A systematic review and meta-analysis of the prevalence ofLeishmania infantumin sandflies in Iran

Abstract

Objective: To determine the overall and pooled prevalence of Leishmania (L.) infantum in sandfly vectors in Iran.

Methods: The present research conducted a systematic review and meta-analysis and searched regional databases such as PubMed, Scopus, Web of Science (WoS), Embase, PAHO Iris, LILACS, WHO Iris, and local databases named: SID, Magiran, Civilica, and also grey literatures. The current research included studies that were conducted in Iran and examined L. infantum in different sandfly vectors. The studies’ quality assessment/risk of bias assessment was evaluated by the Joanna Briggs Institute Critical Appraisal Checklist for prevalence data studies, and the data were analyzed by Stata 14 software. In addition, we examined 22 primary studies to estimate the overall prevalence of L. infantum among various vectors of visceral leishmaniasis.

Results: According to the meta-analysis, the pooled prevalence of Phlebotomus (Ph.) tobbi, Ph. alexandri, Ph. kandelaki, Ph. perfiliewi, Ph. major, Ph. keshishiani were 5.34%, 4.36%, 2.23%, 1.79%, 4.37% and 1.18%. Ph. tobbi has the highest infection rate (25.00%) of L. infantum among the sandfly vectors.

Conclusions: Visceral leishmaniasis is widespread in Fars, Ardebil, and East-Azerbaijan provinces, which are the most important endemic regions in Iran.

Keywords

Visceral leishmaniasis / Sandfly / Systematic review / Meta-analysis / Iran

References

[1] WHO . Fact sheets: Leishmaniasis 2023. [Online]. Available from: https://www.who.int/news-room/fact-sheets/detail/leishmaniasis. [Accessed on 12 January 2023].

[2] Rasit D. New developments in the treatment of cutaneous leishmaniasis. Asian Pac J Trop Med 2022; 15(5): 196-205.

[3] Mohammad J, Abedin S, Keyvan E, Amir H, Leyli ZF, Nazanin S. Identification of climatic and environmental factors associated with incidence of cutaneous leishmaniasis in Central Iran using satellite imagery. Asian Pac J Trop Biomed 2021; 11(1): 40-46.

[4] WHO . The global health observatory; Neglected tropical diseases: Leishmaniasis 2023. [Online]. Available from: https://www.who.int/ data/gho/data/themes/topics/gho-ntd-leishmaniasis#. [Accessed on 30 December 2023].

[5] Wamai RG, Kahn J, McGloin J, Ziaggi G. Visceral leishmaniasis: A global overview. J Glob Health Sci 2020; 2(1). https://doi.org/10.35500/jghs.2020.2.e3

[6] Yaghoobi-Ershadi M. Phlebotomine sand flies (Diptera: Psychodidae) in Iran and their role on Leishmania transmission. J Arthropod Borne Dis 2012; 6(1): 1.

[7] Mohebali M. Visceral leishmaniasis in Iran: A review of the epidemiological and clinical features. Iranian J Parasitol 2013; 8(3): 348.

[8] Mohebali M, Arzamani K, Zarei Z, Akhoundi B, Hajjaran H, Raeghi S, et al. Canine visceral leishmaniasis in wild canines (fox, jackal, and wolf) in northeastern Iran using parasitological, serological, and molecular methods. J Arthropod Borne Dis 2016; 10(4): 538.

[9] Mohebali M, Moradi-Asl E, Rassi Y. Geographic distribution and spatial analysis of Leishmania infantum infection in domestic and wild animal reservoir hosts of zoonotic visceral leishmaniasis in Iran: A systematic review. J Vector Borne Dis 2018; 55(3): 173-183.

[10] Rashti MS, Sahabi Z, Notash AK. Phlebotomus (Larroussius) keshishiani Hchurenkova 1936, another vector of visceral leishmaniasis in Iran. Iran J Publie Health 1995; 24(1-2): 25-30.

[11] Azizi K, Rassi Y, Javadian E, Motazedian M, Rafizadeh S, Yaghoobi Ershadi M, et al. Phlebotomus (Paraphlebotomus) alexandri: A probable vector of Leishmania infantum in Iran. Ann Trop Med Parasitol 2006; 100(1): 63-68.

[12] Azizi K, Rassi Y, Javadian E, Motazedian M, Asgari Q, Yaghoobi-Ershadi M. First detection of Leishmania infantum in Phlebotomus (Larroussius) major (Diptera: Psychodidae) from Iran. J Med Entomol 2008; 45(4): 726731.

[13] Dehkordi AS, Rassi Y, Oshaghi M, Abai M, Rafizadeh S, Yaghoobi-Ershadi M, et al. Molecular detection of Leishmania infantum in naturally infected Phlebotomus perfiliewi transcaucasicus in Bilesavar district, northwestern Iran. Iran J Arthropod Borne Dis 2011; 5(1): 20.

[14] Rassi Y, Abai M, Oshaghi M, Javadian E, Sanei A, Rafidzadeh S, et al. First detection of Leishmania infantum in Phlebotomus kandelakii using molecular methods in north-eastern Islamic Republic of Iran. East Mediterr Health J 2012; 18(4): 387-392.

[15] Rostamian M, Bashiri H, Yousefinejad V, Bozorgomid A, Sohrabi N, Raeghi S, et al. Prevalence of human visceral leishmaniasis in Iran: A systematic review and meta-analysis. Comp Immunol Microbiol Infect Dis 2021; 75: 101604.

[16] Mohebali M, Edrissian G, Akhoundi B, Shirzadi M, Hassanpour G, Behkar A, et al. Visceral leishmaniasis in Iran: An update on epidemiological features from 2013 to 2022. Iranian J Parasitol 2023; 18(3): 279.

[17] Munn Z, Moola S, Lisy K, Riitano D. The Joanna Briggs institute reviewers' manual: The systematic review of prevalence and incidence data. Adelaide, SA: The Joanna Briggs Institute; 2014.

[18] Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group^* T. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Ann Intern Med 2009; 151(4): 264-269.

[19] Hoy D, Brooks P, Woolf A, Blyth F, March L, Bain C, et al. Assessing risk of bias in prevalence studies: Modification of an existing tool and evidence of interrater agreement. J Clin Epidemiol 2012; 65(9): 934-939.

[20] Nadim A, Javadian E, Tahvildar-Bidruni G, Mottaghi M. Epidemiological aspects of Kala-azar in Meshkin shar, Iran: Investigation on vectors. Iran J Public Health 1992; 21(1-4): 61-72.

[21] Sahabi Z, Rashti MS, Nadim A, Javadian E, Kazemeini M, Abai M. A preliminary report on the natural leptomonad infection of Phlebotomus major in an endemic focus of visceral leishmaniasis (VL) in Fars province, south of Iran. Iran J Public Health 1992; 21(1-4): 87-93.

[22] Rassi Y, Javadian E, Nadim A, Tahvildar-Bidruni G. Natural promastigote infection of sand-flies and its first occurrence in Sergentomyia dentata in Ardabil Province, North West of Iran. Iran J Public Health 1997; 26(1-2): 7-12.

[23] Javadian E, Nadim A. Studies on cutaneous leishmaniasis in Khuzestan, Iran. Part II. The status of sandflies. Bull Soc Pathol Exot 1997; 68(5): 467-471.

[24] Emami MM, Yazdi M. Entomological survey of phlebotomine sand flies (Diptera: Psychodidae) in a focus of visceral leishmaniasis in central Iran. J Vector Borne Dis 2008; 45(1): 38.

[25] Salehzadeh A, Iran SR, Latifi M, Mirhoseini M. Diversity and incrimination of sandflies (Psychodidae: Phlebotominae) captured in city and suburbs of Hamadan, Hamadan province, west of Iran. Asian Pac J Trop Med 2014; 7: 177-181.

[26] Rassi Y, Kaverizadeh F, Javadian E, Mohebali M. First report on natural promastigote infection of Phlebotomus caucasicus in a new focus of visceral leishmaniasis in North West of Iran. Iran J Public Health 2004; 33(4): 70-72

[27] Maleki Ravasan N, Ali Oshaghi M, Javadian E, Rassi Y, Mohebali M, Sadrai J, et al. Antifungal activity of essential oil and alcoholic extract of Carum copticum against fluconazole-resistant and susceptible Candida albicans isolated. Pathobiol Res 2008; 11: 81-89.

[28] Rassi Y, Javadian E, Nadim A, Rafizadeh S, Zahraii A, Azizi K, et al. Phlebotomus perfiliewi transcaucasicus, a vector of Leishmania infantum in northwestern Iran. J Med Entomol 2009; 46(5): 1094-1098.

[29] Oshaghi MA, Ravasan NM, Hide M, Javadian EA, Rassi Y, Sadraei J, et al. Phlebotomus perfiliewi transcaucasicus is circulating both Leishmania donovani and L.infantum in northwest Iran. Exp Parasitol 2009; 123(3): 218-225.

[30] Parvizi P, AlaeeNovin E, Ahmadipour F, Baghban M. Finding and molecular typing simultaneous of three Leishmania species in Kalybar, a focus of visceral leishmaniasis in northwest Iran. Int J Infect Dis 2010; 14: 183-189.

[31] Parvizi P, AlaeeNovin E. Simultaneous detection of three Leishmania species in Kaleybar, a focus of visceral leishmaniasis in northwest of Iran. J Ardabil Univ Med Sci 2011; 11(2): 121-133.

[32] Rassi Y, Dehkordi AS, Oshaghi MA, Abai MR, Mohtarami F, Enayati A, et al. First report on natural infection of the Phlebotomus tobbi by Leishmania infantum in northwestern Iran. Exp Parasitol 2012; 131(3): 344-349.

[33] Oshaghi M, Rassi Y, Hazratian T, Fallah E, Rafizadeh S. Natural infection of wild caught Phlebotomus tobbi to Leishmania infantum in East Azerbaijan province, northwestern Iran. J Vector Borne Dis 2013; 50(1): 24.

[34] Parvizi P, Alaeenovin E, Mohammadi S, Baghban N. Occurrence of low density of Leishmania infantum in sandflies from a new focus of visceral leishmaniasis in northwest of Iran. J Vector Borne Dis 2013; 50(2): 127.

[35] Bahrami A, Rassi Y, Maleki N, Oshaghi M, Akhavan A, Yagoobi-Ershadi M, et al. Leishmania infantum DNA detection in Phlebotomus tobbi in a new northern focus of visceral leishmaniasis in Iran. Asian Pac J Trop Dis 2014; 4(2): 110-114.

[36] Naghian A, Oshaghi MA, Moein-Vaziri V, Rassi Y, Sedaghat MM, Mostafavi E, et al. Molecular identification of Leishmania species in Phlebotomus alexandri (Diptera: Psychodidae) in western Iran. J Arthropod Borne Dis 2020; 14(1): 8.

[37] Yaghoobi-Ershadi M, Javadian E, Tahvildare-Bidruni G. Leishmania major MON-26 isolated from naturally infected Phlebotomus papatasi (Diptera: Psychodidae) in Isfahan Province, Iran. Acta Trop 1995; 59(4): 279-282.

[38] Fatollahzadeh M, Khanmohammadi M, Bazmani A, Mirsamadi N, Jafari R, Mohebali M, et al. Survey of feline visceral leishmaniasis in Azarshahr area, north west of Iran, 2013. J Parasit Dis 2016; 40: 683-687.

[39] Rakhshanpour A, Mohebali M, Akhondi B, Rahimi MT, Rokni MB. Serological survey and associated risk factors of visceral leish-maniasis in Qom Province, Central Iran. Iran J Public Health 2014; 43(1): 50.

[40] Zanjirani Farahani L, Mohebali M, Akhoundi B, Saghafipour A, Kakooei Z. Seroepidemiological study on visceral leishmaniasis in an endemic focus of central Iran during 2017. J Parasi Dis 2019; 43: 22-27.

[41] Nourian M, Heidari A, Tajali S, Ghasemi E, Mohebali M, Heidari A. Paediatric visceral leishmaniasis: A retrospective study on clinical manifestations, demographic features and laboratory findings of hospitalised cases in Iran between 2006 and 2016. Trop Doct 2019; 49(1): 59-61.

[42] Heidari A, Mohebali M, Kabir K, Barati H, Soultani Y, Keshavarz H, et al. Visceral leishmaniasis in rural areas of Alborz province of Iran and implication to health policy. Korean J Parasitol 2015; 53(4): 379.