A new focus of anthroponotic cutaneous leishmaniasis and identification of parasite species by nested PCR in Jiroft, Iran

Cutaneous leishmaniasis (CL) is still a global health problem. In Iran, new foci have been established throughout the provinces of the country. The objective of this study was to assess the epidemiological characteristics and to determine the causative parasite in order to implement a suitable control programme in the region. Following reports from provincial health authorities, this study was carried out, by census, in the summer and autumn of 2008 in rural areas of Mohammadabad, Jiroft district, Kerman province, south-eastern Iran. A questionnaire was completed for each case, recording demographic and disease characteristics. Diagnosis was based on direct smear and microscopy, and identification of species was done by nested PCR technique. Overall, 3,516 individuals consisting of 1,743 females (49.6%) and 1,773 males (50.4%) were physically examined for the presence of active lesion(s) or scar(s). The overall prevalence rate was 5.3%, 6.2% in females and 4.5% in males resulting in a significant gender difference (p<0.05). Most of the infection (10.5%) was seen in the 11.20 age group, and the lowest (3%) was seen in the 21.30 age group. Prevalence rate was significantly higher in native residents (88.4%) than non-natives (11.6%) (p<0.05). Most of the lesions were on the face (47%), followed by hands (34%), legs (5%), and other parts of the body (14%). The majority (64%) had 1 lesion, 29% had 2 lesions, and 7% had .3 lesions. The cases emerged sporadically between 1997 and 2002 and increased sharply after 2003 to peak in 2006, becoming endemic thereafter. Twenty-six cases were examined using a nested PCR technique; all examined cases were shown to be Leishmania tropica. This is the first study conducted in the north-east of Jiroft district in proximity to the district of Bam. Most of the cases occurred after the earthquake and relate to the epidemic condition in the city of Bam. Measures should be directed toward anthroponotic CL for future control programmes.