Cutaneous leishmaniasis in primary school children in the south-eastern Iranian city of Bam, 1994-95

Abstract

Between August 1994 and July 1995, 11,517 primary school children aged 6-11 years in the south-eastern Iranian city of Bam, comprising 5560 (48.3%) girls and 5957 (51.7%) boys, were examined for the presence of active lesions or scars of cutaneous leishmaniasis (CL). There was a trend towards increasing prevalence with age, the prevalence being 10.7% in 6-year-old and 20% in > or = 11-year-old children. Overall, 1.3% of the children had active lesions and 14.3% had scars. There was no significant difference between the sexes in the prevalence of active lesions and/or scars. Of the children examined, 54 (0.5%) had leishmaniasis recidivans: 19 girls (35.2%) and 35 boys (64.8%). The number of active lesions or scars per child ranged from 1 to 10. The majority (82.3%) had 1 lesion, 12.4% had 2 lesions, and 5.3% had > or = 3. The average number of lesions was 1.08 (1.03 in girls and 1.18 in boys). The face was the part of the body most commonly involved (63.6%), followed by the hands (20.9%), legs (12.8%) and other parts of the body (2.7%). Examination of isolates from 14 children revealed that in 13 (92.9%) the causal organism was Leishmania tropica and in the other (7.1%) L. major. The survey indicates that the geographical distribution of CL is far wider than previously thought. It also shows that Bam is a suitable areas for a vaccine field trial.

PIP: Cutaneous leishmaniasis, caused by Leishmania tropica, is endemic in southeastern Iran's Kerman Province, including the city of Bam. As a first step toward selecting different arms of a vaccine field trial, all 11,517 primary school students 6-11 years old from Bam were examined between August 1994 and July 1995 for the presence of active lesions or scars of cutaneous leishmaniasis. Overall, 1.3% of children had active lesions and 14.3% had scars. Prevalence tended to increase with age, but there was no difference on the basis of sex. 54 children (0.5%) had leishmaniasis recidivans. The number of active lesions or scars per child ranged from 1 to 10 (average, 1.08). Body parts most frequently affected were the face (63.6%), hands (20.9%), and legs (12.8%). Examinations of isolates from 14 children revealed that L. tropica was the causal organism in 13 (92.9%). These findings indicate that cutaneous leishmaniasis is even more widely distributed throughout Iran than previously thought, probably as a result of agricultural and unplanned urban development. They further confirm that Bam is a suitable location for a vaccine field trial.