Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Liver and Digestive Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.
Comp Immunol Microbiol Infect Dis. 2021 Apr;75:101604. doi: 10.1016/j.cimid.2020.101604. Epub 2020 Dec 14.
Leishmania infantum is the main cause of human visceral leishmaniasis (HVL; also known as kala-azar) in the Middle East and may be fatal if left untreated. This disease was first reported in 1949 in Iran. Despite marked improvements in hygiene and sanitation conditions, the disease is still endemic in some parts of Iran. It is difficult to determine the current prevalence of HVL in Iran due to the scarcity of comprehensive studies in this regard. In response to this gap, a systematic review and meta-analysis was conducted to gain better understanding of HVL epidemiology in the general population of Iran. English and Persian databases were searched for studies reporting the prevalence and risk factors associated with HVL in the Iranian people from January 1995 to December 2019. The reported data were selected according to inclusion and exclusion criteria. The pooled prevalence of HVL infection and its 95 % confidence intervals were calculated. Quality assessment, heterogeneity testing and publication bias assessment were also done. Literature search revealed 3634 studies, of which 35 studies met our eligibility criteria, with a total of 50,716 individuals. The meta-analysis was performed on 31 out of 35 included studies. The estimated pooled prevalence of HVL infection according to seropositivity was 2% (95 % CI: 1-2%) in the general population of Iran in which western and northern provinces had the lowest and the highest prevalence, 0.5 % (95 %CI, 0.2-0.7%) and 3% (95 %CI, 1-5 %), respectively. The seroprevalence of HVL among females (2%; 95 %CI, 1-2 %) was more than males (1%; 95 %CI, 1-2 %). The ≤10 and >10 years age groups had similar seroprevalence rates (1%, 95 %CI, 1-2 % versus 1%, 95 %CI, 0-1 %, respectively). There was no significant difference in terms of geographic area, age and sex. Of 31 studies included in the meta-analysis, the most common diagnostic test was the direct agglutination test (96.77 %). To the best of our knowledge, this is the first systematic review of the prevalence of HVL in Iran. The results showed a low seroprevalence of HVL infection. However, the lack of published reports of HVL in an area does not exclusively mean the absence of the disease or carrier. We therefore recommend further studies in this regard.
利什曼原虫是导致中东地区人类内脏利什曼病（HVL；也称为黑热病）的主要原因，如果不治疗可能致命。这种疾病于 1949 年在伊朗首次报告。尽管卫生和环境卫生条件有了显著改善，但该病在伊朗的一些地区仍然流行。由于在这方面缺乏全面的研究，因此很难确定伊朗目前 HVL 的流行率。针对这一差距，进行了系统评价和荟萃分析，以更好地了解伊朗普通人群中 HVL 的流行病学。从 1995 年 1 月至 2019 年 12 月，检索了英语和波斯语数据库，以查找报告伊朗人 HVL 患病率及其相关危险因素的研究。根据纳入和排除标准选择报告数据。计算 HVL 感染的合并患病率及其 95%置信区间。还进行了质量评估、异质性检验和发表偏倚评估。文献检索显示有 3634 项研究，其中 35 项研究符合我们的入选标准，共有 50716 人。对 35 项纳入研究中的 31 项进行了荟萃分析。根据血清阳性率，伊朗普通人群中 HVL 感染的估计合并患病率为 2%（95%CI：1-2%），其中西部和北部省份的患病率最低和最高，分别为 0.5%（95%CI：0.2-0.7%）和 3%（95%CI：1-5%）。女性（2%；95%CI：1-2%）的 HVL 血清阳性率高于男性（1%；95%CI：1-2%）。≤10 岁和>10 岁年龄组的血清阳性率相似（1%，95%CI：1-2%与 1%，95%CI：0-1%）。在地理位置、年龄和性别方面没有显著差异。在纳入荟萃分析的 31 项研究中，最常见的诊断检测是直接凝集试验（96.77%）。据我们所知，这是伊朗 HVL 患病率的首次系统评价。结果显示 HVL 感染的血清阳性率较低。然而，在一个地区缺乏 HVL 发病的报告并不完全意味着该疾病或携带者不存在。因此，我们建议在这方面进行进一步的研究。
