Volume 10, Issue 1 (Spring 2023)
J Prevent Med 2023, 10(1): 48-59 |
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Research code: 140026
Ethics code: IRSBMU.PHNS.REC.1400.026
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Hatami H, Akbari H, Fereidoni M. Epidemiological, Clinical and Paraclinical Evaluation of Cutaneous Leishmaniasis Cases in Aran va Bidgol City, Isfahan, Iran During 2018-2020. J Prevent Med 2023; 10 (1) :48-59
URL: http://jpm.hums.ac.ir/article-1-618-en.html
URL: http://jpm.hums.ac.ir/article-1-618-en.html
1- Department of Public Health, Environmental and Occupational Hazards Control Research Center, School of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
2- Department of Biostatistics and Epidemiology, Social Determinants of Health Research Center, School of Public Health, Kashan University of Medical Sciences, Kashan, Iran.
3- Department of Public Health, School of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
2- Department of Biostatistics and Epidemiology, Social Determinants of Health Research Center, School of Public Health, Kashan University of Medical Sciences, Kashan, Iran.
3- Department of Public Health, School of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Introduction
Cutaneous leishmaniasis (CL) is an infectious disease caused by a parasite called Leishmania. CL is endemic in the tropical regions of America, Africa, and the Indian subcontinent, and in the subtropical regions of Southwest Asia and the Mediterranean region. Although CL is not usually associated with high mortality, but the high rate of infection and the creation of malformed skin lesions that in some cases remain for more than a few years and the scar remains until the end of life even with standard treatment, are considerable and causes pain and suffering to the patient. Isfahan province is one of the areas in Iran where the CL is endemic, and Aran va Bidgol city located in this province is the center of the endemic. The vectors of the disease are bivalves of t the family Psychodidae, known as sandfly. The species and subspecies of this sandfly are involved in the transmission of about 30 species of Leishmania parasites to mammals. In Iran, 42 species of sandflies belonged to two genera, Phlebotomus and Sargentomia, have been identified so far. Diagnosis of CL is usually based on the clinical symptoms observed in patients and its confirmation through direct examination, culturing, or biopsy. Given the high prevalence of this disease in Isfahan province and Aran va Bidgol city, and considering that no comprehensive study has been conducted in this field in recent years, this study aims to determine the epidemiology of CL in Aran va Bidgol city during 2018-2020.
Methods
This descriptive cross-sectional study was conducted on patients with CL who referred to CL treatment centers in Aran va Bidgol city during 2018-2020.The inclusion criteria were a positive smear test of CL and the availability of complete information of patients in the health center. After the diagnosis, following information of patients were extracted: Age, sex, occupation, nationality, place of residence (city/village), state of residence, simultaneous illness of other family members, history of scars in previous years, location of lesion, number of lesions, month of infection, and travel history. Patients who had incomplete records or whose date of infection was not known were excluded from the study. The sample size was 1020. After collecting the data, the prevalence tables and charts were first drawn according to the variables. Chi-square test was used to analyze the results. P<0.05 was statistically significant. SPSS software, version 22 was used to analyze the data and EXCEL software was used to draw the graphs.
Results
Of 1020 patients, 60% (n=612) were male and the rest were female. 16.5% were under 10 years of age and 94.1% were Iranian; 0.8% had a previous history of CL; 43.6% reported travel history, most of whom had traveled to the city; 89.9% had less than 5 ulcers and the ulcer size of 74.4% patients was less than 3 cm. Most of the ulcers found in the upper limb and 9.5% were in the lower limb. The highest frequency of infection with CL was during September-December. Statistically, there was a significant correlation between the age of affected people and the location of lesions (P<0.01). The ulcers were more common among men and on the upper limbs (59.5%). In terms of occupation, the ulcers were more common among students and on the upper limbs (70.4%). There was no statistically significant relationship between occupation and occurrence of skin ulcers on the trunk (P=0.359), but there was a significant relationship between them in other parts of the body (P<0.001). A statistically significant relationship was observed between the size of ulcers and patients’ sex, age and place of residence (P<0.05).
Discussion
The prevalence of CL in Aran va Bidgol city is higher among young males. The man age of the patients is 34.5 years. Most of patients were housewives, students and rural residents. The main reason for the high prevalence of CL in childhood and youth and in men can be attributed to the type of clothing they wear. Some researchers believed that the possible reason for the decrease in CL with the increase of age is the development of sufficient immunity in old age. In the present study, the frequency of CL ulcers was higher in the upper limbs and in the head/neck. The reason for the relationship between the presence of CL ulcers in the head/neck and gender is generally the type of clothing worn by men and women in the region. By providing the necessary education about this disease and improving the health level of the society and the environment, the incidence of CL can be reduced in the city.
Ethical Considerations
Compliance with ethical guidelines
This study was approved by Tehran University of Medical Science (Code: IRSBMJ.PHNS.REC.1400.026).
Funding
This paper is extracted from the MSc thesis of Mohsen Fereidoni, approved by Department of Public Health, Shahid Beheshti University of Medical Sciences.
Authors' contributions
Conceptualization: Hossein Hatami, Mohsen Fereidoni; Methodology, validation, investigation, resources, writing–original draft preparation, writing–review & editing and visualization: All author; Software, formal analysis and data curation: Hossein Akbari and Mohsen Fereidoni; Supervision & project administration: Hossein Hatami; Funding acquisition: Mohsen Fereidoni.
Conflicts of interest
The authors declared no conflict of interest.
References
Cutaneous leishmaniasis (CL) is an infectious disease caused by a parasite called Leishmania. CL is endemic in the tropical regions of America, Africa, and the Indian subcontinent, and in the subtropical regions of Southwest Asia and the Mediterranean region. Although CL is not usually associated with high mortality, but the high rate of infection and the creation of malformed skin lesions that in some cases remain for more than a few years and the scar remains until the end of life even with standard treatment, are considerable and causes pain and suffering to the patient. Isfahan province is one of the areas in Iran where the CL is endemic, and Aran va Bidgol city located in this province is the center of the endemic. The vectors of the disease are bivalves of t the family Psychodidae, known as sandfly. The species and subspecies of this sandfly are involved in the transmission of about 30 species of Leishmania parasites to mammals. In Iran, 42 species of sandflies belonged to two genera, Phlebotomus and Sargentomia, have been identified so far. Diagnosis of CL is usually based on the clinical symptoms observed in patients and its confirmation through direct examination, culturing, or biopsy. Given the high prevalence of this disease in Isfahan province and Aran va Bidgol city, and considering that no comprehensive study has been conducted in this field in recent years, this study aims to determine the epidemiology of CL in Aran va Bidgol city during 2018-2020.
Methods
This descriptive cross-sectional study was conducted on patients with CL who referred to CL treatment centers in Aran va Bidgol city during 2018-2020.The inclusion criteria were a positive smear test of CL and the availability of complete information of patients in the health center. After the diagnosis, following information of patients were extracted: Age, sex, occupation, nationality, place of residence (city/village), state of residence, simultaneous illness of other family members, history of scars in previous years, location of lesion, number of lesions, month of infection, and travel history. Patients who had incomplete records or whose date of infection was not known were excluded from the study. The sample size was 1020. After collecting the data, the prevalence tables and charts were first drawn according to the variables. Chi-square test was used to analyze the results. P<0.05 was statistically significant. SPSS software, version 22 was used to analyze the data and EXCEL software was used to draw the graphs.
Results
Of 1020 patients, 60% (n=612) were male and the rest were female. 16.5% were under 10 years of age and 94.1% were Iranian; 0.8% had a previous history of CL; 43.6% reported travel history, most of whom had traveled to the city; 89.9% had less than 5 ulcers and the ulcer size of 74.4% patients was less than 3 cm. Most of the ulcers found in the upper limb and 9.5% were in the lower limb. The highest frequency of infection with CL was during September-December. Statistically, there was a significant correlation between the age of affected people and the location of lesions (P<0.01). The ulcers were more common among men and on the upper limbs (59.5%). In terms of occupation, the ulcers were more common among students and on the upper limbs (70.4%). There was no statistically significant relationship between occupation and occurrence of skin ulcers on the trunk (P=0.359), but there was a significant relationship between them in other parts of the body (P<0.001). A statistically significant relationship was observed between the size of ulcers and patients’ sex, age and place of residence (P<0.05).
Discussion
The prevalence of CL in Aran va Bidgol city is higher among young males. The man age of the patients is 34.5 years. Most of patients were housewives, students and rural residents. The main reason for the high prevalence of CL in childhood and youth and in men can be attributed to the type of clothing they wear. Some researchers believed that the possible reason for the decrease in CL with the increase of age is the development of sufficient immunity in old age. In the present study, the frequency of CL ulcers was higher in the upper limbs and in the head/neck. The reason for the relationship between the presence of CL ulcers in the head/neck and gender is generally the type of clothing worn by men and women in the region. By providing the necessary education about this disease and improving the health level of the society and the environment, the incidence of CL can be reduced in the city.
Ethical Considerations
Compliance with ethical guidelines
This study was approved by Tehran University of Medical Science (Code: IRSBMJ.PHNS.REC.1400.026).
Funding
This paper is extracted from the MSc thesis of Mohsen Fereidoni, approved by Department of Public Health, Shahid Beheshti University of Medical Sciences.
Authors' contributions
Conceptualization: Hossein Hatami, Mohsen Fereidoni; Methodology, validation, investigation, resources, writing–original draft preparation, writing–review & editing and visualization: All author; Software, formal analysis and data curation: Hossein Akbari and Mohsen Fereidoni; Supervision & project administration: Hossein Hatami; Funding acquisition: Mohsen Fereidoni.
Conflicts of interest
The authors declared no conflict of interest.
References
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Type of Study: Orginal |
Subject:
Epidemiology
Received: 2022/04/8 | Accepted: 2022/11/12 | Published: 2023/07/1
Received: 2022/04/8 | Accepted: 2022/11/12 | Published: 2023/07/1
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