Molecular Identification and Phylogenetic Analysis of Leishmania major Isolated from Zoonotic Cutaneous Leishmaniasis Foci in Northeast Iran

Background

Epidemiological studies, classification and genetic studies of Leishmania species are effective in treatment, control and prevention in endemic areas. We aimed to investigate the genetic diversity and phylogeny of Leishmania in Zoonotic foci located in northeastern Iran using nagt gene for the first time.

Methods

DNA of 100 confirmed positive slides collected from the health centers of Sarkhes, Darghez, Fariman, Esfarayen, and Sabzevar were extracted during 2020-2021. The partial sequence of kDNA was amplified to identify the species. Twenty-five DNA samples were randomly subjected to amplify by nagt gene primes and were sequenced. The sequences were aligned with reference sequences in National Center for Biotechnology Information (NCBI). Then, the genetic similarities of the sequences were checked using Clustalx2.1 software and the phylogenetic tree was drawn by Mega 7 software.

Results

All the positive samples were diagnosed as L. major. Approximately, half of the sequences of species were similar to two reference genes JX103550.1:404-712 L. major Esfahan and KX759012.1:568-807 L. Major Ilam (more than 90% similarity). According to the results of the phylogeny tree, the closest genotype to our study samples was JX103550.1:404-712 L. major Esfahan.

Conclusion

The most causative agent CL in these areas was L. major. The genetic diversity of L. major was high such as other zoonotic foci in Iran. Due to the high similarity of the strains in the study areas with the strains of Isfahan and Ilam, similar control and prevention methods is suggested in these areas.

Impact of a health educational interventional program on reducing the head lice infestation among pupils in an elementary school of a sub-tropical region: a quasi-experimental study

BACKGROUND

Pediculosis is an important social challenge that can be caused by human head louse, Pediculus humanus capitis. This infestation is cosmopolitan, especially in countries with low hygiene and sanitation. Regular health education classes for students and their parents are required to reduce this infestation in schools and families. This study aimed to evaluate the impact of a health education intervention program on reducing head lice among pupils of an elementary school.

METHODS

In a quasi-experimental study, a total of 880 elementary school girls were screened for pediculosis in (2017-2018). The prevalence of pediculosis follow-up continued monthly until the end of the school year after a two months educational intervention course. Visual inspection was applied for initial diagnosis of infection. The suspected cases were confirmed by wood lamp and potassium hydroxide (KOH) microscopic examination. Also eight questions about diagnostic, epidemiology, treatment and prevention were answered in a questionnaire by 50 volunteer parents before and after the training intervention course, to evaluate their general knowledge and measure the effectiveness of learning. All data were statistically analyzed using SPSS software (version 20.0, SPSS, Inc., Chicago, IL, USA). McNemar's test was also applied to investigate the prevalence rate before and after the intervention. A p -value of less than 0.05 was considered as statistically significant.

RESULTS

At the beginning of study, pre-intervention prevalence of pediculosis among pupils was 8.4% (49/594). The mean age in all pupils was 9.86 ± 1.83 years old and the most infestation was shown in fourth-grade students with 10 years old. Analysis of statistics demonstrated a significant difference between having infestation and the number of members in the families. Post-intervention phase led to a decreased prevalence of pediculosis in pupils to 3% (8/594) (p-value < 0.05). Based on statistical analysis of questions before and after the training in the questionnaire, a significant increase of parental knowledge was observed on the prevention program of pediculosis (p-value < 0.001).

CONCLUSION

The prevalence of pediculosis was significantly reduced following the educational interventions in the school. The applied interventions may be implemented in other residual centers to get rid of this important infestation.

Anisakis spp, DNA detection in paraffin-embedded tissue biopsies recovered from patients with gastritis using real-time PCR in Bushehr, Persian Gulf, Iran

Anisakiasis is a zoonotic fish-born parasitic disease caused by anisakid nematodes. Paraffin-embedded blocks containing biopsy samples taken from patients suffering gastritis with unknown causes were investigated by real-time PCR, in the Bushehr region, Iran; where human anisakiasis has not been reported, so far. A total of 50 paraffin-embedded blocks were randomly selected from 250 archived blocks of the patients with gastritis. A SYBER green-based real-time PCR targeting the ITS1 region was developed for the identification of Anisakis genus. An 86 bp partial fragment of the Anisakis spp. ITS1 gene was amplified successfully. A total of 3 out of 50 samples (6 %) had positive amplification in the samples and their pathology reports showed a significant finding of moderate chronic gastritis with or without ulcers. In conclusion, the developed qPCR could be used for detecting Anisakis spp. larval DNA in human biopsy blocks. This study showed the hidden human cases of anisakiasis in the Bushehr for the first time.

Three cases of brain hydatidosis in North Khorasan, Iran

Cystic hydatidosis is a serious public health problem in Iran. Although cysts can develop in almost all organs and the brain cysts are very rare. Here, we present 3 confirmed cases of brain hydatidosis and the patients who underwent successful surgery. Pathological examinations demonstrated the presence of cystic hydatidosis.

Spatio-temporal variability of malaria infection in Chahbahar County, Iran: association with the ENSO and rainfall variability

Malaria is one of the most widespread communicable diseases in the southeast regions of Iran, particularly the Chabahar County. Although the outbreak of this disease is a climate-related phenomenon, a comprehensive analysis of the malaria-climate relationship has not yet been investigated in Iran. The aims of this study are as follows: a) analyzing the seasonal characteristics of the various species of the infection; b) differentiating between number of patients during El Niño and La Niña and also during the wet and dry years. The monthly malaria statistics collected from twelve health centers were firstly averaged into seasonal scale and then composited with the corresponding data of the ground-based meteorological records, Southern Oscillation Index (SOI), and the satellite-based rainfall data. The proper statistical tests were used to detect differences in the number of patients between El Niño and La Niña and also between the adopted wet and dry episodes. Infection rate from the highest to the lowest was associated with summer, autumn, spring, and winter, respectively. Plasmodium falciparum, P. vivax, and the other species were responsible for 22%, 75%, and 3% of the sickness, respectively. The outbreak of P. falciparum/P. vivax occurs during autumn/summer. Due to the malaria eradication programs in urban areas, infection statistics collected from the rural areas were found to be more climate-related than that of urban regions. For rural/urban areas, the infection statistics exhibited a significant decline/increase during El Niño episodes. In autumn, spring, and winter, the patient number has significantly increased/decreased during the dry/wet years, respectively. These relationships were, however, reversed in summer.

Gastrointestinal Myiasis Due to Sarcophaga argyrostoma (Diptera: Sarcophagidae) in Mashhad, Iran: A Case Report

Myiasis is infection with a fly larva, usually occurring in tropical and subtropical areas. A 32-years-old immunocompromised woman with fever, gastrointestinal pain, cramps, vomiting; and fatigue was referred to Ghaem Hospital in Mash-had in July 2018. Entomological characterisation of cephaloskeletons, posterior spiracles of the excreted larvae and genital dissection of male fly were diagnosed as Sarcophaga (Liopygia) argyrostoma. Accidental intestinal myiasis caused by unplanned intake of dipterous larvae by contaminated food staff or water. Patients with immune deficiency may be more at risk for the threat of maggot’s infestation, so in such cases, hospital standard should be more in attention. To best of our knowledge, S. argyrostoma has not been reported before in the indexed literature from Iran.

Prevalence and economic impact of cystic echinococcosis and liver fluke infections in slaughtered sheep and goat in north-central Iran, 2008-2018

Cystic echinococcosis (CE) and liver fluke infections as important zoonotic infections impose a large socioeconomic impact on societies. As an endemic region for these infections, slaughterhouse inspections should be more considered in Iran. This study aimed to analyze the 11-year record of offal condemnation due to CE, fascioliasis, dicrocoeliasis infections in sheep and goat and its economic impact at Alborz slaughterhouse, north-central Iran. The prevalence rate was calculated as the infected organs (as nominator) divided by the slaughtered cases (as the denominator) in each year and month. The annual percent changes was used to determine trends of parasitic diseases over time. The relationship between metrological indexes and the prevalence of parasitic diseases was determined by the linear regression model. Statistical analyses were done using STATA software 14. For an estimate, the economic impact, the total numbers of offal condemnation were calculated. The overall prevalence rate of fascioliasis, dicrocoeliasis, and CE was 0.95%, 2.17%, and 12.74%, respectively. There was a declining trend in the prevalence of fascioliasis and dicrocoeliasis, whereas, the prevalence of CE increased from 7.57% in 2008 to 9.53% in 2018, representing an annual change of + 0.02%. The direct economic impact was estimated at US$ 1,670,977 and US$ 25,148 for liver and lung, respectively. The number of condemned organs due to these infections is noticeable in Alborz Province, north-central, Iran. The high economic impact of these infections showed the necessity of implementing a continuously infected animal's trace-back and disease control in the site of infection.

Molecular diagnosis and genotyping of Pneumocystis jirovecii in bronchoalveolar lavage samples obtained from patients with pulmonary disorder

Background and Purpose:

Pneumocystis pneumonia (PCP) is one of the most common and life-threatening fungal diseases in patients with human immunodeficiency, treated with immunosuppressive medications. Immunocompetent people can also be a spreading agent for PCP. Regarding this, the aim of the present study was to diagnose and identify Pneumocystis jirovecii in bronchoalveolar lavage (BAL) samples obtained from patients with pulmonary disorder using a molecular method.

Materials and Methods:

For the purpose of the study, BAL samples (n=138) were collected from patients, undergoing bronchoscopy at the different departments of university hospitals affiliated to Mashhad University of Medical Sciences, Mashhad, Iran, during a period of one year (i.e., April 2014 until May 2015). Giemsa staining and molecular identification were carried out for each sample. The samples were also subjected to nested polymerase chain reaction (PCR), sequencing, and genotyping based on mitochondrial ribosomal large subunit (mtLSU rRNA) of P. jirovecii. The phylogenic tree was constructed by MEGA6 software.

Results:

The results of direct microscopic examination revealed the presence of P. jirovecii in 3 (2.2%) out of 138 samples; in addition, nested PCR and sequencing led to the detection of species in 17 (12.3%) samples. Out of patients with positive results, 10 (25%) and 7 (7.1%) cases were immunosuppressed and immunocompetent, respectively. The most common clinical symptoms among patients with pneumocystis were fever, dyspnea, and dry cough. In addition, genotypes III and II were the dominant genotypes in our dataset.

Conclusion:

Nested PCR and sequencing methods showed higher sensitivity and specificity as compared with a direct staining technique. Genotype III was identified as the most dominant type in patients with pulmonary disorder in Mashhad.

Unusual vaginal bleeding due to a leech bite in a girl from a tropical area: A case report

This study describes the isolation of a leech following the presentation of unusual vaginal bleeding. Vaginal bleeding in children due to a leech bite is very rare. This is the first report of severe bleeding in a virgin 14-year-old girl from Mashhad, Iran due to the presence of a leech in the vagina.

Prevalence and time-trend analysis of intestinal parasitic infections in north-central Iran, 2012-2016

Intestinal parasitic infections are still considered as health challenges, predominately in the areas with low sanitation and socioeconomic conditions. Owing to the socioeconomic impact, these infections are considered as important Neglected Tropical Diseases in developing countries, including Iran. This study aimed to evaluate the prevalence and time-trend of intestinal parasitic infections in Nazarabad, Alborz Province north-central Iran. In a cross-sectional study, medical records of 4427 suspected cases of intestinal parasites, referred to the Nazarabad health network, from 2012 to 2016 were reviewed. Bio-data, as well as laboratory data, were extracted after obtaining ethics approval. The descriptive and time-trend analyses were applied to the data. Linear regression analysis was used for the time-trend analysis. The results indicated that 18.0% of the cases to have at least one parasite in their intestine. A total of 4.5% (36/798) of positive cases has mixed infection. The median age was 31 with a range from 4 to 84 years. There are 12 different parasites detected. Blastocystis (9.2%) and Giardia (7.4%) were more prevalent parasites in the cases. Time-trend analysis showed a decreasing trend of the infection from 2012 to 2016. The most prevalent infection was found in the spring months. These infections are still among the health challenges in north-central Iran. More investigations are needed to determinate the main sources of these parasites in this area. More effective control programs are needed to combat these infections, especially in the spring and summer months.

Bayesian spatial analysis of the surgical incidence rate of human cystic echinococcosis in north-eastern Iran

BACKGROUND

Cystic echinococcosis (CE) is a zoonotic disease that presents a public health challenge and a socioeconomic burden on developing areas in the Middle East. This study used spatial methods to assess the distribution of surgically managed CE cases in an endemic region of north-eastern Iran.

METHODS

For the years 2001-2007, a case series of all 446 patients that were surgically treated for CE in a referral hospital in north-eastern Iran was evaluated. Patients seen at the referral hospital represent 35 counties in three provinces (Razavi Khorasan, North Khorasan, and South Khorasan). A Besag, York and Mollie (BYM) spatial model was used to produce smoothed standardized incidence ratios (SIRs) for surgically managed cases of CE for the 35 counties represented in this study.

RESULTS

Out of 446 surgically managed patients, 54% were male. County-level crude incidence rates ranged from 0 to 3.27 cases per 100,000 population. The highest smoothed SIR (3.46) was for Sarakhs County in the province of Razavi Khorasan, while the lowest smoothed SIR (0.05) was for Birjand County, located in the province of South Khorasan.

CONCLUSION

SIRs for CE were highest for the province of Razavi Khorasan, which has large ranching and agricultural industries. Additional studies are needed to better evaluate the role of climate, land cover, and livestock rearing on local Echinococcus granulosus transmission in Iran.

Macracanthorhynchus hirudinaceus: the most common helminthic infection of wild boars in southwestern Iran

A pathological and epidemiological study on Macracanthorhynchus hirudinaceus infection on 25 wild boars Sus scrofa in southwestern Iran was done. Overall 24 helminthes (18 female and 6 male) were collected from the intestine of 13 infected wild boars. Thus, the prevalence of acanthocephalans among the 25 examined boars was 52 %. Pathological evaluation revealed damages caused by the acanthocephalans penetrated in the small intestine tissue. Helminthes caused severe necrosis with ulcer and inflammation in tunica sub mucosa layer. High prevalence of this helminthic infection may cause severe hazard for farmers, residents and also wild life animals.

The Oldest Recorded Case of Acromegaly and Gigantism in Iran

Here we commemorate the character and academic authority of Prof. Zabiholah Gorban (1903-2006), the founder of Shiraz medical school. No doubt, in the scope of history of contemporary medicine, he has been efficient and effective. With respect to this fact, his article on a rare case described in Acta anatomica published in Iran in 1966, entitled (Observations on a giant skeleton) is browsed and reviewed. A case named Siah Khan with combined acromegaly and gigantism that appears to have letters to say still after nearly half a century.

Nosocomial myiasis with Lucilia sericata (Diptera: Calliphoridae) in an ICU patient in Mashhad, Northeastern of Iran

Myiasis is the invasion of larvae to human or animal live tissues by flies belonging to the order Diptera and families like Calliphoridae, Sarcophagidae, Oesteridae, etc. Although rare, nosocomial myiasis must be noted carefully, especially in case of hospitalized patients. A 63-year old man admitted to an ICU ward in Mashhad is investigated and presented in this research. On the 35(th) day of hospitalization, about 100 larvae 6-7 mm in length, yellow to cream and fusiform were observed around the tracheotomy site. They were identified as second instar larvae of Lucilia genus of the family Calliphoridae based on morphological characters of the larvae. However, for exact identification of the species, the emerging adults must also be tested. According to the standard key of adult flies, they were identified as Lucilia sericata.