Emerging Cases of Fascioliasis in Lorestan Province, Western Iran: Case Series Report.

Fascioliasis is a zoonotic disease caused by Fasciola spp. We report five serologically and molecularly confirmed cases in an emerging region in Iran. A retrospective, case series study, performed in Lorestan Province, west of Iran between January 2015 and June 2016. From 1256 patients examined, 16 patients had positive serum ELISA. Five cases were approved as infected with fasciolosis using stool exam and PCR. Age ranged from 24 to 80 yr with mean age of 45 years. All of patients were adults and four of them had abdominal and back pain. Other symptoms included fever and chills, coughing and sore throat, weight loss, cutaneous manifestations. All patients lived in the rural environment, and four reported the ingestion of raw aquatic plants such as watercress. In fecal examination for fluke eggs, four samples were positive for F. hepatica eggs. Conventional PCR analysis showed that five human stools were positive for F. hepatica. All of 5 patients were treated with the usual dose of triclabendazole. A history of recent consumption of raw aquatic plants (in 4 out of 5 patients) is an important finding, but in one patient the source of infection remained unclear. Lorestan should be considered as an emerging region for this disease and further research in this province should be carried out.

Investigation on Mosquitoes Fauna (Diptera: Culicidae) and Probable Vector of West Nile Virus in Lorestan Province, Western Iran.

Background: Fauna and larval habitat characteristics studies on mosquitoes are important tools to identify the breeding places of the vectors and management of the control strategies. This study was done to provide data on Culicidae fauna, larval habitat characteristics and identifying potential vectors of West Nile virus in Lorestan Province, west of Iran. Methods: Culicidae mosquitoes were collected at three counties and nine site stations from Lorestan Province, west of Iran in 2017. Adult mosquitoes were collected using human and animal bite collection methods, New Jersey and CDC light traps and pit shelters by aspirator. Larva were collected by dipping method. RT-PCR technique was employed for detection of the West Nile virus among mosquito's samples. Results: 4805 mosquitoes were collected from three counties and nine sites in Lorestan Province during June-October 2017, including 4363 adults and 442 larvae. The most abundant species collected from all counties in both adult and larval stages were Culex pipiens (49.10%), Cx. theileri (31.82%), Anopheles maculipennis (11.09%), An. superpictus (2.66%), An. stephensi (2.12%), Cx. perexiguus (1.89%), An. dthali (1.17%) and An. sacharovi (0.15%) respectively. West Nile virus was detected in none of mosquitoes examined. Conclusion: The results of this study revealed that arbovirus vectors such as Cx. pipiens along with Cx. theileri and Cx. perexiguus are well adapted to a broad range of habitats and different climatic conditions in Lorestan Province. That necessitates further routine surveillance of arboviral infections.

Autochthonous Transmission of West Nile Virus by a New Vector in Iran, Vector-Host Interaction Modeling and Virulence Gene Determinants.

Using molecular techniques and bioinformatics tools, we studied the vector-host interactions and the molecular epidemiology of West Nile virus (WNV) in western Iran. Mosquitoes were collected during 2017 and 2018. DNA typing assays were used to study vector-host interactions. Mosquitoes were screened by RT-PCR for the genomes of five virus families. WNV-positive samples were fully sequenced and evolutionary tree and molecular architecture were constructed by Geneious software and SWISS-MODEL workspace, respectively. A total of 5028 mosquito specimens were collected and identified. The most prevalent species was Culex (Cx.) pipiens complex (57.3%). Analysis of the blood-feeding preferences of blood-fed mosquitoes revealed six mammalian and one bird species as hosts. One mosquito pool containing non-blood-fed Cx. theileri and one blood-fed Culex pipiens pipiens (Cpp.) biotype pipiens were positive for WNV. A phylogram indicated that the obtained WNV sequences belonged to lineage 2, subclade 2 g. Several amino acid substitutions suspected as virulence markers were observed in the Iranian WNV strains. The three-dimensional structural homology model of the E-protein identified hot spot domains known to facilitate virus invasion and neurotropism. The recent detection of WNV lineage 2 in mosquitoes from several regions of Iran in consecutive years suggests that the virus is established in the country.

Seroepidemiology of human fascioliasis in rural and nomad areas of Lorestan Province, western Iran, in 2016 and 2017.

According to previous studies in Lorestan Province, western Iran on human fascioliasis, we aimed to understand the epidemiology of the disease and to identify the cases in rural and nomad regions of this province. The studied population was a rural and nomadic population of nine districts of Lorestan province, of which 1053 were selected according to the population of each studied county based on random sampling in 2016-2017. Initially, a questionnaire was completed for each person, including age, gender, education, occupation, use of local native aquatic plants and history of travel to the northern provinces of the country where fasciolosis has been reported mostly. Then, 5 ml blood samples were taken and the samples were evaluated as for anti-Fasciola specific antibodies using ELISA technique. Overall, 1053 individuals were participated, of which 28 (2.66%) were infected with fasciolosis and 18 positive cases were female. The highest infection rate was in the age group of 20-29 years (23%) followed by 30-39 years of age (22%). There was no significant difference between the rate of infection in terms of gender (P = 0.89), age (P = 0.15), travel history to the northern provinces of the country (P = 0.089), history of aquatic plant consumption called Balmak natively (P = 0.48), history of surface water consumption (springs, streams) (P = 0.18), and occupation (P = 0.43). Considering the results of current and previous studies it seems that the disease in the Lorestan province is expanding and new foci in different parts of the province are formed or are being formed. Therefore, the preventive measures, control and treatment should be taken in areas with parasites transmission.

Morphological and molecular identification of Culicidae mosquitoes (Diptera: Culicidae) in Lorestan province, Western Iran.

Culicidae mosquitoes are main vectors of arboviruses that cause arboviral diseases in humans. Studies on fauna, ecology, biology, resting behaviors of Culicidae mosquitoes are important and greatly impacts the control of arboviral diseases that are transmitted by vectors. The aim of the present study was to determine fauna of mosquitoes (Diptera: Culicidae) based on morphological and molecular (genomic) identification and their habitats in Lorestan province, Western Iran. Meanwhile mosquito samples were examined for arbovirus infection. Culicidae mosquitoes were caught in 2015 and 2016 from human homes, animal dwellings, storehouses and pit shelters in Lorestan province, Western Iran, using an oral aspirator (hand catch), total catch, human and animal bait and light trap methods. The samples were identified on the genus and species. Six species of Culex and eight species of Anopheles were caught. One complex species (Cx. pipiens complex) and a hybrid between Cx. pipiens pipiens biotype pipiens and Cx. pipiens pipiens biotype molestus were identified. Among all of the trapped mosquitoes (4211), 94.68% were from genus Culex mosquitoes (3987), which indicate that this genus is the dominant in Lorestan province, Western Iran. Anopheles comprised of 201 individuals out of the total catch. Arboviruses were not detected in these samples.

Seroepidemiological study of Q fever, brucellosis and tularemia in butchers and slaughterhouses workers in Lorestan, western of Iran.

Most zoonoses are occupational diseases. Q fever, brucellosis and tularemia are major zoonotic diseases for butchers and slaughterhouse workers. However, little information is available about these infectious diseases in such professional populations in western of Iran. The aim of this study was to investigate the seroprevalence and risk factors associated with these three zoonoses among butchers and slaughterhouse workers in the Lorestan province of Iran. In 2017, 289 individuals (144 butchers or slaughterhouse workers, and 145 people from the general population) were enrolled in 11 different counties of this province. Collected serum samples were tested by ELISA for detection of IgG antibodies against Coxiella burnetii, Brucella spp. or Francisella tularensis antigens. The seroprevalence of Q fever, brucellosis and tularemia among all participants were 23.5%, 31.8% and 3.8%, respectively. The seroprevalence of brucellosis and Q fever among butchers and slaughterhouse workers (43.7% and 29.8%, respectively) were significantly higher (p < 0.05) than those of the general population (20% and 17.2%, respectively). A contact history with small ruminants (sheep and goats) was associated with a higher risk of positive serology for all three studied zoonoses. The high seroprevalence for Q fever and brucellosis we found among butchers and slaughterhouse workers suggests that both diseases are common in these populations of the Lorestan province. Since these two infectious diseases are clinically unspecific, they must be systematically included in the etiological diagnosis of infectious diseases occurring in these at-risk populations. In addition, we recommend specific training programs as well as the use of personal protective equipment in these occupational groups to reduce the occurrence of these zoonotic diseases.

Seroepidemiological study of Q fever in Lorestan province, western Iran, 2014.

BACKGROUND AND OBJECTIVES: Q fever is a zoonotic disease and farm animals serve as the main reservoir of the disease. The aim of this study was to evaluate the seroprevalence of Q fever in sheep, in Lorestan province in western Iran. MATERIALS AND METHODS: In this cross-sectional study, 330 blood samples were collected from sheep, from each county in Lorestan province. The samples were tested by ELISA for the presence of immunoglobulin (IgG) against Coxiella burnetii. RESULTS: Among the samples tested, 45 samples (13.64%) were seropositive. Of 35 studied herds, 21 (60%) had a history of infection. In terms of number of positive samples, there was no significant difference between the three geographical regions (central, west and east) (p=0.687). There was no statistically significant difference between age groups (p =0.604). Gender also had no effect on infection rates, in female and male sheep (p =0.814). No significant difference was observed between the number of lactation and positive serology (p =0.376). The rate of infection with Q fever and abortion also had no statistically significant difference (p =0.152). CONCLUSION: The findings of this study showed that sheep in Lorestan were infected by Q fever and the cycle of disease transmission had been established between animals and ticks.

Seroprevalence of Human Fasciolosis in Lorestan Province, Western Iran, in 2015-16.

BACKGROUND: The aim of this study was the seroepidemiological survey for detecting the status of human fasciolosis in Lorestan Province, western Iran. METHODS: This cross-sectional study was conducted in 2015-16. Based on statistical estimations, 1256 serum samples were collected from different parts of Lorestan Province, western Iran, and stored at -20 °C until use. The collected serum samples were analyzed at Tehran University of Medical Sciences, Tehran, Iran using indirect ELISA method. RESULTS: Anti-Fasciola antibodies were detected in 16 (1.3%) individuals. Regarding the seropositivity to fasciolosis, no significant differences were found between age groups, sex, level of education and occupation; however significant differences were observed regarding location, consuming local freshwater plants and water resources (P<0.02.). CONCLUSION: Local freshwater plants and unfiltered water resources were probably the main sources of the infection. Health education by local health centers to elevate awareness of people, and providing facilities for safer drinking water, especially in rural areas may help decrease the risk of fasciolosis infection in this region.

Epidemiological Study of Animal Bites and Rabies in Lorestan Province in West of Iran During 2004-2014 for Preventive Purposes.

BACKGROUND: Despite the progress made, animal bites and rabies are one of the important health problems in the country. The purpose of this study was to investigate the epidemiology of animal bites and rabies during 2004-2014 in Lorestan Province to prevent them in population of the province for the future prospective aspects. MATERIALS AND METHODS: In a descriptive cross-sectional study, all those cases bitten in the province, during 2004 and 2014, were studied. The required information about the age, sex, the bitten organ, type of the invasive animal time, and location of the event were collected in questionnaires and then analyzed. RESULTS: The total number of cases of animal rabies during the period of study was 43,892, shown at the rate of 223.23 in 100,000 people. Seventy-eight percent of animal bites in rural areas, 41.42% in the ages 10-29-year-old, 26.8% of cases were students, 56.77% leg bites, and 82.5% of dog bites. Four cases of human rabies were observed during this period. CONCLUSIONS: Rate of animal bites and rabies is high in Lorestan Province. Controlling animals such as dogs and cats in the province through training people at risk, especially among the students, rural areas and inter-sectorial coordination to eliminate stray animals should be considered over and over. Preventive actions to avoid bites are a priority.