Effectiveness of Paromomycin on Cutaneous Leishmaniasis in Iran: A Systematic Review and Meta-Analysis

BACKGROUND

Some treatment reported for cutaneous leishmaniasis. The studies examined the impact of the paromomycin has different characteristics and results. The aim of the present study was to conduct a systematic review and meta-analysis of all randomized clinical trials evaluating the effectiveness of paromomycin in the treatment of cutaneous leishmaniasis in Iran.

METHODS

Literature search was conducted using MEDLINE, Web of Science, Scopus, Scientific Information Database, IranMedex, Magiran, Iranian Registry of Clinical Trials (from February 2000 to May 2016), and references cited in the text of selected studies. Search terms used were "paromomycin", "cutaneous leishmaniasis", "randomized"," aminosidine", "controlled trial", and "clinical trial". Random effects models were used to calculate the measure of association, with 95% confidence intervals, to analyze the efficacy of paromomycin in the treatment of cutaneous leishmaniasis.

RESULTS

Initial search yielded 76 citations. Of these original results, 9 met our specific selection criteria. Four of the randomized controlled trials compared the efficacy of paromomycin in the treatment of cutaneous leishmaniasis with that of a placebo; they were included in the meta-analysis. The success rate of treatment with paromomycin was higher than that with the placebo (pooled RR=4.50, 95% CI: 2.54 to 8.02; P=0.001 and I²=26.7%), whereas the difference with the non-placebo treatments was nonsignificant (pooled RR=0.79, 95% CI: 0.58 to 1.073; P=0.131 and I²=83.3%).

CONCLUSION

No significant difference was observed between paromomycin and the other treatments in their effectiveness in the treatment of cutaneous leishmaniasis. Because no single drug is effective against all the forms of leishmaniasis, we suggest multidrug therapy.

Saprinus planiusculus (Motschulsky' 1849) (Coleoptera: Histeridae), a beetle species of forensic importance in Khuzetan Province, Iran

Background

Medico legal forensic entomology is the science and study of cadaveric arthropods related to criminal investigations. The study of beetles is particularly important in forensic cases. This can be important in determining the time of death and also obtain qualitative information about the location of the crime. The aim of this study was to introduce the Saprinus planiusculus on a rat carrion as a beetle species of forensic importance in Khuzestan province.

Methods

This study was carried out using a laboratory bred rat (Wistar rat) as a model for human decomposition. The rat was killed by contusion and placed in a location adjacent to the Karun River. Observations and collections of beetles were made daily during May to July 2015.

Results

Decomposition time for rat carrion lasted 38 days and S. planiusculus was seen in the fresh to post decay stages of body decomposition and the largest number of this species caught in the decay stage.

Conclusion

The species of beetle found in this case could be used in forensic investigations, particularly during the warm season in the future.

Faunal Distribution and Seasonal Bio-Ecology of Naturally Infected Sand Flies in a New Endemic Zoonotic Cutaneous Leishmaniasis Focus of Southern Iran

BACKGROUND

Cutaneous leishmaniasis is a major health problem in Iran in spite of implementation of control program. This infectious disease caused morbidity in less than 27000 people in 2010. This study was set to determine some ecological aspects of sand flies in Fasa district, Fars Province, southern Iran during 2011-2012.

METHODS

A total of 4792 sand flies were captured by means of sticky paper and CDC miniature light traps in 10 selected villages from the beginning to the end of the active season, from which 1115 specimens were captured for abundance study and 3677 specimens captured for monitoring monthly activities in Fasa. After species identification, extracted DNA was processed for detection of Leishmania parasite infection in sand flies.

RESULTS

Twelve species (6 Phlebotomus, 6 Sergentomyia) were identified. The most common sand fly was P. papatasi (82.4%) which represented 86.6% of sand flies from indoors and 82.7% from outdoors. The monthly activity of the species extended from April to the end of November. There were two peaks in the density curve of this species, one in June and the second in September. Natural infection to L. major was detected in P. papatasi (25 out of 130 sand flies, 19.2%).

CONCLUSION

Phlebotomus papatasi is considered as a main vector of zoonotic cutaneous leishmaniasis in Fasa, Fars Province, south of Iran.

Molecular detection of Crimean-Congo haemorrhagic fever virus in ticks collected from infested livestock populations in a New Endemic Area, South of Iran

OBJECTIVE

Crimean-Congo haemorrhagic fever (CCHF) is a viral zoonotic disease with potentially fatal systemic effects on man. We aimed to determine the presence of CCHF virus among collected ticks from domestic livestock from October 2012 to September 2013.

METHODS

A total of 1245 hard and soft ticks were collected from naturally infested ruminants in Marvdasht County, Fars Province, south of Iran. Nine tick species and one unidentified species in four disparate genera were detected. A total of 200 ticks were randomly selected and analysed by reverse transcription-polymerase chain reaction (RT-PCR) for the presence of CCHF virus genome.

RESULTS

The viral genome was detected in 4.5% (9 samples) of the studied tick population. The infected ticks belonged to the species of Hyalomma marginatum' Hyalomma anatolicum and Rhipicephalus sanguineus. The viruses detected in these three tick species were clustered in the same lineage as Matin and SR3 strains in Pakistan and some other Iranian strains. These results indicate that the ticks were wildly infected with a genetically closely related CCHF virus in the region.

CONCLUSION

Regular controls and monitoring of livestock to reduce the dispersion of ticks and providing information to those involved in high-risk occupations are urgently required.

First phylogenetic analysis of a Crimean-Congo hemorrhagic fever virus genome in naturally infected Rhipicephalus appendiculatus ticks (Acari: Ixodidae)

Crimean-Congo haemorrhagic fever (CCHF) is a potentially fatal systemic viral disease in many parts of the world, including Iran. The nationwide incidence of human CCHF in endemic areas was 870 confirmed cases with 126 deaths (case fatality rate, CFR = 17.6 %) in the decade leading to 2012. The detection of the CCHF virus (CCHFV) genome in tick vectors is of fundamental importance for identifying these ticks as potential reservoirs of CCHFV infection. From May to October 2013, following detection of four new clinical cases resulting in two deaths in the city of Mashhad (northeast Iran), hard ticks were recovered from infested livestock in 40 villages in Khorasan-Razavi province and examined by the microscopic method for species identification. About a quarter of the ticks were then subjected to reverse-transcription polymerase chain reaction (RT-PCR) to detect the CCHFV genome. The PCR products were then sequenced, and their phylogenetic lineages were determined. A total of 407 hard ticks were captured, representing seven different species in two distinct genera. Members of the genus Hyalomma were widely distributed in all but two of the villages studied, and this was also the most frequent (83.3 %) tick genus. Of 105 adult ticks subjected to RT-PCR, four (3.8 %) ticks were found positive for the CCHFV genome. One brown ear tick, Rhipicephalus appendiculatus, was found to be naturally infected for the first time anywhere in the world. Ticks of Hyalomma asiaticum, Hyalomma marginatum, and Rhipicephalus turanicus were also found to be naturally infected with CCHFV. CCHFV found in these four different tick species were clustered in the same lineage with the Matin and SR3 strains from Pakistan and some other strains from Iran, indicating that these tick species were naturally infected with genetically closely related CCHFV in the region. The presence of CCHFV infection in four different hard tick species was confirmed using RT-PCR in northeast Iran. Part of this infection was attributed to Rh. appendiculatus, which is thus a potential new natural vector of CCHFV in Iran. It is also confirmed by phylogenetic analysis that CCHFV in this region is genetically closely related, even in the different tick species.

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.

Nested polymerase chain reaction and sequence- based detection of leishmania infection of sand flies in recently emerged endemic focus of zoonotic cutaneous leishmaniasis, southern iran

BACKGROUND

Geographical distribution of zoonotic cutaneous leishmaniasis (ZCL) has continuously been extended in recent years in Iran. The Beiza District is one of the newly-emerged endemic foci of ZCL in southern Iran. The main aim of the present study was to detect the vector(s) of ZCL in this area.

METHODS

To detect the fauna and vectors of ZCL in this district, sand flies were caught using sticky papers. Seventy randomly selected female sand flies out of 730 were molecularly investigated for Leishmania infection using species-specific nested polymerase chain reaction (PCR) assay between April and October 2010.

RESULTS

A total of 2543 sand flies were caught. The fauna was identified as 10 species (five Phlebotomus spp. and five Sergentomyia spp.). Phlebotomus papatasi was the most dominant species both indoors and outdoors (37.55% and 16.35 %, respectively). L. major was detected in 5 out of 48 investigated Phlebotomus papatasi (10.41%). Sequence-based characterization was carried out to confirm the PCR findings. The positive samples were shown to have 75-88% similarity with L. major sequences in GenBank.

CONCLUSION

According to the findings of the present study, similar to the other foci of ZCL in Iran, P. papatasi is the proven and primary vector of CL. This study could be drawn upon for future strategy planning in this newly emerged endemic focus.

Molecular detection of Leishmania major kDNA from wild rodents in a new focus of zoonotic cutaneous leishmaniasis in an Oriental region of Iran

Human cutaneous leishmaniasis is one of the most challenging public health issues in many tropical and subtropical countries of the world, including Iran. More than half (54%) of the new zoonotic cutaneous leishmaniasis (ZCL) cases among the Eastern Mediterranean countries were reported from Iran in 2008. The detection of Leishmania parasites in rodents is essential to incriminate them as probable reservoir hosts of ZCL infection. As a result of the annual detection of about 200-250 clinical ZCL cases in the Jask district of southern Iran, feral rodents were trapped, identified to species level, and examined for Leishmania presence by preparing routine blood smears on microscopic slides from 2007 to 2008. Overall, 27 Tatera indica, 17 Gerbillus nanus, 29 Meriones persicus, 26 M. hurrianae, and 7 M. libycus were identified. Females of T. indica, M. hurrianae, and G. nanus appeared to be naturally infected with the protozoan parasite, L. major. This is the first report of microscopic and molecular detection of this trypanosomatid parasite infecting these three rodents reported from Hormozgan province in southeast Iran. More than three-quarters (82%) of the parasite-infected rodents came from the eastern plain of this province, but none of the other rodents were found to be smear-positive or kinetoplast DNA-positive by PCR. M. hurrianae, G. nanus, and T. indica are therefore incriminated as three potential reservoir hosts of L. major in Oriental parts of Iran.

Reverse transcription PCR-based detection of Crimean-Congo hemorrhagic fever virus isolated from ticks of domestic ruminants in Kurdistan province of Iran

Crimean-Congo hemorrhagic fever (CCHF) is a potentially fatal viral vector-borne zoonosis which has a mortality rate of up to 30% without treatment in humans. CCHF virus is transmitted to humans by ticks, predominantly from the Hyalomma genus. Following the report of two confirmed and one suspected death due to CCHF virus in Kurdistan province of Iran in 2007, this study was undertaken to determine the fauna of hard ticks on domestic ruminants (cattle, sheep, and goats) and their possible infection with CCHF virus using reverse transcription PCR technique. This is the first detection of CCHF virus in ticks from the Kurdistan province of Iran. Overall, 414 ixodid ticks were collected from two districts in this province. They represented four genera from which 10 separate species were identified. The Hyalomma genus was the most abundant tick genus (70%). It was the only genus shown to be infected with the CCHF virus using RT-PCR technique. The number of ticks positive for CCHF virus was 5 out of 90 (5.6%) adult ticks. The three remaining genera (Haemaphysalis, Rhipicephalus, and Dermacentor) were all negative following molecular survey. Four of the five virally-infected ticks were from cattle mainly in the Sanandaj district. We concluded that CCHF virus is present in the Hyalomma ticks on domestic ruminants (cattle) in Kurdistan province of Iran.

First molecular detection of Leishmania major within naturally infected Phlebotomus salehi from a zoonotic cutaneous leishmaniasis focus in southern Iran

Human cutaneous leishmaniasis (CL) is a major notifiable public health problem in many parts of Iran. It is often caused by the zooflagellate parasite Leishmania major which is mainly transmitted by the bites of female phlebotomine sandflies belonging to the genus Phlebotomus (Diptera: Psychodidae). The annual incidence of CL in Fars province, southern Iran, was about 108-144 in 2007. The leishmanial infections of wild sandflies that may act as vectors were thus investigated at an endemic focus in this province. In all 330 female Phlebotomus sandflies were screened for the detection of Leishmania-specific kinetoplast DNA (kDNA) by polymerase chain reaction (PCR) methods. A two stage nested PCR protocol was used to establish the identity of Leishmania major species in naturally infected sandflies. The L. major kDNA was detected in 18 (5.5%) individual sandflies which belonged to four different Phlebotomus species (Phlebotomus papatasi, Phlebotomus salehi, Phlebotomus sergenti and P. major group). For the first time, one naturally infected P. salehi specimen contained the kDNA of the protozoan parasite, L. major, with a main band of 560 base pairs identified using the nested PCR method. It seems most likely therefore that P. salehi is potentially a rare sylvatic vector of L. major parasites in parts of this province. This is the first combined morphological and molecular studies of P. salehi in Iran.

Gerbillus nanus (Rodentia: Muridae): a new reservoir host of Leishmania major

Gerbillus nanus Blanford, 1875 known as Baluchistan gerbil, is a granivorous solitary naked-footed species. No evidence of its natural infection with the protozoan parasite, Leishmania, has so far been provided. Cutaneous leishmaniasis (CL) is a major public health problem in many parts of the world, including Iran. The annual nationwide incidence of human CL due to Leishmania major (CLM) in endemic rural areas was above 18,000 cases in 2008. The detection of L. major in rodents is of fundamental importance for incriminating them as potential reservoirs of CLM infection. Between April 2007 and April 2008, following detection of 245 clinical cases in Jask region of south-east Iran, wild rodents were captured and checked by the microscopic slide smears for leishmanial infections. Overall, 106 gerbilline rodents were captured from which 17 were identified as Gerbillus nanus. Females of Meriones hurrianae, Tatera indica and G. nanus were found to be naturally infected with L. MAJOR. The presence of these parasites in G. nanus has never been reported before. All the amastigote-infected rodents came from the eastern plain of this region, except one T. indica from the western plain which was found to be smear-positive or kinetoplast DNA-positive by PCR. The highest (11·8%) prevalence of infection among rodents confirmed by PCR to be infected with L. major was attributed to Baluchistan gerbil, G. nanus, which is thus incriminated as a potential reservoir host of L. major in Iran.

Post-earthquake outbreak of cutaneous leishmaniasis in a rural region of southern Iran

Human cutaneous leishmaniasis (CL) is of increasing public-health importance in Iran. On 10 July 2003, two mild earthquakes struck the rural town of Zarindasht in the southern Iranian province of Fars. The results of passive detection of CL cases in this town (in which patients with any skin lesions were evaluated) from April 2002 to April 2004 indicated that the earthquakes may have led to an outbreak of the disease; annual incidence increased from 58·6 detected cases/100,000 in the 12 months before the earthquakes to (an outbreak peak of) 864 detected cases/100,000 in the following 12 months. In addition, the incidence of detected CL in the town that was struck by the earthquakes in 2003 was significantly higher in the 12 months after the earthquakes than that recorded, over the same 12 months, for Fars province as a whole (P<0·05). Most (70%) of the cases detected in the town were aged ≤10 years, about half (50·4%) of the detected skin lesions were on the face, and most (89·7%) of the skin lesions were caused by Leishmania major. Incidence over the study period showed marked seasonality, with most (79·5%) of the detected cases occurring between November and February. In areas where the disease is endemic, CL may need to be considered among the health threats posed by natural disasters such as earthquakes, and increased surveillance for CL after future earthquakes may be justified.

Treatment outcome of Paederus dermatitis due to rove beetles (Coleoptera: Staphylinidae) on guinea pigs

Linear dermatitis (or dermatitis linearis, DL) is a skin blistering inflammatory lesion caused by exposure to the pederin toxin from rove beetles. Although it is prevalent in many countries of the Middle East region, this is not a notifiable disease. In recent years, a number of clinical symptoms outbreaks of DL has been reported from a few neighboring countries of Iran, but no report of experimental treatment among small laboratory rodents is known. This is a prerequisite to ascertain the nature of the best treatment strategy in cases of infestation with these beetles, as it occurs among local settlers during hot seasons in certain parts of the southern Iranian province of Fars. Live Paederus beetles were collected, identified to species level, sexed apart and partly processed to obtain their hemolymph toxin pederin in ethanol for dermal application on guinea pigs. Two Paederus species were found. Paederus ilsae (Bernhauer) (Coleoptera: Staphylinidae) was more abundant than P. iliensis (Coiffait). Recovery from DL due to live P. ilsae beetles was quicker and less complex than that of pederin in ethanol on guinea pigs. The application of potassium permanganate with calamine to heal DL was also more effective than fluocinolone treatment. This topical corticosteroid is thus considered less able to avert the cytotoxic action of pederin on the skin of guinea pigs than the antipruritic and cleansing agents. It seems likely that fluocinolone has certain effects which delays the recovery period for the treated skin.

Synergist efficacy of piperonyl butoxide with deltamethrin as pyrethroid insecticide on Culex tritaeniorhynchus (Diptera: Culicidae) and other mosquitoe species

Continuous and indiscriminate use of pesticides, especially in tropical countries for public health or agriculture purpose, has led many vector populations to become resistant to organochlorides, organophosphates, and even to carbamates and pyrethroids. Development of resistance by a vector population has been one of the reasons for the failure of the control measures in many countries. This investigation demonstrates the efficacy of piperonyl-butoxide (PBO) with deltamethrin, as pyrethroid insecticide, against the field-collected mosquitoe larvae of five species, Aedes aegypti, Anopheles culicifacies, An. stephensi, An. vagus, and Culex quinqufasciatus, and two morphological variants of Cx. tritaeniorhynchus (type A from grand pools of Mysore city and type B from rice fields of Mandya district). For testing the synergistic effect of PBO, stock solutions of deltamethrin and PBO were mixed in 1:6 ratio. The synergistic ratio and the percent suppression in deltamethrin tolerance were calculated by using LC(50) values. From the results, it is clear that, PBO is an effective synergist with deltamethrin against all of species undertaken in this investigation. So, it is suggested that PBO is a good synergist in this area for decreasing the use of pesticides in environment in vector control.

Respiratory toxicity of raw materials used in ceramic production

The main purpose of this study was to assess the pulmonary reactions associated with exposure to raw materials used in ceramic production (RMCP). This was a cross sectional study in which 33 male workers with current exposure to RMCP and 20 healthy male unexposed workers (referent group) were interviewed and respiratory symptom questionnaires were administered to them. Furthermore, they underwent chest X-ray and lung function tests. Additionally, personal dust monitoring for airborne inhalable and respirable dust was carried out at dusty areas of the industry. To determine the chemical composition, possible silica phases and SiO(2) contents of dust samples, they were analyzed by both X-ray diffraction (XRD) and X-ray fluorescence (XRF) techniques. Demographic and socioeconomic variables of both groups were similar, except that referent individuals were, to some extent, older and heavier than their exposed counterparts. Personal dust monitoring showed that the concentrations of inhalable and respirable dust were very high and dust contained large amounts of crystalline silica. Additionally, respiratory symptom questionnaires revealed that exposed workers, compared to their unexposed counterparts, had higher prevalences of cough, wheezing, phlegm and shortness of breath. Likewise, significant decrements in some parameters of pulmonary function were noted and most of the exposed subjects showed abnormalities in their chest radiographs. These data provide further evidence in favor of the notion that exposure to RMCP, probably due to their silica contents, is associated with respiratory symptoms, radiographic abnormalities and functional impairments.

Efficacy of piperonyl butoxide (PBO) as a synergist with deltamethrin on five species of mosquitoes

Development of insecticide resistance has been a challenging problem for a long time and new solutions are yet to emerge. In this regard, the use of synergist with the insecticide is thought to play a key role in reducing the resistance levels. Present study demonstrates the efficacy of PBO with deltamethrin against the field collected mosquito larvae of five species of Aedes, Anopheles and Culexfrom in and around Mysore.

Pediculus capitis infestation according to sex and social factors in Hamedan, Iran

Pediculus capitis or head-louse infestation has been a worldwide public-health problem, especially among school-aged children. To determine the intensity of infestation (abundance) among schoolchildren, children's sex and social factors were analyzed as modifiers of the general prevalence of parasitism. The study included 847 schoolchildren (407 girls, 440 boys) aged 6-12 years, from 12 public rural primary schools of Hamedan, Hamedan Province, Iran. Classic prevalence was obtained as the percentage of children with nits and/or lice. The general prevalence was 6.85% (girls: 13.5%; boys: 0.7%, p<0.001), head lice were much more common in girls than boys. The results showed significant variations in head lice infestation, and factors such as parents' literacy, type of hair, previous infestation, sharing of bed and comb, and care centers, while there was no significant variation between school grade, parents' job, members of family, and pediculosis in the studied areas (p>0.05). Sex and social factors are important modifiers of P. capitis general prevalence and degree of infestation. The classification of children by intensity of infestation allowed a more precise delimitation of this condition, which is especially important for disease surveillance and application of control measures.

Variation in morphological characters of Culex tritaeniorhynchus (Diptera: Culicidae), a Japanese encephalitis vector at Mysore, India

Studies on Culex tritaeniorhynchus Giles, were undertaken to find deviation if any, on the mean of siphonal index, comb scales, pecten teeth, denticles on apical pecten tooth, anal gills index and length of basal hair tufts on siphon in the fourth instar larvae from ground pools of Mysore city and paddy fields outside Mysore. A total of 344 larvae including 172 samples from Mysore and 172 samples from a 26 km radius outside Mysore were collected. Analysis of variance demonstrated significant differences between the two populations on 7 parameters based on morphological characteristics such as comb scales, length of siphon, width of siphon at the middle, length of anal gills, siphonal index, anal gills index and the length of basal hair tufts. So Cx. tritaeniorhynchus from different breeding places in and around Mysore city in south India can be different varieties. One variety comparatively has shorter siphon index ratio, less comb scales, less anal gills index ratio and longer basal hair tufts on siphon than the other one. Mating behavior of these varieties show that, variety from the city pools was moderate eurygamous and the one from mainly paddy fields, moderate stenogamous.