Situational Analysis of Visceral Leishmaniasis in the Most Important Endemic Area of the Disease in Iran
Background: Visceral leishmaniasis is one of the most important vector borne diseases in the world, transmitted by sand flies. Despite efforts to prevent the spread of the disease, cases continue worldwide. In Iran, the disease usually occurs in children under 10 years. In the absence of timely diagnosis and treatment, the mortality rate is 95–100%. The main objective of this study was to determine the spatial and temporal distribution of visceral leishmaniasis as well as its correlation with climatic factors for determining high-risk areas in an endemic focus in northwestern Iran.
Methods: In this cross-sectional study, data on VL cases were collected from local health centers in Ardabil Province, Iran during 2001–2015 to establish a geodatabase using ArcGIS10.3. Data analysis was conducted using SPSS23 and ArcMap Spatial Analyst. MaxEnt model was used to determine ecologically suitable nichesfor the disease.
Results: Two hotspots were found in Meshkinshahr and Germi counties with 59% and 23% of total cases, respectively. There was an increase in the incidence rate of VL in Ardabil County from 2.9 in 2009 to 9.2/100,000 population in 2015. There was no spatial autocorrelation between county and total number of cases (P> 0.05). Higher NDVI, lower altitude and southern aspects had positive effects on the presence probability of VL.
Conclusion: The number of cases of this disease have been rising since 2013 and doubled in 2015. According to the derived distribution maps, the disease is spreading to new locations such as Ardabil and Namin counties.
Pavlin BI, Schloegel LM, Daszak P (2009) Risk of importing zoonotic dis-eases through wild¬life trade, United States. Emerg Infect Dis. 15(11): 1721–1726.
Chappuis F, Sundar S, Hailu A, Ghalib H,
Rijal S, Peeling RW, Alvar J, Boelaert M (2007) Visceral leishmaniasis: what are the needs for diagnosis, treatment and con¬trol?. Nat Rev Microbiol. 5(11): 873–882.
Millán J, Ferroglio E, Solano-Gallego L (2014) Role of wildlife in the epidemi-ol¬ogy of Leishmania infantum infec¬tion in Europe. Parasitol Res. 113(6): 2005–2014.
Di Muccio T, Scalone A, Bruno A, Ma-rangi M, Grande R, Armignacco O, Gradoni L, Gramiccia M (2015) Epi-de¬miology of im¬ported leishmaniasis in Italy: Im¬pli¬cations for a European en¬demic coun¬try. PloS One. 10(6): e0129418.
Santos AL, d'Avila-Levy CM, Kneipp LF, Sodré CL, Sangenito LS, Branquinha MH (2017) The Widespread Anti-Protozoal Action of HIV Aspartic Pep-tidase Inhib¬itors: Focus on Plasmodi-um spp., Leish¬mania spp. and Trypa-nosoma cruzi. Curr Top Med Chem. 17(11): 1303–1317.
Bailey MS (2013) Local treatments for cu¬taneous leishmaniasis. Clin Infec¬t Dis. 57 (3): 381–383.
Pace D (2014) Leishmaniasis. J Infect. 69 (1): S10–18.
Ready PD (2014) Epidemiology of viscer-al leishmaniasis. Clin Epidemiol. 6: 147–154.
Edrissian Gh, Hafizi A, Afshar A, So-leiman-Zadeh G, Movahed-Danesh AM, Garoussi A (1988) An endemic fo¬cus of visceral leish¬maniasis in Mesh¬kin-Shahr, east Azerbaijan Prov-ince, north-west part of Iran and IFA se-ro¬logical survey of the disease in this area. Bull Soc Pathol Exot Filiales. 81(2): 238–248.
Desjeux P (2004) Leishmaniasis: current situation and new perspectives. Comp Im¬munol Microbiol Infect Dis. 27(5): 305–318.
Mohebali M, Hajjaran H, Hamzavi Y, Mobedi I, Arshi S, Zarei Z, Akhoundi B, Naeini KM, Avizeh R, Fakhar M (2005) Epidemiological aspects of ca¬nine visceral leishmaniosis in the Is¬lamic Republic of Iran. Vet Parasitol. 129(3–4): 243–251.
Mohebali M (2013) Visceral leishmania-sis in Iran: review of the epidemiolog-i¬cal and clin¬ical features. Iran J Parasi-tol. 8 (3): 348–358.
Moradi Asl E, Mohebali M, Moham-madi-ghalehbin B, Ganji A, Molaei S, Mehrivar R, Zareei Z (2014) Study on changes in epi¬demiological patterns and pa¬ram¬eters of visceral leishmania¬sis in pa¬tients re¬ferred to health care centers of Meshkin Shahr during 2001–2012: (A retrospective study). J Ardabil Univ Med Sci. 14(1): 63–70.
Herwaldt BL (1999) Leishmaniasis. Lan-cet. 354(9185): 1191–1199.
Mohebali M, Javadian E, Yaghoobi Er¬shadi MR, Akhavan AA, Hajjaran H, Abaei MR (2004) Characterization of Leish-ma¬nia infec¬tion in rodents from en-demic ar¬eas of the Is¬lamic Republic of Iran. East Mediterr Health J. 10: 591–599.
Pavlovskiĭ EN (1966) Natural Nidality of Transmissible Diseases: In Relation to Land¬scape, Epidemiology, of Zooan¬thro¬-
ponoses. Peace Publishers. Mos¬cow.
Bevilacqua PD, Paixão HH, Modena CM, Castro MC (2001) Urbanization of vis¬ceral leishmaniose in Belo Hori-zonte, Brazil. Arq Bras Med Vet. 53(1): 1–8.
Bhunia, GS, Kesari S, Chatterjee N, Ku-mar V, Das P (2013) The burden of vis¬ceral leish¬maniasis in India: Chal-leng¬es in using re¬mote sensing and GIS to un¬derstand and control. ISRN In¬fec¬t Dis. 2013: 1–14.
Sudhakar S, Srinivas T, Palit A, Kar SK, Battacharya SK (2006) Mapping of risk prone areas of kala-azar (Visceral leish¬mani¬asis) in parts of Bihar state, India: an RS and GIS approach. J Vec¬tor Borne Dis. 43(3): 115–122.
Bavia ME, Carneiro DD, Gurgel Hda C, Madureira Filho C, Barbosa MG (2005) Remote sensing and geographic infor¬mation systems and risk of Amer-ican visceral leishmaniasis in Bahia, Brazil. Parassitolo¬gia. 47(1): 165–169.
Salahi-Moghaddam A, Mohebali M, Ali M, Habibi M, Zarei Z (2010) Ecologi-cal study and risk mapping of visceral leish¬maniasis in an endemic area of Iran based on a geo¬graphical infor¬mation sys¬tems ap¬proach. Geospat Health. 5(1): 71–77.
Ghatee MA, Sharifi I, Haghdoost AA, Kanannejad Z, Taabody Z, Hatam G, Abdol¬lahipanah A (2013) Spatial cor-relations of population and ecological factors with dis¬tribution of visceral leish¬maniasis cases in southwestern Iran. J Vector Borne Dis. 50(3): 179–187.
Rajabi M, Mansourian A, Pilesjö P, Ba-zmani A (2014) Environmental model-ling of vis¬ceral leishmaniasis by sus-cep¬tibility-mapping using neural net-works: a case study in north-western Iran. Ge¬ospat Health. 9(1): 179–191.
Rassi Y, Javadian E, Nadim A, Zahraii A, Vatandoost H, Motazedian H, Mohe¬bali M (2005) Phlebotomus (Lar-rous¬sius) kan¬delakii the principal and prov¬en vector of visceral leishmania-sis in north west of Iran. Pak J Biol Sci. 8 (12): 1802–1806.
Rassi Y, Javadian E, Nadim A, Rafiza-deh S, Zahraii A, Azizi K, Mohebali M (2009) Phlebotomus perfiliewi trans-cau¬casicus, a vector of Leishmania in-fan¬tum in northwest¬ern Iran. J Med En¬tomol. 46(5): 1094–1098.
Rassi Y, Abai MR, Oshaghi MA, Javadi-an E, Sanei A, Rafidzadeh S, Arzama-ni K (2012a) First detection of Leish-mania infantum in Phlebotomus kan-delakii using molecular methods in north-east¬ern Islamic Republic of Iran. East Med¬iterr
Health J. 18(4): 387–392.
Rassi Y, Dehkordi AS, Oshaghi MA, Abai MR, Mohtarami F, Enayati A, Zarei Z, Ja¬vadian E (2012b) First re-port on natu¬ral in¬fection of the Phlebotomus tobbi by Leish¬mania in-fantum in northwestern Iran. Exp Para-sitol. 131(3): 344–349.
Dehkordi AS, Rassi YA, Oshaghi MA,
Abai MR, Rafizadeh S, Yaghoobi-Er-shadi MR, Mohebali M, Zarei Z, Moh-tarami F, Jafarza¬deh B, Ranjbarkhah A, Javadian E (2011) Molecular detec-tion of Leishmania infantum in natu-rally in¬fected Phlebotomus perfiliewi transcau¬casicus in Bilesavar district, north¬west¬ern Iran. Iran J Arthropod Borne Dis. 5 (1): 20–27.
Azizi K, Rassi Y, Javadian E, Motazedi-an MH, Rafizadeh S, Yaghoobi-Ershadi MR, Mohe¬bali M (2006) Phlebotomus (Paraph¬leboto¬mus) alex-andri: a proba¬ble vector of Leish¬mania infantum in Iran. Ann Trop Med Para-sitol. 100(1): 63–68.
Azizi K, Rassi Y, Javadian E, Motazedi-an MH, Asgari Q, Yaghoobi-Ershadi MR (2008) First detection of Leish-mania infantum in Phlebotomus (Lar-roussius) major (Diptera: Psychodi-dae) from Iran. J Med Entomol. 45(4): 726–731.
Hanafi‐Bojd AA, Rassi Y, Yaghoobi‐Ershadi MR, Haghdoost AA, Akhavan AA, Char¬rahy Z, Karimi A (2015) Predicted distribution of visceral leishmaniasis vectors (Diptera: Psy¬cho¬didae, Phlebotominae) in Iran: A niche model study. Zoonoses Public Health. 62(8): 644–654.
Ministry of Health (MOH) and Medical Education (ME) of Iran (2010) Annual Re¬port of Malaria Control Depart-ment.
CDC, Iran, Tehran, p. 50.
Edrissian GH, Hafizi A, Afshar A, So-leiman-Zadeh G, Movahed-Danesh AM, Garoussi A (1988) An endemic fo¬cus of visceral leish¬maniasis in Mesh¬kin-Shahr, east Azerbaijan Prov-ince, north-west part of Iran and IFA se-ro¬logical survey of the disease in this area. Bull Soc Pathol
Exot Filiales. 81(2): 238–248.
Elmahallawy EK, Martinez AS, Rodri¬guez-Granger J, Hoyos-Mallecot Y, Agil A, Mari JM, Fernandez JG (2014) Diagno-sis of leishmaniasis. J Infect Dev Ctries. 8(8): 961–972.
Mohebali M, Taran M, Zarei Z (2004) Rapid detection of Leishmania infan-tum infection in dogs: comparative study using an immu¬nochromatographic dip¬stick rk39 test and di¬rect agglutina-tion. Vet Parasitol. 121(3): 239–245.
Encyclopedia of the Stateless Nations: Ethnic and National Groups Around the World (2014). 4: 225–229.
Phillips SJ, Dudík M, Schapire RE (2004) A maximum entropy approach to spe¬cies dis¬tribution modeling. Pro-ceeding ICML '04 Proceedings of the twenty-first international conference on Ma¬chine learning. p. 83.
Phillips S (2006) A brief tutorial on Maxent. AT and T Research.
ESRI (2015) ArcGIS Desktop: Release (Version 10.3.1). Redlands, CA: Envi-ronmental Systems Research Institute.
Edrisian GH, Hajaran H, Mohebali M, Soleimanzaeh G, Bokaei S (1996) Ap-plication and evaluation of direct ag-glutination test in sero-diagnosis of vis¬ceral leishmaniasis in man and ca-nine reservoirs in Iran. pp. 119–124.
Molaie S, Mohebali M, Gangi A, Pour-farzi F, Emdadi D, Modarres-sadrani N, Nasiri M, Soleimanzadeh Gh, Farajza-deh M, Zarei Z (2010) Seroepidemio¬logical study of vis¬ceral leishmaniasis (Kala-azar) in Ardabil Province, Iran, 1986–2009. Arma¬ghane-Danesh. 15(3): 262–272.
Góes MA, Melo CM, Jeraldo VD (2012) Time series of visceral leishmaniasis in Aracaju, state of Sergipe, Brazil (1999 to 2008): hu¬man and canine as-pects. Rev Bras Epidemi¬ol. 15(2): 298–307.
Palaniyandi M, Anand PH, Maniyosai R (2014) Climate, landscape and the en-vi¬ronments of visceral leishmaniasis trans¬mis¬sion in India, using remote sensing and GIS. J Geophys Remote Sens. 3(3): 1–6.
Saraiva L, Leite CG, de Carvalho LO, Andrade Filho JD, de Menezes FC, Fiúza VD (2012) Information system and geographic infor¬mation system tools in the data analyses of the control program for visceral leishmani¬ases from 2006 to 2010 in the sanitary dis¬trict of Ven-da Nova, Belo Horizonte, Minas Ge-rais, Brazil. J Trop Med. 2012: 254361.
Najibullah S, WalidSediqi A (2009) Na¬tion¬al Malaria and Leishmaniasis Con¬trol Pro-gram. Ministry of Public Health, Afghan-istan.
Kassiri H, Mortazavi HS, Ghorbani E (2012) Study of the epidemiological at¬tributes of visceral leishmaniasis in Meshkin-Shahr Dis¬trict, Ardabil Prov-ince, North-West of Iran (1987–2006). Jundishapur J Health Sci. 4(1): 21–34.
Gramiccia M, Scalone A, Di Muccio T, Orsini S, Fiorentino E, Gradoni L (2013) The bur¬den of visceral leish-maniasis in Italy from 1982 to 2012: a retrospective analysis of the multi-an-nual epidemic that occurred from 1989 to 2009. Euro Surveill. 18(29): 20535.
Martins-Melo FR, da Silveira Lima M, Ramos Jr AN, Alencar CH, Heukel-bach J (2014) Mortality and case fatality due to visceral leishmaniasis in Brazil: a na¬tion¬wide analy¬sis of epidemiology, trends and spatial pat¬terns. PloS One. 9(4): e93770.
Choobineh H, Mamishi S, Bahonar A, Safdari R, Rezaian M, Vaezzadeh F (2005) Clinical and epidemiological as¬pects of Kala-Azar in hospitalized cases in Children’s Medical Center (1988-
. Iran J Pediatrics. 15(4): 327–332.
Altaf C, Ahmed P, Ashraf T, Anwar M, Ahmed I (2005) Clinicopathological fea¬tures of childhood visceral leish¬man¬i¬asis in Azad Jammu and Kashmir Pakistan. J Ayub Med Coll Abbottabad. 17(4): 48–50.
Rey LC, Martins CV, Ribeiro HB, Lima AA (2005) American visceral leish-man¬i¬asis (Ka¬la-Azar) in hospitalized children from an en¬demic area. J Pedi-atr (Rio J). 81(1): 73–78.
Abedi-Astaneh F, Hajjaran H, Yaghoobi-Ershadi MR, Hanafi-Bojd AA, Mohe-bali M, Shirzadi MR, Rassi Y, Akha-van AA, Mahmoudi B (2016) Risk Mapping and Sit¬uational Analysis of Cutaneous Leishmania¬sis in an En-demic Area of Central Iran: A GIS-Based Survey. PLoS One. 11(8): e0161317.
Absavaran A, Rassi Y, Parvizi P, Oshaghi MA, Abaie MR, Rafizadeh S, Mohe-bali M, Zarea Z, Javadian E (2009) Iden¬tifi¬cation of sand flies of the sub-genus Lar¬roussius based on molecular and mor¬phological characters in North Western Iran. Iran J Arthropod Borne Dis. 3(2): 22–35.
Oshaghi MA, Maleki-Ravasan N, Hide M, Ja¬vadian E, Rassi Y, Sadraei J, Mohe¬bali M, Sedaghat MM, Hajjaran H, Za¬rei Z, Moh¬tarami F (2009) Phlebotomus perfiliewi transcaucasi-cus is circulating both Leishma¬nia do-novani and L. in¬fantum in northwest Iran. Exp Parasitol. 123(3): 218–225.
Mahami M, Mohebali M, Keshavarz H, Hajaran H, Akhoondi B, Zarei Z, Charedar S (2006) A seroepidemiologi¬cal survey of vis¬ceral leishmaniasis (Ka-la-Azar) in Germi District, Ardabil Province. J Sch Public Health Inst Pub¬lic Health Res. 4(1): 45–55.
Mohebali M, Edrissian GH, Nadim A, Hajjaran H, Akhoundi B, Hooshmand B, Za¬rei Z, Arshi Sh, Mirsamadi N, Manouchehri-Naeini K, Mamishi S, Sanati AA, Moshfe AA, Charehdar S, Fakhar M (2006) Applica¬tion of direct agglutination test (DAT) for the diag-no¬sis and seroepide-miological stud¬ies of visceral leishmaniasis in Iran. Iran J Parasitol. 1(1): 15–25.
Mohebali M, Edrissian GH, Shirzadi MR, Akhoundi B, Hajjaran H, Zarei Z, Mo-laei S, Sharifi I, Mamishi S, Mahmoudvand H, Tor¬abi V, Moshfe A, Malmasi A, Motazedian MH, Fakhar M (2011) An observational study on the current distribution of visceral leish¬maniasis in dif¬ferent geo-graphical zones of Iran and im¬plication to health policy. Travel Med Infect Dis. 9(2): 67–74.
Moshfe A, Mohebali M, Edrissian G, Za¬rei Z, Akhoundi B, Kazemi B, Sh Jam-shidi, M Mahmoodi (2008) Seroepide-miolog¬ical study on canine visceral Leishmaniasis in Meshkin-Shahr Dis-trict, Ardabil Province, northwest of Iran during 2006–2007. Iran J Parasi-tol. 3(3): 1–10.
Barati M, Mohebali M, Alimohammadi-an MH, Khamesipour A, Akhoundi B, Za-rei Z (2015) Canine visceral leishmani-asis: sero¬prevalence survey of asymp-to¬matic dogs in an endemic area of north¬west¬ern Iran. J Par¬asit Dis. 39(2): 221–224.
Jeyaram A, Kesari S, Bajpai A, Bhunia GS, Krishna Murthy YV (2012) Risk Zone Mod¬elling and Early Warning Sys¬tem for Viscer¬al Leishmaniasis Kala-Azar Disease in Bi¬har, India Us-ing Re¬mote Sensing and GIS. Int Arch Photogramm Remote Sens Spatial Inf Sci. XXXIX-B8: 71–75.
Franco AO, Davies CR, Mylne A, Dedet JP, GÁllego M, Ballart C, Gramiccia M, Grado¬ni L, Molina R, Gálvez R, Moril¬las-Márquez F, Barón-López S, Pires CA, Afonso MO, Ready PD, Cox J (2011) Predicting the dis¬tribution of ca¬nine leishmaniasis in western Eu-rope based on environmental varia-bles. Para¬sitology. 138(14): 1878–18791.
Bhunia GS, Kesari S, Jeyaram A, Kumar V,
Das P (2010) Influence of topogra¬phy on the endemicity of Kala-Azar: a study based on remote sensing and geo¬graph¬ical information system. Geospa¬tial health. 4 (2): 155–165.
|Issue||Vol 11 No 4 (2017)|
|Visceral leishmaniasis Seroepidemiology GIS Iran|
|Rights and permissions|
|This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.|