment of cutaneous leishmaniasis, sometimes leads to a local allergic reaction. This study aimed to evaluate the effect of local allergic reaction to intralesional Glucantime on recovery course of cutaneous leishmaniasis. Methods: In a retrospective cross-sectional study, the data of patient records of cases with cutaneous leishmaniasis, who underwent local treatment with Glucantime in Imam Reza dermatology clinic, Mashhad, Iran, from March 2006 to March 2011, were evaluated. All cases that showed a localized allergic reaction to Glucantime were selected as the case group and the cases of cutaneous leishmaniasis without any allergic reaction to treatment were selected as control group. Patients were evaluated in subsequent follow-up periods for improvement after Glucantime injection. Findings: The mean number of injections needed for complete recovery was 6.54± 3.76 in patients with topical allergic reaction and 9.77 ± 5.14 in control group; there was a statistically significant difference between two groups (P = 0.002). The time to complete recovery in patients with topical allergic reaction to Glucantime was insignificantly shorter. Conclusion: This study showed that patients with local allergic reaction to Glucantime require fewer numbers of injections to achieve complete recovery than non-allergic patients.

Old World cutaneous leishmaniasis (OWCL) is a relatively common parasitic infection that is among endemic diseases in many regions worldwide, particularly in Iran. Leishmania major and Leishmania tropica species with over 500,000 and 400,000 annual cases are considered the two main causes of OWCL, respectively. Diagnosis and treatment of cutaneous leishmaniasis (CL) can be difficult due to alterations in clinical manifestations and resistance to treatment. There is currently no vaccine available for (CL). Its systemic treatment also has serious and severe side effects. The uncomplicated cases of (CL) in a person with healthy immunity can be managed alone by topical treatment as an effective and less complicated treatment and may not require other systemic therapies. This study aims to describe topical treatment methods for OWCL.

Background and purpose: Cutaneous leishmaniasis is a skin disease manifested as chronic ulcerative skin lesions. Current standard therapies for this disease are associated with some problems such as high cost, numerous side effects, need for injections, and drug resistance. Sambucus ebulus is used in treatment of skin inflammation. This study aimed at investigating the effects of S. ebulus leaf extract on cutaneous leishmanisis. Materials and methods: This clinical trial was performed in 110 patients who were divided into intervention (n=55) and control groups (n=55). All patients received the standard treatment for leishmanisis. In addition, the intervention group received topical treatment of S. ebulus leaf extract 5%, while the control group received placebo. The therapy was continued until complete epithelialization of the lesions. Before the intervention and at the end of each week (until complete epithelialization of the lesions), healing progress and clinical characteristics of the lesions, including the size, induration, and degree of epithelialization were recorded. Results: The intervention accelerated the decrease in mean diameter of lesions (P

Background and purpose: Cutaneous leishmaniasis is the second most important tropical disease after malaria which is endemic in many countries, including Iran. This study was conducted to investigate the epidemiology and geographical distribution of cutaneous leishmaniasis in Golestan province, Iran. Materials and methods: This descriptive cross-sectional study was carried out in patients with the signs of cutaneous leishmaniasis attending Golestan health-care centers, 2014-2016. Two thin smears were prepared from the margin of lesions and stained using Giemsa stain. They were then studied by light microscope. Data were analyzed applying ANOVA in SPSS V21. Results: There were 1823 cases, of whom 1815 (99.56%) were found positive for the presence of amastigotes. The highest incidence rate of cutaneous leishmaniasis was in fall and in children younger than 9 years of age. Spatial distribution of the disease showed hotspots in Kalaleh and Maraveh Tappeh (P

Background and Objectives: Cutaneous leishmaniasis (CL) is one of the health problems in Iran, especially in Kerman Province. The aim of this study was to determine the morbidity rate of CL in two new foci in the east and southeast of Kerman. Methods: At the end of 2017, demographic data were obtained from the health centers of Kerman. Using cluster sampling, 800 households (40 clusters of 20 households) were studied in Allahabad (southeast) and Sarasiab (east), Keramn. From each subject, data were collected regarding age, sex, number and location of the ulcer(s), scarring, and time and place of infection. The collected data were analyzed using SPSS software. Results: The prevalence of CL was 9.6 in Allahabad and 42.8 in Sarasiab and the incidence (new cases) was 3.2 and 3.8, respectively. The highest rate of infection was found in Allahabad in the age group under 6 years old and in the Sarasiab was over 40 years old. There was a significant difference in nationality and local transmission between the rwo regions (P

Background and purpose: There are various clinical forms of cutaneous leishmaniasis (CL) and there is lack of access to diagnostic local laboratories especially in endemic regions. The present study aimed to conduct molecular examination of the typical and atypical clinical forms of CL in endemic area of Bam, Iran. Materials and methods: This cross-sectional study was carried out between 2013 and 2014. The diagnosis was performed by direct smears from skin lesions, Giemsa staining, and microscopic examination. Total DNA was extracted from positive and negative direct smears. PCR method was used to determine the genus and species of Leishmania. Results: In this study, 353 suspected cases of CL in Bam Health Center were investigated of whom 278 (78.7%) were positive by microscopic examination. Forty skin smears from typical lesions were positive by both PCR and microscopic examinations, but out of 40 skin smears from atypical lesions which were negative by microscopic observation, Leishmania DNA was detected in 6 (15%) samples. Leishmania tropica was identified in all positive samples. Conclusion: In current study, microscopy method was not found reliable enough for diagnosis of CL. Therefore, for early diagnosis of the disease PCR is recommended in negative smears of patients suspected of CL.

Background Cutaneous Leishmaniasis (CL) is an important infection with a high incidence rate. The spatiotemporal dynamics of this disease is mainly determined by three main components of parasite, reservoir and vector. Climatic factors can significantly affect its incidence through their impact on these components. Materials and Methods: The present study aimed to assess the effects of climatic changes on the incidence rate of CL in Mashad, Iran. To this end, first different phases of drought were identified through Standard Precipitation Index (SPI). Then the relationship between the incidence of CL and these phases was analyzed with non-parametric Kruskal-Wallis test and Dunn-Bonferroni test at a significance level of 95%. Results: The results of the non-parametric Kruskal-Wallis test on the incidence of CL in the three phases of drought showed a significant relationship between them. Dunn-Bonferroni test showed that the incidence of CL was significantly higher during the years with severe drought as compared to years with normal rainfall. The significant increase in the mean incidence of CL during severe drought can be attributed to limited food sources available to the vectors, which are mostly rodents. Conclusion: Scarcity of food sources during drought makes rodents, as the main vector of the disease, to seek food and be more exposed to sandflies. That is how the incidence of CL increases.

Background and Objective: Leishmaniasis is one of the most important vector-borne diseases which transmitted by sand flies to humans and other animals. This study was conducted to determine the effect of wild rodents control in decreasing zoonotic cutaneous leishmaniasis (ZCL) in Golestan province, north of Iran during 2016. Methods: In this descriptive-analytic study, rodent control operation was conducted using Zinc phosphide 2.5% in May, July and September 2019 in 45 villages of Gonbad Kavous County in Golestan province, north of Iran during 2016. The stages of operation in each of the villages were scored, as we considered 25 score for each stage of destruction of nests (one stage) and baiting in nests (three stages). Also, incidence rate which is reported in each of the villages was extracted. Finally, the relationship between rodenticide scores in each village with the incidence of disease was compared. Results: There were rodent’s active burrows around 45 villages. After the end of rodents control operation, 17 villages got 0-25 scores, 8 villages 26-50, 16 villages 51-75 and 4 villages 76-100. The mean incidence rate in these villages was determined 3466.9±2473.5, 2828±1929.1, 4515.4±3478.4 and 636.3±546.6, respectively. There was a significant relationship between the implementation of rodents control operation and incidence rate of ZCL, so that in villages with a score of between 76-100, the incidence rate was significantly lower than in the villages with a score of between 51 -75 and 26-50 (P

Background: Leishmaniasis is a zoonosis disease. About 350 million people are at risk of developing a disease, with 1.5 to 2 million new cases every year in the world. The aim of this study was to determine the space-time clusters of cutaneous leishmaniasis in north of Khuzestan Province, Iran. Methods: In this cross-sectional study, the annual cutaneous leishmaniasis incidence per 100,000 individuals in each county was determined for the past five years. Reported from 2011 to 2015 in North of Khuzestan Province, Iran. Geographical information system (GIS) and spatial scan statistic method were used to identify spatial clusters of cutaneous leishmaniasis cases at the county level. Pure retrospective temporal analysis scanning was performed to detect the temporal clusters of cutaneous leishmaniasis cases with high rates using the discrete Poisson model. The space-time cluster was detected with high rates through the retrospective space-time analysis scanning using the discrete Poisson model. Results: The overall cutaneous leishmaniasis incidence increased from 2011 to 2015. A total of 3 high-risk counties were determined through Local Moran’s I analysis from 2011 to 2015. Local Moran’s I enabled the detection of the spatial autocorrelation for a county with its adjacent county. The method of spatial scan statistics identified different 11 significant spatial clusters. The space-time clustering analysis determined that the most likely cluster included 11 counties, and the time frame was October 2014. The secondary cluster included one counties in October 2014. The tertiary cluster included six counties, and the time frame was from June 2014 to November 2015. Conclusion: Spatial and temporal clusters of cutaneous leishmaniasis have increased in the northern region of Khuzestan Province, and most clusters have occurred in November.

Background and purpose: The leishmaniases are a group of diseases that appear as cutaneous, mucocutaneous, and visceral leishmaniasis, transmitted by different species of sand flies. Cutaneous leishmaniasis (CL) is considered as a major public health problem in Iran. The current study was carried out to determine the spatial and temporal distribution of CL in Mazandaran Province, Iran according to Geographical Information System (GIS). Materials and methods: This retrospective descriptive study was carried out according to demographic and epidemiologic data collected from patients diagnosed with CL during 2009-2017 recorded in Health deputy of Mazandaran University of Medical Sciences. The spatial and temporal distribution of CL in different cities of Mazandaran Province was mapped using ArcGIS 10.4 software. Results: The number of patients with CL was 378 during the years studied. The highest and lowest numbers of CL patients were seen in Sari and Abbas Abad, respectively (n=71, n=2, respectively). Most of the cases (n= 182) were reported in east of Mazandaran and the least number of cases (n= 73) were observed in the west of province. The incidence rate in the west of the province was lower than that of the center and east of the province. Conclusion: Distribution of CL in Iran, agricultural activities, livestock breeding, and migratory status in Mazandaran Province call for appropriate planning to control this disease.

Abstract Background and Aim: Leishmaniasis is one of the most common epidemic diseases in tropical regions of the world. The disease is affected by economic, social, cultural, environmental and climatic factors. Fars province is one of the areas with high prevalence of this disease. Due to the occurrence of climate change in recent years in the country and in this province, the present study was conducted to evaluate the epidemiology of cutaneous Leishmaniasis in Marvdasht city in 2017. Methods: This descriptive-analytic study was conducted on the epidemiology of cutaneous Leishmaniasis in Marvdasht city in 2015. Accordingly, demographic data of all patients registered in the Marijuana Medical Center's Marijuana Infection Unit were extracted and analyzed by descriptive statistics, independent t test, and Kruskal Wallis using SPSS version 16 software. Results: The incidence of disease in the whole population was 13.44, in men 14.4 and in 12.4% in 10 thousand people. Most cases were in the age group of 21-30, housewives, and villagers. The hands had the most lesion and most people had more than 5 lesions. Also, the incidence of illness in the fall season was higher than in other seasons. There was no statistically significant difference in the incidence of disease based on gender (p

Cutaneous leishmaniasis is a zoonotic disease caused by two species of Leishmania major and L. tropica in Iran. The disease has been known and treated in Iran by many of the most prominent Iranian physicians including Avicenna and Rhazess over the past centuries. In Qajar era, following the introduction of modern medical knowledge, and major changes in our understanding of diseases, the diagnostic and treatment methods were changed. The first new reports on this disease were provided by European physicians living in Iran. During the 1940s, some prominent Iranian researchers began to study the epidemiology, treatment and laboratory specification of the disease in different parts of the country. Due to the outbreak of the disease during the Iraq-Iran war in a dense human population (soldiers), health authorities had to try different ways to control the disease. Most importantly, soldiers were injected with live parasite vaccine. However, this procedure did not continue after the war, and immunization with inactivated vaccine replaced it and passed different phases of clinical trials. Finally, these studies were published as scientific papers. The present paper summarizes the history and control of leishmaniasis in Iran.

Background: Despite advances in diagnosis and treatment, leishmaniasis is now considered a severe public health problem, particularly in developing countries, such as Iran. Leishmaniasis is among the six most important, parasitic diseases of the world affecting 88 countries in almost every continent. The disease is complex with different clinical presentations such as visceral, cutaneous and mucocutaneous forms. Cutaneous leishmaniasis (CL) is the most common form of the disease in Iran. Antimony compounds are the first line treatment of CL. The treatment of leishmaniasis in endemic areas relies on chemotherapy, and in several parts of the world the mainstay remains the pentavalent antimony (SbV)-containing drugs Pentostam (sodium stibogluconate) and Glucantime (meglumine). There is no comprehensive study on treatment failure rate of this compounds. This study was designed to evaluate treatment failure rate and possible involving factors of antimonial resistance in CL to facilitate and improve treatment strategies of this disease. Methods: All patients with CL referred to Skin Disease and Leishmaniasis Research Center (SDLRC), from October 2011 to October 2013, treated with antimony compounds were assessed in this study. Patient characteristics (gender, age and place of residence), number, type and location of the lesions, comorbidities and type of treatment were recorded and analyzed. Results: Rate of treatment failure with Meglusan was 4.3%. Failure rate in men and in patients with previous history of cutaneous leishmaniasis was more than women or patients without CL history (P= 0.000, 0.024 respectively). The results of this study showed that treatment failure was higher in patients with systemic treatment than intralesional (IL) or combination therapy (both IL and systemic treatment) group but this difference was not statistically significant. Also, size and number of the lesions, wound infection, the patient's age, location, education and occupation do not have a significant correlation with treatment failure. Conclusion: Greater treatment failure rate of Meglusan compared to Glucantime (4.3% versus< 1%, respectively) is an important issue to be considered in CL therapeutic strategy.

Introduction Leishmaniasis is a parasitic disease caused by a number of Leishmania species which is manifested in two forms: cutaneous (cutaneous or CL) and visceral (Kala-azar). The disease is transmitted by the bite of the infected sand flies. The present study aimed at analyzing the epidemiology of cutaneous leishmaniasis and the factors affecting it over the time period from 2012-2016 in South Khorasan Province. Methods This cross-sectional study was conducted through a descriptive methodology. The subjects included patients diagnosed with CL and treated between 2012-2016. The collected data were statistically analyzed using SPSS v. 21. Results The average age of the patients was 75.17 ± 89.26. Each patient had approximately 2 lesions on average, with a mean size of 59.1 ± 12.2 [mm]. About 62% of the subjects (263 people) were male. The most frequent cases were observed in 2015 and the least ones occurred during 2014, respectively. Only 3 cases were Afghan citizens while the remaining were Iranians. Patients’ residences were almost evenly distributed. Discussion and Conclusions The results showed that there has been no decrease in the number of patients over the last few years in South Khorasan. Considering the relatively high incidence of CL in the province and its rising trend, more attention should be paid to educational programs and preventive measures.

Background and Objectives: Leishmaniasis as a zoonosis disease, occurs in three forms of cutaneous, mucocutaneous, and visceral (kala-azar). The causative agent of this disease is a protozoa of the Leishmania genus, which is commonly transmitted by species of sand flies. Given that explanation of an effective control strategy for vector-borne diseases requires identification of the fauna of their vectors, the present study was carried out to detect the fauna of Leishmaniasis vectors in Khusf county. Methods: In this cross-sectional study, sand flies were captured using sticky traps in different parts of Khusf county from May 2015 to October 2015, Then, the species of female samples were mounted and identified using valid species identification key. Results: In this study, from total 370 collected sand flies samples, 238 sand flies were related to animal areas and 132 sand flies were from human areas. Out of 115 female sand flies, Phlebotomus sergenti with frequency of 27.82% and Sergentomyia dentata with frequency of 34.78%, were reported as the dominant species in the region. Conclusion: According to the findings of this study, the dominant species in the region was among the vectors of urban cutaneous leishmaniasis, and considering the presence of Leishmania tropica in the region, the health system of this county must consider required care for the control of cutaneous leishmaniasis disease.

Introduction: Leishmaniasis is a major health problem in Iran and it has a heavy economic burden on communities. Therefore, the aim of this study is to investigate the effects of climate on the prevalence and incidence of leishmaniasis in Yazd. Methods: This is an ecological study. Data was collected from health department of Yazd University of Medical Sciences during the years 2003-2007 by age and sex, monthly and information about climate factors on monthly and annual basis including temperature, Relative humidity of air, precipitation from the general weather office of Yazd city, the information was entered into SPSS 16 software and analyzed by descriptive statistics as well as Spearman correlation and time delay analysis and analyzed the relationship and correlation between the elements of the cluster and the occurrence Cutaneous Leishmaniasis was performed in Yazd city. Resultus: According to the findings of this study, the most reported cases of leishmaniasis in men aged 11 to 30 years with 561 (69.9%), and in women in the age group of 71 and over with 41 The case (66.1%) and the highest upward trend were 2004 to 2005, 2009 to 2012, and in the month of October. Conclusion: The results of this study indicate that there is a strong and positive relationship with relative humidity and precipitation, which can guide policymakers in the area of health policy in this province to control and more effective prevention measures.

Background & objective:Cutaneous leech is one of the six major diseases and an example of epidemic diseases in tropical regions. Prevalence and spread of this disease is affected by environmental factors and climatic conditions as well as economic, social and cultural issues. In this research, Analytic Hierarchy Process and network analyzes are used to prepare susceptible cutaneous leeches map. Considering high incidence of cutaneous leech in Khuzestan province, Izeh city was selected as a case study. Materials & Methods: For this purpose, the number of patients affected by this disease in Izeh was obtained from the Provincial Health Center from 2009 to 2014. Information layers of elevation, rainfall, temperature, humidity, distance from river, distance from rural areas and land use were identified as effective parameter and their maps were prepared in GIS environment. Parameters were compared in pairs by using AHP and ANP and weight of each factors determining their impacts was calculated in Expert Choice and Super Decision software. Then these parameters were combined based on their obtained weights in ArcGIS software and the final cutaneous leech map was prepared. Evaluation of these methods was performed using relative operation curve (ROC) and 16 points related to leech disease. Result: The results of weighting effective parameters using AHP and ANP showed that the highest weight is related to elevation, temperature and rainfall parameters, respectively. The results of ROC assessment showed that in preparing the map, ANP had an accuracy of 87.8% and AHP had an accuracy of 68.9%. Conclusion:The results of ANP showed that this model had suitable accuracy in preparing susceptible cutaneous leech map and AHP had moderate accuracy in preparing susceptible cutaneous leech map.

Background: Currently, cutaneous leishmaniasis (CL) as a parasitic disease is treated with Glucantime and Pentostam in most of the endemic countries. This study aimed to identify factors affecting the glucantime therapy duration rate in patients with CL using a survival analysis model. Methods: This retrospective descriptive-analytic study was conducted on 1017 CL patients that were referred to the urban and rural comprehensive health centers of Qom Province under the supervision of Qom University of Medical Sciences, Qom, Iran, from April 2014 to March 2019 through the census. The recovery time was measured by the Kaplan-Meier method, and then the survival function was plotted based on each variable. The Log-Rank test was applied to analyze the differences among variables, and after the evaluation of the PH assumption by Shoenfeld residuals, a stepwise forward Cox progressive regression was used to determine factors affecting intralesional or systematic treatment duration in the patients involved with cutaneous leishmaniasis. Results: The recovery rate of lesions in cutaneous leishmaniasis cases was found to be 96.7% by the intralesional treatment and 93% by the systematic one. The mean recovery time for cutaneous leishmaniasis patients was 8.00 weeks for the intralesional treatment and 18.00 days for the systematic treatment. The only significant variable in the intralesional treatment was observed on cases with thigh lesions, meaning that those patients who had CL lesions on their thighs experienced a significant reduction in their recovery time. Furthermore, the lesion variable was also significant (P=0.039) as the recovery chance of those patients who had four or more CL lesions was 30% less. Conclusion: The existence of lesions on CL patients’ thighs and a low number of lesions in CL patients can decrease the recovery time. The use of the Cox regression model in medical studies is more appropriate because not only does it consider the occurrence of the event but also it can reveal the occurrence time of the disease. [ABSTRACT FROM AUTHOR]

Background and Objective: Cutaneous leishmaniasis is endemic in Iran and it can be observed in two clinical forms, anthroponetic cutaneous leishmaniasis and zoonotic cutaneous leishmaniasis. The objective of this study was to determine the demographic characteristics of cutaneous leishmaniasis in Dasht-e Azadegan County, Iran. Subjects and Methods: This retrospective study was conducted in Dasht-e-Azadegan city in 2014-2018, based on patient’s demographic data collection: sex, age, occupation, number and location of wounds, geographical area and season of outbreak. Data were analyzed by SPSS software version 20. Results: The number of patients with cutaneous leishmaniasis in the 5-year period was 1320 persons, of which 720 of them were male (54.54%) and 600 of them were female (45.46%). The highest number of leishmaniasis was seen in the age group of 10-19 (23.78%) and 20-29 (23.63%) respectively. In addition, 61.74% of patients were urban and the rest were rural. Significant differences were observed between the geographical area, occupational group, and season with cutaneous leishmaniasis. About 59.54% of patients had one wound and the mostly in the hands (28.78%). The highest seasonal prevalence was in winter and in January and February. During the period under review, the highest incidence of the disease was observed in Abu-Hamiyzeh, and overall the incidence of the disease decreased in the beginning of 2018. Conclusion: Due to the endemic nature of the disease and the prolonged activity of Phlebotomus papatasi in this city, increasing the awareness of high risk individuals is essential to reduce the incidence and prevent the disease. [ABSTRACT FROM AUTHOR]

Old World cutaneous leishmaniasis (OWCL) is a relatively common parasitic infection that is among endemic diseases in many regions worldwide, particularly in Iran. Leishmania major and Leishmania tropica species with over 500,000 and 400,000 annual cases are considered the two main causes of OWCL, respectively. Diagnosis and treatment of cutaneous leishmaniasis (CL) can be difficult due to alterations in clinical manifestations and resistance to treatment.There is currently no vaccine available for (CL). Its systemic treatment also has serious and severe side effects.The uncomplicated cases of (CL) in a person with healthy immunity can be managed alone by topical treatment as an effective and less complicated treatment and may not require other systemic therapies.This study aims to describe topical treatment methods for OWCL. [ABSTRACT FROM AUTHOR]

Background and purpose: Cutaneous leishmaniasis is a skin disease manifested as chronic ulcerative skin lesions. Current standard therapies for this disease are associated with some problems such as high cost, numerous side effects, need for injections, and drug resistance. Sambucus ebulus is used in treatment of skin inflammation. This study aimed at investigating the effects of S. ebulus leaf extract on cutaneous leishmanisis. Materials and methods: This clinical trial was performed in 110 patients who were divided into intervention (n=55) and control groups (n=55). All patients received the standard treatment for leishmanisis. In addition, the intervention group received topical treatment of S. ebulus leaf extract 5%, while the control group received placebo. The therapy was continued until complete epithelialization of the lesions. Before the intervention and at the end of each week (until complete epithelialization of the lesions), healing progress and clinical characteristics of the lesions, including the size, induration, and degree of epithelialization were recorded. Results: The intervention accelerated the decrease in mean diameter of lesions (P<0.05) but had no significant effect on the mean duration of therapy (P=0.31), treatment outcome (P=0.87), degree of recovery (P= 0.95). Conclusion: The use of S. ebulus leaf extract ointment (5%) along with the standard therapy showed no effect on the treatment outcome of lesions caused by cutaneous leishmaniasis. [ABSTRACT FROM AUTHOR]

Background and purpose: Cutaneous leishmaniasis is the second most important tropical disease after malaria which is endemic in many countries, including Iran. This study was conducted to investigate the epidemiology and geographical distribution of cutaneous leishmaniasis in Golestan province, Iran. Materials and methods: This descriptive cross-sectional study was carried out in patients with the signs of cutaneous leishmaniasis attending Golestan health-care centers, 2014-2016. Two thin smears were prepared from the margin of lesions and stained using Giemsa stain. They were then studied by light microscope. Data were analyzed applying ANOVA in SPSS V21. Results: There were 1823 cases, of whom 1815 (99.56%) were found positive for the presence of amastigotes. The highest incidence rate of cutaneous leishmaniasis was in fall and in children younger than 9 years of age. Spatial distribution of the disease showed hotspots in Kalaleh and Maraveh Tappeh (P<0.05). Conclusion: In this study, the prevalence of cutaneous leishmaniasis was higher in rural areas. Also, some areas such as Kalaleh and Maraveh Tappeh require urgent attention of prevention sector. [ABSTRACT FROM AUTHOR]

Cutaneous leishmaniasis (CL) is an endemic parasitic disease of major health impact in many parts of the world and is caused by several species of the protozoan parasite Leishmania. Antimonial compounds (i.e glucantime and pentostam) are the first-line treatment for cutaneous leishmaniasis with emerging drug resistance as a problem. The control of Leishmania is further complicated by the emergence of drug-resistant parasites. In the clinical settings, resistance to SbV containing drugs is now well established and it was found to occur in South America, Europe, the Middle East and most notably in India. Clinical resistance to organic pentavalent antimonials, in the form of sodium stibogluconate (pentostam) or N-methylglucamine antimoniate (glucantime), has long been recognized. However, it is unknown whether the clinical failure of chemotherapy is attributable to the development of drug resistance mechanisms in the parasite or to a variety of host factors that might also contribute to low drug response. Reported rate of drug-resistance to antimonial compounds in Iran varies from 9.4% to 94.2% and there is not any comprehensive study on this issue. Indeed, in the endemic region treatment with SbV fails in more cases; thus, in general patients infected with resistant parasites are unresponsive although exceptions have been reported. This article aims to review the mechanisms of drug resistance to these compounds. The main resistance factors include genetical, enzymatic, intracellular (such as apoptosis and cytoskeleton changes) and resistance proteins. Also, mechanisms related to drug transport and intracellular activation are discussed. Various methods of drug resistance detection such as culture and molecular methods (i.e polymerase chain reaction) are reviewed. Although the exact mechanism of action glucantime is not clear, it seems that protein and gene factors involved in cellular drug entry are the main causes of drug resistance. Cross-sectional studies on meglumine antimoniate resistance in endemic areas of cutaneous leishmaniasis in Iran are highly recommended. Also, studies for evaluation of alternatives therapies for antimonial resistant cases are required.

BACKGROUND AND OBJECTIVE: L. tropica is the major cause of cutaneous and visceral leishmaniasis in Iran. Due to lack of an accurate, sensitive and noninvasive detection test in animal model is a major problem. Here, we designed L. tropica stably transfected with two reporter genes as fused form, enhanced green fluorescent protein (egfp) and Luciferase (luc), named as egfp-luc to use as a specific tools for detection and measurement of parasite load in live animals. METHODS: In an experimental study, linearized cassette containing egfp-luc genes was stably integrated into Iranian strain of wild-type L. tropica genome, 18srRNA locus, by homologous recombination. Transfectants were screened by G418 resistance, confirmed by PCR and western blotting and the expression of EGFP signals were observed by fluorescent microscope and flow cytometry. FINDINGS: Primary phenotype observations of parasite (by fluorescent microscopy and flow cytometry) were shown that recombinant L. tropicaEGFP-LUC was successfully produced EGFP protein into cytoplasm. Quantification of EGFP intensity was more than 90%. Furthermore, the results of PCR and western blotting verified the proper integration into genome and expression of both genes in promastigotes. CONCLUSION: This is the first report to show the generation of recombinant L. tropicaEGFP-LUC expressing two reporter genes simultaneously.

Background and Objectives: Leishmaniasis encompasses a wide range of clinical complaints from skin injury to fatal visceral infections. Detailed information about the economic burden of the disease can help health care decision makers to estimate the magnitude of the problem, economic advantages obtained from the prevention of this disease, resource allocation, and disease management. The study was conducted to determine the economic burden of leishmaniasis in humans and animals in Iran in 2013. Methods: The cost unit was determined through public service tariffs determined by the Ministry of Health and Medical Education and interviews with experts, and service costs were calculated by multiplying the cost unit for one person by all infected cases. The course of the disease and the services provided to patients were obtained from the review of the literature and records and interview with experts. Results: The economic burden of leishmaniasis was estimated more than IRR 213 billion ($6,700,000). Moreover, 39%, 27%, 18%, and 16% of the costs were related to indirect costs, direct medical costs, indirect medical costs, and dogs, respectively. The average direct medical cost of cutaneous and visceral leishmaniasis was IRR 3381186 ($106) and IRR 9392832 ($295) per person, respectively. Conclusion: The economic burden of leishmaniasis compared to some diseases such as hydatid cyst showed a smaller number( 232.3 million$). It is recommended that IIranian health politicians consider the economic burden of other diseases.

Introduction:Different studies undertaken in the animal modeling show that Interferon-gamma deficiency impairs healing process of Leishmania infection. It seems that the level of Interferon-gamma production could also affect the healing duration of Leishmania lesion in humans. The current study aims to investigate the possibility of Interferon-gamma application for recognition of cases afflicted by non-healing Leishmaniasis. Materials and methods: Peripheral blood mononuclear cells (PBMCs) of 32 patients, who were afflicted by healing or non-healing Leishmaniasis, were isolated and the levels of interferon-gamma were determined, using ELISA method. Afterwards, the cut-off point of interferon-gamma to identify patients afflicted by non-healing Leishmaniasis was calculated through ROC-Curve analysis. Furthermore, Leishmanin Skin Test (LST) was performed for every patient. Results: Levels of Interferon-gamma produced by PBMCs stimulated with Soluble Leishmania Antigen (SLA) or Phytohemaglotinine were significantly higher in healing patients, compared with non-healing individuals (p

Background: Despite the increasing developments in treatment of skin diseases, leishmaniasis is still considered as one of the major health problems. Despite the spontaneously improving of the disease, its scars can highly create emotional and social problems for the patients. In this study, the effect of combination therapy of intralesional glucantime plus glycolic acid 70% and salicylic 20% was compared with intralesional glucantime alone in reducing scars of this disease. Methods: 75 patients with cutaneous leishmaniasis, which had 2 lesions at the same anatomical location, participated in the study (150 lesions). 75 lesions were treated with combination therapy and 75 with intralesional glucantime alone. For each patient a questionnaire was filled. All the data were analyzed using SPSS software. Findings: After 8 weeks of treatment, 37.3% of lesions cured completely with intralesional glucantime and 42.7% with combination therapy. There was no statistically significant difference between the improvements among the two groups (P > 0.05). Conclusion: Intralesional glucantime plus glycolic acid 70% and salicylic 20% was not more effective in cutaneous leishmaniasis compared to intralesional glucantime alone and did not reduce the mean time of improvement.

Background and purpose: Iran is one of the endemic focuses of cutaneous leishmaniasis (CL) in the world. The disease is commonly seen in some tropical regions of Kermanshah province (West of Iran). In this study, patients with CL were diagnosed and identified using RFLP-PCR and DNA sequencing. Materials and methods: In this descriptive study all suspected cases of CL attended a clinic affiliated with Kermanshah University of Medical Sciences in 2015 were diagnosed by microscopic and molecular methods. The Leishmania species were identified by PCR-RFLP and genomic sequencing. Results: There were 65 patients of whom 47 (72.3%) were detected as CL including 64.6% males and 35.4% females. Among the patients 49.2% were resided in Kermanshah, and 50.8% lived in other cities of the province. It was found that 47.7% of the patients had history of travel to other provinces in previous months. Leishman bodies were detected in 50.8% and 72.3% of the patients by microscopic observation and PCR technique, respectively. By RFLP-PCR, 14.9% and 84.1% of positive samples were identified as Leishmania tropica and Leishmania major, respectively. The PCR product sequences of 5 samples confirmed the results of PCR-RFLP in identification of the Leishmania species. Conclusion: Leishmania major is the main cause of CL in Kermanshah province. PCR is believed to be more sensitive than microscopic method for detection of CL and RFLP-PCR is an appropriate technique for identification of Leishmania species.