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Sunday, January 19, 2014

Leishmaniasis Epidemic in Iran and Brazil

Leishmaniasis is a parasitic disease spread by the bite of the female sandfly. There are different forms of leishmaniasis. Cutaneous leishmaniasis affects the skin and mucous membranes. Skin sores usually start at the site of the sandfly bite. In a few people, sores may develop on mucous membranes. Systemic, or visceral, leishmaniasis affects the entire body. This form occurs 2-8 months after a person is bitten by the sandfly. Most people do not remember having a skin sore. This form can lead to deadly complications. The parasites damage the immune system by decreasing the numbers of disease-fighting cells. Cases of leishmaniasis have been reported on all continents except Australia and Antarctica.
The chancellor of Tehran University of Medical Sciences announced on Monday [13 Jan 2014] that every year 20 000 cases of leishmaniasis are diagnosed as other types of skin disease. Ali Akbar Sari alluded to the fact that there may be more people than the reported number affected by the disease, the IRNA news agency reported.
For treatment of the skin disease, proper steps should be taken within limited time to reduce patients' complications, he added. He encouraged physicians to keep themselves constantly updated on all skin diseases, otherwise they may misdiagnose rare or outdated diseases.
Leishmaniasis is a disease caused by protozoan parasites and transmitted by the bite of an infected female sand fly. Symptoms of the disease appear in weeks to months after the bite of the sand fly. Less commonly, symptoms arise only years later when a person's immune system becomes suppressed. The 5 classic symptoms of more severe disease are: weight loss, which may be severe; low blood counts; enlargement of the liver and spleen; fever, which is usually intermittent; high levels of immune globulin in the blood. The skin may turn dark. Some people who recover will have a persistent rash or pigment changes in the skin. The kidney is also affected, which may lead to renal failure. Other organs, including the bowel and the lung, may be affected. The infected person should seek proper medical care immediately.
Cutaneous leishmaniasis (CL) is an increasing public health problem. Anthroponotic CL caused by _Leishmania tropica_ is found in Tehran as well as in some other large or medium-sized cities and their outskirts. Outbreaks are related to population increase, unplanned urban development and an increase in sandfly population. In the city of Bam, there was an 8-fold increase in the number of cases over the 5 years after the 2003 earthquake. Recent outbreaks in Bam caused 2884 cases in 2007, 3442 in 2008 and 1372 in 2009, with a high rate of recidivant leishmaniasis
CL caused by _L. major_ is endemic and very common in many rural areas, especially in the plains of the north east, near the Russian border, and in the north of the Esfahan province, in the centre of the country, but has recently spread to its southern parts and to Fars province, in southwest Iran. About 70 per cent of CL in Iran is caused by _L. major_.
The endemicity is so high that almost 80 per cent of the rural population contracts the disease before the age of 10 and non-immune newcomers practically all become infected. This area may be the most important focus. However, a recent epidemiological survey in 3 villages in Shiraz province, where underreporting was suspected, found a prevalence of scars of 16.2 per cent and of infection of 23 per cent
In Brazil the number of fatalities due to the parasitic disease, visceral leishmaniasis, has increased by 43.75 per cent in the Central-Western Brazilian state of Mato Grosso do Sul, according to a Campo Grande News report today [14 Jan 2014]. Based on data from the SES (State Health Department), the state has reported a 15 per cent increase in leishmaniasis deaths in 2013 compared with the previous year, despite there being fewer total cases.

From January 2013 to 20 Nov 2013, 207 cases were reported with 23 deaths from the disease. In 2012, 303 cases with 20 deaths were recorded. According to the report, in the last 3 years [2011-2013] the cases of deaths has been increasing in the state. In 2010, there were 214 cases and 18 deaths; in 2011, there were 273 cases with 16 deaths.
Source ProMED-mail

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