An Epidemiological Study of Cutaneous Leishmaniasis Using Active Case Finding among Elementary School Students in Pakdasht, Southeast of Tehran, Iran 2013-2014

Cutaneous leishmaniasis is one of the prevalent health problems in tropical and subtropical areas including Iran. Therefore, it is essential to identify the prevalence and new foci of this disease in different regions of Iran. This study aimed to determine the epidemiology of cutaneous leishmaniasis by active surveillance in elementary schools in Pakdasht City, Southeast of Tehran, Iran 2013-2014. This cross sectional study was carried out on 4800 students from 60 elementary schools in Pakdasht during October 2013 to March 2014. After examining the students, some epidemiological data such as age, gender, date, anatomic location of the lesion(s) in the body, number and size of lesion(s), lesion type, and travel history to endemic areas was recorded in a checklist. Students with active lesions were examined using parasitological and molecular methods (PCR). Totally, 31 students (0.64%) had leishmaniasis, of which 15 (0.31%, 95% CI, 0.15%, 0.47%) had active lesions and 16 (0.33%, 95% CI, 0.17%, 0.49%) had leishmaniasis scars. Molecular testing showed that Leishmania major was the causative agent of leishmaniasis in all patients with active lesion. The highest frequency of cutaneous leishmaniasis was found in the age group 10-12 years (P=0.03). There was a significant difference between the frequency of the disease in different months (P=0.04) and the anatomic location of the lesion/scar (P=0.04). Moreover, t-test revealed that there was a significant relationship between number of lesions/scars and the age group (P<0.001). The leishmanial type diagnosed in all patients was L. major. This finding suggests that Pakdasht might be a new focus for zoonotic cutaneous leishmaniasis.