A newly emerged cutaneous leishmaniasis focus in central Iran

SummaryObjectivesThis study was performed to evaluate the epidemiological status of cutaneous leishmaniasis (CL) in the most important endemic foci of Qom Province, central Iran. The city of Qom is the largest center for Shi’a scholarship in the world and is a significant pilgrimage destination.MethodsDuring 2006–2011, all suspected CL patients with skin lesion(s) referred to regional health centers of Ghomrood and Ghanavat regions, and all actively detected cases, were examined clinically and parasitologically for CL. Patient information was recorded and patients were categorized based on the number and size of the lesions. Odds ratios (OR) of different risk factors were calculated.ResultsA total of 849 (59.2% male, 40.8% female) confirmed cases of CL were enrolled; the average incidence rate of the disease was 14.9 per 100000 people. During the study period 2006–2011, the trend in CL incidence showed no sudden variations in the areas studied, except for an outbreak of CL in 2009. Leishmania major was identified as the causative agent based on internal transcribed spacer 1 (ITS1) ribosomal DNA PCR analysis. During the study period, the age distribution of CL cases was relatively stable, with the majority (50%) of patients aged 1–25 years. Most cases (n = 468; 55.1%) had a single lesion and 82 (9.6%) patients had four or more lesions (range 1–29). The risk of developing multiple lesions was significantly increased in patients with seasonal jobs (summer workers) (p = 0.023; OR 1.516) and significantly decreased in patients who were affected in winter (p = 0.010; OR 0.398). The risk of developing large-sized lesions (>1cm) was significantly increased in patients in the age groups >25 years (p = 0.001–0.015; OR 2.5–3.5) and decreased in patients with seasonal jobs (summer workers) (p = 0.005; OR 0.570).ConclusionsThe present data show the importance of CL as a health problem in suburban areas of Qom Province. In order to identify other epidemiological aspects of leishmaniasis in this area, studies on vectors and reservoirs are recommended. Since leishmaniasis caused by L. major is typically zoonotic, control measures should focus on rodents as the main reservoirs and Phlebotomus papatasi as the main vector. Awareness should be raised in the high-risk populations comprising people with diabetes, young adults (<25 years old), and those who work outdoors during the summer

Scorpion fauna and epidemiological aspects of scorpionism in southeastern Iran

ABSTRACTObjectiveTo identify the scorpion fauna and classify the epidemiological aspects of scorpionism in an endemic region, Southeast Iran.MethodsScorpionism data were collected from health centers and hospitals in Sistan-Baluchestan Province during 2010-2011. Specimens were collected at night, using UV light, between May and October 2012.ResultsIn total, 246 scorpions were collected from two families (Buthidae and Scorpionidae). Five species including Odontobuthus odonturus, Hottentotta (Buthotus) jayakari, Compsobuthus matthiesseni, Scorpio maurus and Orthochirus scrobiculosus are reported for the first time from this area. Androctonus crassicauda was the dominant species. In total, 3 638 scorpion sting cases were recorded by health system, the majority of which were females. Stings mostly occurred in July and the age group of 15–24 years presented the highest frequency. Scorpionism decreased during 2011 compared with that in 2010 (68.2%).ConclusionsBased on the results, scorpionism is a serious health problem in this area and increasing knowledge of residents regarding the prevention methods of scorpion stings is recommended. Additional research on the scorpion fauna, their ecological and molecular variety in this part of the country is needed as well as the correlation between scorpions' species and the clinical signs and symptoms

The prevalence of pediculosis capitis and its associated risk factors in primary schools of girls in rural district

زمینه و هدف: آلودگی به شپش سر یکی از بیماری های شایع در تمام سنین و دارای انتشار جهانی است. آلودگی به شپش سر در مراکز تجمعی مانند مدرسه‌ها، پادگان‌ها و خوابگاه ها زیاد و در مدارس، بویژه مدرسه‌های ابتدایی دخترانه در حد قابل توجهی می باشد. این مطالعه با هدف تعیین شیوع آلودگی به شپش سر و عوامل موثر بر آن در دانش آموزان مدارس ابتدایی دخترانه مناطق روستایی استان قم در سال 1390 انجام شد. روش بررسی: این مطالعه توصیفی- تحلیلی بر روی 900 نفر از دانش آموزان دختر ساکن در مناطق روستایی استان قم که به روش نمونه گیری تصادفی چند مرحله ای انتخاب شدند، انجام شد. داده ها با استفاده از پرسشنامه و معاینه موی سر از نظر آلودگی به شپش جمع آوری شدند و با آزمون های آماری کای اسکور و رگرسیون لجستیک چندگانه مورد تجزیه و تحلیل قرار گرفتند. یافته‌ها: در بین 900 دانش آموز مورد بررسی، 120 نفر (3/13) آلوده به آلودگی با شپش سر تشخیص داده شدند. در آنالیز بین متغیرهای محل سکونت، شغل و تحصیلات پدر، میزان تحصیلات مادر، تعداد افراد خانوار، وجود حمام در منزل، تعداد دفعات استحمام، تعداد دفعات شانه‌زنی، سابقه ابتلا به شپش سر، وجود یا عدم وجود مربی بهداشت در مدرسه، دسترسی یا عدم دسترسی به خدمات بهداشتی درمانی و ابتلا به آلودگی با شپش سر ارتباط معنی دار آماری مشاهده شد (05/0>P). نتیجه گیری: علل شیوع این بیماری در بین دانش آموزان استان قم با عواملی مثل عدم وجود مربی بهداشت در مدرسه، عدم دسترسی کافی به خدمات بهداشتی درمانی، عدم توجه کافی به رعایت بهداشت فردی مرتبط بود. بنابراین رعایت بهداشت فردی، آموزش دادن در مورد راه های آلودگی و پیشگیری از بیماری و فراهم کردن امکانات بهداشتی می تواند در کاهش آلودگی و عوارض ناشی از آن نقش مهمی داشته باشد

Epidemiological features of brucellosis and factors affecting its treatment failure and relapse in Qom Province, Iran

Background: Brucellosis is one of the major health problems in many areas of the world, especially in the Mediterranean and the Middle East regions.Objective: To determine the epidemiological characteristics, clinical signs, and risk factors of relapse rate in patients with brucellosis, Qom Province, Iran.Methods: A descriptive-analytic study was conducted on 410 confirmed brucellosis cases in Qom Province, central Iran, from 2015 to 2019, based on epidemiological checklists and according to the Iran Ministry of Health and Medical Education (MOHME). Univariate and multiple logistic regression analyses were conducted using Stata software version 14.Results: The relapse rate of brucellosis was 6.6% until nine months after s arting the treatment, and all recurrent cases were infected by Brucella melitensis. Based on univariate logistic regression analysis, the delayed treatment and type species of Brucella were significant factors affecting the relapse of brucellosis. The relapse rates were 5.4%, 6.2%, and 20.0% in patients whose delayed treatments were &lt;50, 51-150, and &gt;151days, respectively. Based on the multiple logistic regression, it was observed that delayed treatment &gt;50 days increased the rate of relapse more than four times.Conclusion: The delayed initiation of treatment was a significant factor influencing the relapse of brucellosis; therefore, it is necessary to provide enough diagnostic and laboratory facilities, and people need to be educated about the signs and symptoms of the disease

Control of American Cockroach (Periplaneta americana) in Municipal Sewage Disposal System, Central Iran

Background: Cockroaches consists of 4000 species, of which 40 species are serious domestic pests. They have involved the mechanical transmission of various pathogenic viruses, bacteria, and protozoans to humans. This study aimed to determine different control methods of P. americana in sewage system of Esfahan City, central Iran using different insecticides recommended by WHO. Methods: Totally, 164 manholes with at least more than three cockroaches were selected until 2017 for this study. The species of cockroaches were identified; the adults and nymphs were counted and recorded. Each sewer shaft was assigned to one treatment method in an ascending order of number of cockroaches counted, coding the treatment method with paint on the lower part of the wall near the manhole cover. The manhole shafts were then inspected at 1 and 5 months’ post-treatment. Data analyzed by statistical methods.Results: Almost all of the products (Excluding boric acid with bait formulation) resulted in appropriate control with­in one month of application. The appropriate products for chemical control of cockroaches were the chlorpyrifos 5% Emulsifiable Concentrate (EC), diazinon 5% (EC), diazinon 0.05% (EC) and cypermethrin 5% Fog. These pesticides achieved an optimal reduction of population providing more than 90% control of cockroaches for five consecutive months. Conclusion: The emulsifiable concentrates and fog formulations in the control were more successful compared to other methods and this was penetration deep into the hiding places of cockroaches.</p

Spatial Distribution of Scorpionism in Ardabil Province, North West of Iran

Background Scorpion stings are the most important health problems in tropical and subtropical countries. The aim of this study was to assess spatial distribution of scorpions and scorpionism in Ardabil province, Iran. Materials and Methods This descriptive–analytic study wascarried out in all 10 counties of Ardabil province, Northwestern Iran.The clinical and demographic data of scorpion sting cases were collected from questionnaires belonging to an 8 year - period of 2010 to 2017. In addition, scorpions were captured using Ultra-violet (UV) light, Pitfall traps and digging methods. After species identification, Arc GIS 9.3 software was applied for mapping spatial distribution of them. Data were analyzed by SPSS software (version 21.0). Results A total of 958 scorpion sting cases were documented. One hundred ninety cases (19.83%) of them were occurred in age grou

Predicting the environmental suitability for onchocerciasis in Africa as an aid to elimination planning

Recent evidence suggests that, in some foci, elimination of onchocerciasis from Africa may be feasible with mass drug administration (MDA) of ivermectin. To achieve continental elimination of transmission, mapping surveys will need to be conducted across all implementation units (IUs) for which endemicity status is currently unknown. Using boosted regression tree models with optimised hyperparameter selection, we estimated environmental suitability for onchocerciasis at the 5 × 5-km resolution across Africa. In order to classify IUs that include locations that are environmentally suitable, we used receiver operating characteristic (ROC) analysis to identify an optimal threshold for suitability concordant with locations where onchocerciasis has been previously detected. This threshold value was then used to classify IUs (more suitable or less suitable) based on the location within the IU with the largest mean prediction. Mean estimates of environmental suitability suggest large areas across West and Central Africa, as well as focal areas of East Africa, are suitable for onchocerciasis transmission, consistent with the presence of current control and elimination of transmission efforts. The ROC analysis identified a mean environmental suitability index of 071 as a threshold to classify based on the location with the largest mean prediction within the IU. Of the IUs considered for mapping surveys, 502% exceed this threshold for suitability in at least one 5 × 5-km location. The formidable scale of data collection required to map onchocerciasis endemicity across the African continent presents an opportunity to use spatial data to identify areas likely to be suitable for onchocerciasis transmission. National onchocerciasis elimination programmes may wish to consider prioritising these IUs for mapping surveys as human resources, laboratory capacity, and programmatic schedules may constrain survey implementation, and possibly delaying MDA initiation in areas that would ultimately qualify.SUPPORTING INFORMATION : FIGURE S1. Data coverage by year. Here we visualise the volume of data used in the analysis by country and year. Larger circles indicate more data inputs. ‘NA’ indicates records for which no year was reported (eg, ‘pre-2000’). https://doi.org/10.1371/journal.pntd.0008824.s001FIGURE S2. Illustration of covariate values for year 2000. Maps were produced using ArcGIS Desktop 10.6. https://doi.org/10.1371/journal.pntd.0008824.s002FIGURE S3. Environmental suitability of onchocerciasis including locations that have received MDA for which no pre-intervention data are available. This plot shows suitability predictions from green (low = 0%) to pink (high = 100%), representing those areas where environmental conditions are most similar to prior pathogen detections. Countries in grey with hatch marks were excluded from the analysis based on a review of national endemicity status. Areas in grey only represent locations masked due to sparse population. Maps were produced using ArcGIS Desktop 10.6 and shapefiles to visualize administrative units are available at https://espen.afro.who.int/tools-resources/cartography-database. https://doi.org/10.1371/journal.pntd.0008824.s003FIGURE S4. Environmental suitability prediction uncertainty including locations that have received MDA for which no pre-intervention data are available. This plot shows uncertainty associated with environmental suitability predictions colored from blue to red (least to most uncertain). Countries in grey with hatch marks were excluded from the analysis based on a review of national endemicity status. Areas in grey only represent locations masked due to sparse population. Maps were produced using ArcGIS Desktop 10.6 and shapefiles to visualize administrative units are available at https://espen.afro.who.int/tools-resources/cartography-database. https://doi.org/10.1371/journal.pntd.0008824.s004FIGURE S5. Environmental suitability of onchocerciasis excluding morbidity data. This plot shows suitability predictions from green (low = 0%) to pink (high = 100%), representing those areas where environmental conditions are most similar to prior pathogen detections. Countries in grey with hatch marks were excluded from the analysis based on a review of national endemicity status. Areas in grey only represent locations masked due to sparse population. Maps were produced using ArcGIS Desktop 10.6 and shapefiles to visualize administrative units are available at https://espen.afro.who.int/tools-resources/cartography-database. https://doi.org/10.1371/journal.pntd.0008824.s005FIGURE S6. Environmental suitability prediction uncertainty excluding morbidity data. This plot shows uncertainty associated with environmental suitability predictions colored from blue to red (least to most uncertain). Countries in grey with hatch marks were excluded from the analysis based on a review of national endemicity status. Areas in grey only represent locations masked due to sparse population. https://doi.org/10.1371/journal.pntd.0008824.s006FIGURE S7. Covariate Effect Curves for all onchocerciasis occurrences (measures of infection prevalence and disability). On the right set of axes we show the frequency density of the occurrences taking covariate values over 20 bins of the horizontal axis. The left set of axes shows the effect of each on the model, where the mean effect is plotted on the black line and its uncertainty is represented by the upper and lower confidence interval bounds plotted in dark grey. The figures show the fit per covariate relative to the data that correspond to specific values of the covariate. https://doi.org/10.1371/journal.pntd.0008824.s007FIGURE S8. Covariate Effect Curves for all onchocerciasis occurrences (measures of infection prevalence and disability). On the right set of axes we show the frequency density of the occurrences taking covariate values over 20 bins of the horizontal axis. The left set of axes shows the effect of each on the model, where the mean effect is plotted on the black line and its uncertainty is represented by the upper and lower confidence interval bounds plotted in dark grey. https://doi.org/10.1371/journal.pntd.0008824.s008FIGURE S9. ROC analysis for threshold. Results of the area under the receiver operating characteristic (ROC) curve analysis are presented below, with false positive rate (FPR) on the x-axis and true positive rate (TPR) on the y-axis. The red dot on the curve represents the location on the curve that corresponds to a threshold that most closely agreed with the input data. For each of the 100 BRT models, we estimated the optimal threshold that maximised agreement between occurrence inputs (considered true positives) and the mean model predictions as 0·71. https://doi.org/10.1371/journal.pntd.0008824.s009TABLE S1. Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER) checklist. https://doi.org/10.1371/journal.pntd.0008824.s010TABLE S2. Total number of occurrence data classified as point and polygon inputs by diagnostic. We present the total number of occurrence points extracted from the input data sources by diagnostic type. ‘Other diagnostics’ include: DEC Patch test; Knott’s Method (Mazotti Test); 2 types of LAMP; blood smears; and urine tests. https://doi.org/10.1371/journal.pntd.0008824.s011TABLE S3. Total number of occurrence data classified as point and polygon inputs by location. https://doi.org/10.1371/journal.pntd.0008824.s012TABLE S4. Covariate information. https://doi.org/10.1371/journal.pntd.0008824.s013TEXT S1. Details outlining construction of occurrence dataset. https://doi.org/10.1371/journal.pntd.0008824.s014TEXT S2. Covariate rationale. https://doi.org/10.1371/journal.pntd.0008824.s015TEXT S3. Boosted regression tree methodology additional details. https://doi.org/10.1371/journal.pntd.0008824.s016APPENDIX S1. Country-level maps and data results. Maps were produced using ArcGIS Desktop 10.6 and shapefiles to visualize administrative units are available at https://espen.afro.who.int/tools-resources/cartography-database. https://doi.org/10.1371/journal.pntd.0008824.s017This work was primarily supported by a grant from the Bill & Melinda Gates Foundation OPP1132415 (SIH). Financial support from the Neglected Tropical Disease Modelling Consortium (https://www.ntdmodelling.org/), which is funded by the Bill & Melinda Gates Foundation (grants No. OPP1184344 and OPP1186851), and joint centre funding (grant No. MR/R015600/1) by the UK Medical Research Council (MRC) and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement which is also part of the EDCTP2 programme supported by the European Union (MGB).The Neglected Tropical Disease Modelling Consortium which is funded by the Bill & Melinda Gates Foundation, the UK Medical Research Council (MRC) and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement which is also part of the EDCTP2 programme supported by the European Union (MGB).http://www.plosNTDS.orgam2022Medical Microbiolog

Study of the Epidemiological Status of Crimean-Congo Hemorrhagic Fever Disease in Qom Province, 2011, Iran

Background and Objectives: Crimean-Congo Hemorrhagic fever (CCHF) is an acute viral febrile hemorrhagic disease that is common between human and animal. This study was performed with the aim of determining epidemiological status of CCHF in Qom province. Methods: This descriptive study was done on patients with clinical signs or with an epidemiological history of CCHF, who were referred to hospitals, health centers, and private clinics during 2011. Then, based on guideline of the National Technical Committee of the Ministry of Health, patients were classified into three groups of suspected, probable and confirmed. The data were analyzed by frequency table, chi-square test, and Fisher’s exact test. p<0.05 considered as significant.Results: Twelve out of 38 patients, after diagnosis were placed in the suspected to CCHF group, went under follow-up and treatment. Among them, 5 cases (41.67%) were confirmed, 2 cases (16.67%) were probable, and 5 cases (41.67%) were suspected (only had some symptoms). The majority of patients were male (91.76%) with the age range of 15-30 (83.34%), and resident in urban areas (75%). 58.34% of the whole patients were farmers, students, or butchers. 83.34% of patients reported a history of contact with animals, and the mortality rate of confirmed cases was 20%.Conclusion: According to the results of this study, training of people at risk, and doing safety measures, such as keeping fresh meat in the refrigerator for 24 hours and using gloves while household cleaning fresh meat are necessary

The Evaluation of Intralesional Glucantime and Cryotherapy plus Intralesional Glucantime Therapeutic Efficacy on Zoonotic Cutaneous Leishmaniasis: A Randomized Clinical Trial

Background: Currently, Glucantime is considered the first-line treatment of cutaneous Leishmaniasis. This study aimed to evaluation of intralesional Glucantime (IG) and Cryotherapy (Cryo) plus intralesional Glucantime (Cryo and IG) therapeutic efficacy on Zoonotic Cutaneous Leishmaniasis in Qom province, Iran. Materials and Methods: In this randomized controlled trial of 197 CL patients reported from Qom health centers, Iran during (2014-2017), 112 cases were entered to this study. According to the Iranian Ministry of Health therapeutic guide line of CL, 54 cases with 116 lesions received IG weekly, and 58 patients with 115 lesions received the IG once a week coupled with Cryo using liquid nitrogen once every two weeks. The average volume of injected solution per lesion was 0.2 ml to 0.5 ml into the border of the healthy skin and the onset of erythema in the lesions using insulin syringe needles. In second therapeutic method; cryotherapy with liquid nitrogen was performed by dipstick technique. At first, the lesion size and induration of lesions were recorded. After 7 and 12 weeks of treatment, lesions healing rate was monitored. Healing was defined as complete re-epithelialization and disappearance of induration. Results: Out of 112 CL patients, 54 cases with 116 lesions received IG, and 58 patients with 115 lesions received Cryo and IG. At 7th week after the initiation of treatment, complete healing was observed in 56 out of 116 lesions (48.1%) in the group which received weekly IG and 83 out of 115 lesions (72.2%) in the group which received biweekly Cryo plus IG. At 12th week after the treatment, the cure rate was 91% and 100% in group which received weekly IG and group which received IG once a week coupled with cryotherapy (p=0.001). Conclusion: Based on the findings, IG once a week coupled with cryotherapy was more effective compared with weekly IG and reduced the period of treatment

Phlebotomus (Adlerius) kabulensis (Diptera: Psychodidae) a new record sand fly species from Iran: Morphological and molecular aspects

Objective: To represent a new geographical record, Phlebotomus (Adlerius) kabulensis (P. kabulensis), which is suspected to be a potential vector of visceral leishmaniasis. Methods: For the first time, P. kabulensis specimens were collected using the sticky paper traps method in outdoor places in mountainous areas with vegetation coverage of three provinces in Iran. Identification of males was based on ecological, morphological, morphometric and molecular (mtDNA cytochrome b gene sequences) criteria. Generally, males have two ascoids on the 8th antennal segment and one ascoid on segments 9th to 15th, aedeagus with normal obtuse-angled sub-terminal notch and coxite with 27–50 groups of hairs on the distal half of its body. Results: Morphometric measurement revealed that P. kabulensis specimens were the same as compared with seven other morphological characters in three provinces of the country but lengths of the coxite were significantly different. The PCR result of the cytochrome b (Cyt b)-mtDNA fragment shows 550-bp length, with its special nucleotide arrangement. The male and female of P. kabulensis were newly discovered members of the subgenus Adlerius from Iran. Initial DNA analysis indicated how distinct this species is. Conclusions: The results show that the P. kabulensis female will be identified by comparing with other Adlerius female groups regarding its morphometric characters and molecular sequencing