Microsoft Word - 8-Hashareh Dr Alavian Epidemiological RTL.doc Iranian J Arthropod-Borne Dis, (2009), 3(2): 50-54 SM Alavinia et al: Some Epidemiological Aspects… 50 Short Communication Some Epidemiological Aspects of Cutaneous Leishmaniasis in Northern Khorasan Province, Iran *SM Alavinia 1, K Arzamani 1, MH Reihani 2, J Jafari 3 1Educational Development Center, Deputy of Education, Northern Khorasan University of Medical Sci- ences, Iran 2 Center of Disease Control, Deputy of Health, Northern Khorasan University of Medical Sciences, Iran 3 Center of Disease Control, Health Center of Esfarayen, Northern Khorasan University of medical sci- ences, Iran (Received 27 Apr 2009; accepted 16 Nov 2009) Abstract Background: Cutaneous leishmaniasis (CL) is a widespread tropical infection which has a high incidence rate in Iran. The aim of this study was to determine some epidemiological aspects of disease in Northern Khorasan Prov- ince, Iran. Methods: From 2005 to 2008, data concerning 1453 patients with CL were collected and analyzed from the different districts of health service registry of the province. The statistical analyses were carried out with SPSS version 12.0 for windows. Results: The highest number of patients was in 2005 with 555 cases in this year. 19.3% of patients aged younger than 5-year and 57.5% were older than 15 year. 37.8% had only one lesion, and 40.5% had at least three lesions. The highest incidence of disease was observed in Jajarm district in 2005 (381.1 per 100,000), and the lowest incidence rate was in Farouj district in the same year. The disease was observed in all months of the year with the highest inci- dence rate from September to November. Conclusion: Although Jajrm is a known foci in Iran, based on our knowledge there is no report in the literature on assessing the prevalence of CL in this region in recent years. We also found that the disease is endemic in Northern Khorasan Province. Keywords: Cutaneous leishmaniasis, Epidemiology, Iran Introduction Cutaneous leshmaniasis (CL) is a wide- spread tropical infection caused mainly by two species of Leishmania, L. tropica and L. major, transmitted by phlebotomus sandflies (Oumeish 1999, Bailey Lockwood 2007). Al- though CL is endemic in 88 countries in Africa, Asia, Europe and North and South America (Herwaldt 1999), 90% of all cases occur in six countries including Afghanistan, Brazil, Iran, Peru, Saudi Arabia, and Syria (Desjeux 1996). There are an estimated numbers of 12 million cases worldwide, with 1.5-2 million new cases added each year (WHO 1984, 1990). In the recent years, CL has emerged as a significant cause of morbidity and social stigma in war-torn countries such as Afghanistan (Reithinger et al. 2005). This disease is still a great health problem in Iran. The prevalence of infection has been reported as 1.8% to 37.9% in different provinces of Iran. (Yaghoobi- Ershadi et al. 2002, Talari et al. 2006). Sev- eral new foci have been reported in recent years, indicating the potential spread of dis- ease in Iran (Razmjou et al. 2009). The pre- *Corresponding author: Dr Seyed Mohammad Alavinia, Email: malavinia2000@yahoo.com Iranian J Arthropod-Borne Dis, (2009), 3(2): 50-54 SM Alavinia et al: Some Epidemiological Aspects… 51 valence of disease is high in some provinces of Iran, including Isfahan (Nadim et al. 1968, Nadim and Faghih 1968, Salimi 2000), Shiraz (Moaddeb et al. 1993), Khorasan (Javadian et al.1967), Khuzestan and Kerman (Nadim and Seyedi-Rashti 1971). The aim of this study was to evaluate the incidence and some epidemiological as- pects of cutaneous leishmaniasis in Northern Khorasan Province during 2005 - 2008. Materials and Methods From 2005 to 2008, 1453 patients in- fected with cutaneous leishmaniasis were col- lected from health service registry of six dis- tricts of Northern Khorasan Province, Iran. The patients were diagnosed clinically, para- clinically or both and the diagnosis were con- firmed by a physician. A questionnaire about the name, sex, habitation area, date of onset, date of diagnosis, number of lesions, and lo- cation of the lesions was completed for each patient. The statistical analyses were carried out with SPSS version 12.0 for windows. Results Table 1 shows the basic characteristics of the study population. The mean age of the study population was 23.2 yr (SD= 18.7) with 19.3% younger than 5 yr, and 57.5% older than 15 yr. The most cases were observed in 2005 with 555 cases. There was a significant difference be- tween percentage of male and female with cu- taneous leishmaniasis (P< 0.001). 37.8% of patients had one lesion, and 40.5% had at least 3 lesions. 42.9% of the patients had le- sion on their face. Table 2 shows the distribution of dis- ease stratified by districts in Northern Khorasan Province from 2005 to 2008. Jajarm had the highest (45.4%) and Farouj had the lowest number of the disease (1.4%) during these years. Fig.1 shows the incidence rate of the disease for each district in the study popula- tion. The disease was reported in all months of the year with the highest rate from Sep- tember to November (Fig. 2). Table1: Baseline characteristics of 1453 patients with cutaneous leishmaniasis in Northern Khorasan Province, Iran: 3/2005- 9/2008 N 23.2 ± 18.7 1453 Age (yr) (mean ± SD) 42.9 624 Female (%) 37.8 21.7 40.5 549 315 589 Number of lesions (%) 1 2 >=3 60.8 39.2 570 884 Location (%) Urban Rural 28.3 644 44.3 397 27.3 412 Diagnosis Clinical Laboratory Both Table 2. Distribution of 1453 patients with cutaneous leishmaniasis in different districts of Northern Khorasan Province from 3/2005-9/2008 3/2005-3/2006 3/2006-3/2007 3/2007-3/2008 3/2008-9/2008 District n % n % n % n % Bojnourd 75 13.5 45 11.8 54 12.3 12 15.4 Esfarayen 235 42.3 90 23.6 150 34.2 16 20.5 Jajarm 218 39.3 214 56.2 196 44.6 31 39.7 Shirvan 22 4.0 22 5.8 24 5.5 12 15.4 Maneh & Samalghan 4 0.7 4 1.0 6 1.4 2 2.6 Farouj 1 0.2 6 1.6 9 2.1 5 6.4 Total 555 100.0 381 100.0 439 100.0 78 100.0 Iranian J Arthropod-Borne Dis, (2009), 3(2): 50-54 SM Alavinia et al: Some Epidemiological Aspects… 52 30.7 68.0 23.9 179.4 368.1 13.7 4.2 1.8 0 50 100 150 200 250 300 350 400 In ci d en ce country province Bojnourd Esfarayen Jajarm Shirvan Maneh&sam alghan Farouj Location Fig. 1. Incidence rate of the cutaneous leishmaniasis in 1453 patients from different districts of Northern Khorasan Province compared with incidence rate in Iran: 3/2005-9/2008 Fig. 2. Month distribution of 1375 patients with cutaneous leishmaniasis in Northern Khorasan Province- 3/2005- 3/2008 Iranian J Arthropod-Borne Dis, (2009), 3(2): 50-54 SM Alavinia et al: Some Epidemiological Aspects… 53 Discussion The results showed that Northern Kho- rasan Province is an endemic area of cutane- ous leishmaniasis. We also assessed the pre- valence of this disease in details in Jajarm as a known focus in Iran. Some limitations should be taken into account in this study. First of all, we used the data from health service archive. It is possi- ble that some patients with cutaneous leish- maniasis are visited and treated by physicians out of the province. Based on our knowledge the number of these cases is low and can be ignored. Secondly, since this disease is a self- limited one, some patients might have been cured without any medications. Unfortunately the information about the number of these patients is not available; therefore it is possi- ble that the incidence of the disease were underestimated in the present study. Thirdly, as we used the data about the patients, find- ing the relationship between the disease and the potential risk factors were not possible. Age distribution of the disease through this province showed that 19.3% of the pa- tients are under the age of 5 yr. Analyzing the incidence of disease in Iran showed more than 2 times higher incidence in this province. The most likely reason is an increase in human– sandfly contact. This is attributed to the devel- opment of villages and the spread of the hu- man population into the habitats of the local vectors. Although another study has introduced Esfarayen district as a focus of cutaneous leish- maniasis (Javadian et al. 1976), we found Ja- jarm district as an active focus of the disease in Iran. We found a significant sex difference for the incidence of cutaneous leishmaniasis. The low incidence of the disease among females could be due to the way of dressing among women in Iran. Another reason is that men nor- mally work outside, considering the reservoirs of the disease, we expect higher incidence of the disease among men. The month distribution of the disease through the province reflects the rural type of the disease, which is more prominent in two districts (Esfarayen and Jajarm). The month distribution assessment of the disease in each districts showed also some urban foci of dis- ease in the province. These two patterns of distribution of disease are caused by the du- ration of the disease, which is much longer in the urban type (Nadim 1969). Therefore, the highest number of patients could be found in all month in urban type. 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