Cutaneous leishmaniasis in Iran: A systematic review and meta-analysis.

Cutaneous leishmaniasis as a public health concern that attracts many attentions in endemic area. There is no exact estimation of cutaneous leishmaniasis in Iran. This study aimed to assess the exact prevalence of disease and carried out in databases including: Pub Med, Google Scholar, Science Direct, Scopus, Web of Science, Magiran, Iran doc, Barakatkns and Scientific Information Database (SID) from 2000 to 2019. Totally 84 studies were eligible to be included in this systematic review and Meta-analysis study. Based on a random effect model the pooled prevalence of leishmaniasis was estimated 45% (95% CI: 39%-51%; I^2 = 99.8%P < 0.001). The highest prevalence of CL was related to Isfahan 66% (53%-78%), Golestan 64% (62%-65%) and Fars province 63% (38%-84%) and the lowest prevalence was estimated in Kermanshah province 4% (4%-5%), Hormozgan 10% (8%-11%), Bushehr 12% (1%-35%) and Kerman 15% (9%-22%) provinces respectively. The lowest prevalence was associated with L. trapica spices 23% (11%-38%) and the highest was associated with L. major spices 32% (21%-45%). The prevalence with both L. trapica and L. major spices was achieved 60% (48%-71%). It is essential for health authorities to take steps to control and prevent the epidemic by rapid treatment of patients, destroying gerbils and promotion of general and health education for the local population.

Global status of neglected human Linguatula infection: a systematic review of published case reports.

Human linguatulosis is a rare but highly specialized pentastomid parasitic infection all around the world. The disease is caused by worm-like parasites which share some morphologic features of arthropods and annelids. The life cycle of Linguatula spp. is provided as an example of pentastomid biology. The adult forms of Linguatula spp. are found in the nasal passages and frontal sinuses of dogs and other canids, domestic animals, and humans. Infestation may occur in the viscera, where immature forms develop in the liver, spleen, lungs, eyes, and other organs, or in the nasopharyngeal area. This review includes previous studies on the genus Linguatula in Iran and other countries from 1940 to 2019. Considering a few reports of human infestation, a comprehensive search was performed on both English and Persian databases for publications reporting human cases all around the world. Finally, 30 papers of 62 human cases were included in this study. The mean age of the patients was 25.8 years (varied from 8 to 79 years). Altogether, 41 (66.1%) and 21 (33.9%) of the patients were female and male respectively. The maximum cases (n = 25) were from Sudan. Nasopharynx was the most frequently involved organ in human cases. Our findings offer that physicians should consider the Linguatula infection in patients with complaints like unexpected dysphagia, with coughing, sneezing, and vomiting, after consuming raw/undercooked contaminated ruminant's viscera.

Status of babesiosis among domestic herbivores in Iran: a systematic review and meta-analysis.

Babesiosis is a protozoal disease caused by Babesia spp. in mammals and humans worldwide. It is one of the most important tick-borne diseases, which affects livestock productions, reproductions, and accordingly failing economy. In this, systematic review and meta-analysis, study, the prevalence of babesiosis among domestic herbivores in Iran, between 1998 and 2015, was methodically reviewed. Nine databases including five English and four Persian databases were explored. A total of 49 articles, as regards the examination of 13,547 sheep, 1920 goats, 7167 cattle, and 940 horses, corresponding to prevalence of babesiosis from different regions of Iran were gathered for our qualifying criteria. The overall prevalence of babesiosis was expected to be 14% (95% CI 12%, 16%) in domestic herbivores. Our results showed the highest prevalence in Khorasan Razavi (18.6%) and West Azarbaijan (15.2%) and the lowest in Mazandaran (8.8%) and Isfahan provinces (9.6%), respectively. The high prevalence of Babesia infection in herbivores (mostly sheep and goats) confirms the established enzootic situation of babesiosis in Iran, particularly in western and northeastern regions of the country. Our data offered important and updated information on the epidemiology of babesiosis, for the first time, in domestic herbivores in Iran, and will likely be contributing to the expansion of the screening and control strategies to reduce health and economic impacts among farm animals.

Isolation and Genotyping of Acanthamoeba spp. as Neglected Parasites in North of Iran.

Acanthamoeba, a free-living amoeba, is widely distributed in the environment, water sources, soil, dust, and air. It can cause keratitis in contact lens wearers with poor hygiene and also fatal granulomatous amebic encephalitis (GAE) in immunocompromised hosts. The aim of this study was to gain some insights into the distribution and genotypes of the potentially pathogenic species of Acanthamoeba present in water sources in north of Iran. Total 43 Acanthamoeba species were isolated from 77 water samples taken from different water sources within the Mazandaran province in Northern Iran (Sari city and suburbs). Isolates were identified based on cyst and trophozoite morphological characteristics as well genetics. PCR fragments corresponding to the small-subunit 18S rRNA gene were sequenced for 20 of 43 positive isolates. The results revealed that 83.3% of sequenced isolates belonged to the T4 genotype and the rest belonged to the T2 genotype. Our results indicated that Acanthamoeba is widely distributed in Sari city. As the incidence in Iran of amoebic keratitis has increased in recent years, the exact estimation of the prevalence of this amoeba and its predominant genotype may play a crucial role in prevention of the disease. Sari city has several rivers, seashores, and natural recreational amenities, which attract visitors during the year. This is the first report of Acanthamoeba genotypes from water sources in Sari city, Mazandaran province of Iran, and the results suggest that more attention is needed to protect the visiting population and immunocompromised individuals.

Trichomonas vaginalis infection among Iranian general population of women: a systematic review and meta-analysis.

Trichomonas vaginalis (T. vaginalis) is one of the main causes of vaginitis, prostatitis, and cervicitis all over the world. Little information is available regarding the burden of T. vaginalis infection in Iranian women. This systematic review and meta-analysis were carried out to determine the prevalence of T. vaginalis among general population of Iranian women. Data were systematically collected from 1992 to 2012 in Iran on such electronic databases as PubMed, Google Scholar, Science Direct, Scopus, Web of Science, Magiran, Irandoc, Iran medex, Scientific Information Database (SID), Global Health, and LILACS. Additionally, abstracts of national scientific congresses and dissertations were included. A total of 30 articles attempted to examine 70,373 individuals and reported the prevalence of trichomoniasis from different regions of Iran. The overall prevalence rate of trichomoniasis in Iran was estimated to be 8% (95% confidence interval (CI) = 0.07 to 0.09) with the maximum 38.8% (95% CI = 0.036 to 0.042) and the minimum 0.009% (95% CI = 0.008 to 0.010), respectively. Also, it was found that the prevalence in Central provinces is higher than other ones. In all studies, the average of age was 24.5 with the maximum and the minimum of 45 and 22.5 years old, respectively. The present review revealed that infection rate is relatively high among Iranian women, and risk factors such as hygienic situation, behavior and local culture, poor socioeconomic condition, feeble moral considerations, and increase in marriage age must be considered in the management of controlling programs.

The effect of verapamil on in vitro susceptibility of promastigote and amastigote stages of Leishmania tropica to meglumine antimoniate.

Pentavalent antimonials are the standard treatment for cutaneous leishmaniasis (CL) with low efficacy and resistance is emerging. CL is increased significantly in respect to incidence rate and expanding to new foci. In the present study, the effect of verapamil on in vitro susceptibility of promastigote and amastigote stages of Leishmania tropica to meglumine antimoniate (MA, Glucantime) was evaluated using colorimetric assay (MTT) and in a macrophage model, respectively. Verapamil, as a calcium channel blocker, affects drug uptake by preventing of drug efflux from the cells. In promastigote form, several concentrations of MA with or without verapamil showed significant decrease (P < 0.05) in optical density. The overall mean IC50 value with combination of MA plus verapamil (IC50 = 116.03 µg/ml) was significantly less than MA (IC50 = 225.14 µg/ml) alone (P < 0.05) for promastigote stage. Similarly, the amastigote stage was more susceptible to treatment with MA plus verapamil to that of MA alone (P < 0.05). Analysis of overall effect of different concentrations of MA alone, compared with combination of MA plus verapamil by mean infection rate of amastigotes in each macrophage showed a significant difference (P < 0.05).These findings indicated some degree of synergistic effects between MA and verapamil on in vitro susceptibility of L. tropica to MA. Further works are required to evaluate this synergistic effect on animal model or volunteer human subjects.

Three cases of brain hydatidosis in North Khorasan, Iran.

Cystic hydatidosis is a serious public health problem in Iran. Although cysts can develop in almost all organs and the brain cysts are very rare. Here, we present 3 confirmed cases of brain hydatidosis and the patients who underwent successful surgery. Pathological examinations demonstrated the presence of cystic hydatidosis.

Indoor environment assessment of special wards of educational hospitals for the detection of fungal contamination sources: A multi-center study (2019-2021).

Background and Purpose: The hospital environment was reported as a real habitat for different microorganisms, especially mold fungi. On the other hand, these opportunistic fungi were considered hospital-acquired mold infections in patients with weak immune status. Therefore, this multi-center study aimed to evaluate 23 hospitals in 18 provinces of Iran for fungal contamination sources. Materials and Methods: In total, 43 opened Petri plates and 213 surface samples were collected throughout different wards of 23 hospitals. All collected samples were inoculated into Sabouraud Dextrose Agar containing Chloramphenicol (SC), and the plates were then incubated at 27-30ºC for 7-14 days. Results: A total of 210 fungal colonies from equipment (162, 77.1%) and air (48, 22.9%) were identified. The most predominant isolated genus was Aspergillus (47.5%), followed by Rhizopus (14.2%), Mucor (11.7%), and Cladosporium (9.2%). Aspergillus (39.5%), Cladosporium (16.6%), as well as Penicillium and Sterile hyphae (10.4% each), were the most isolates from the air samples. Moreover, intensive care units (38.5%) and operating rooms (21.9%) had the highest number of isolated fungal colonies. Out of 256 collected samples from equipment and air, 163 (63.7%) were positive for fungal growth. The rate of fungal contamination in instrument and air samples was 128/213 (60.1%) and 35/43 (81.2%), respectively. Among the isolated species of Aspergillus, A. flavus complex (38/96, 39.6%), A. niger complex (31/96, 32.3%), and A. fumigatus complex (15/96, 15.6%) were the commonest species. Conclusion: According to our findings, in addition to air, equipment and instrument should be considered among the significant sources of fungal contamination in the indoor environment of hospitals.

Rare case report of deep vein thrombosis associated with brucellosis in Iran.

Brucellosis caused by species of Brucella is among the most prevalent zoonotic diseases that can involve any organ. Here we present a case of deep vein thrombosis due to brucellosis. We described a 62 old male farmer with a history of brucellosis and deep vein thrombosis on his right leg.

Prevalence of intestinal parasitic infection in food handlers of Iran: A systematic review and meta-analysis.

Food handlers regardless of whether preparing or serving food, play key roles in the transmission of food-borne infections. This study aimed to evaluate the prevalence of intestinal parasitic infections in food handlers in Iran. In the present study, a comprehensive literature search was carried out in electronic databases, including PubMed, Scopus, Google Scholar, Science Direct, Magiran, Scientific Information Database (SID), Iran Medex and Iran Doc, to identify all the published studies from 2000 to 31st April 2019. A total of 25 articles from different regions of Iran were identified and fulfilled our eligibility criteria. Totally, 140,447 cases were examined and 1163 cases were infected with intestinal parasites. Of all cases, 19,516 were male and 5901 were female with 1163 and 652 infected cases, respectively. The overall prevalence of intestinal parasitic infections was evaluated 14.0% [95% CI: 11.0-17.0%]. It is revealed that protozoan, such as Giardia lamblia, with prevalence of 41.0% [95% CI: 25.0-59.0%], Blastosystis hominis with 28.0% [95% CI: 15.0-44.0%] and Entamoeba coli with 22.0% [95% CI: 16.0-29.0%] had the highest prevalence while, Dientamoeba fragilis 5.0% [95% CI: 4.0-7.0%], Iodamoeba bütschlii 5.0% [95% CI: 2.0-8.0%], Chilomastix mesnili 5.0% [95% CI: 2.0-9.0%] and Endolimax nana with 3.0% [95% CI: 1.0-7.0%], were less prevalent. Infection with Ascaris lumbricoides7.0% [95% CI: 0.0-29.0%] was more prevalent helminth followed with Enterobius vermicularis 3.0% [95% CI: 1.0-5.0%], Hymenolepis nana 2.0% [95% CI: 1.0-3.0%], Taenia spp. 2.0% [95% CI: 0.0-7.0%] and Trichuris trichiura 1.0% [95% CI: 0.0-1.0%]. The high prevalence of commensal parasites, such as Entamoeba coli, which does not need cure is indicating the importance of personal hygiene in food handlers. Our results revealed the high prevalence of intestinal parasitic infection in food handlers in Iran. Monitoring programs to prevent and controlling of transmission to individuals are needed.

Giant Cerebral Hydatid Cyst: A Rare Case Report.

The diagnosis of hydatid cyst should be considered in children with seizure in endemic regions.

Initial Evidences of Salt and Pepper Retinal Lesions (SPRL) in Patients with Intestinal Protozoan Infections in Iran.

BACKGROUND: It is made clear that salt and pepper retinal lesion (SPRL) has subsequently associated with the infection with Giardia lamblia (G. lamblia). However, little is known regarding the prevalence of SPRL among patients suffered from parasitic infections in the world. OBJECTIVE: This study aimed to determine the prevalence of SPRL among patients with intestinal protozoan infections, for the first time, in Sari, northern Iran. METHODS: In this case-control study, a total of 150 subjects participated: 75 were in the patients group diagnosed to have an intestinal parasite and 75 in the control group without any intestinal infection. Fecal samples were obtained from all participants and examined with wet mount and formalin-ether methods. The retina of both groups was examined by an ophthalmologist. RESULTS: Overall, salt and pepper retinal changes were diagnosed in 12 (16 %) patients with at least one parasitic infection (7 females and 5 males). G. lamblia was diagnosed in 6 subjects (50%), Blastocystis hominis in 5 (41.6%), and Entamoeba coli in 1 (8.3 %). Most of the patients (58.3%) had a mild infection. Bilateral retinal involvement was observed in 75% of the patients. Furthermore, macula involvement was observed in 91.7 % with SPRL. CONCLUSION: Our findings indicated the relatively high prevalence of SPRL in subjects with giardiasis and blastocystosis. It can be concluded that not only G. lamblia but also B. hominis can cause SPRL in Sari, Iran. Further studies are needed to find other etiologic parasites able to cause retinal damages.

Primary pelvic hydatid cyst in an infertile female, A case report.

It is important to consider hydatidosis as a differential diagnosis in all suspected cysts in endemic regions. The wide range of hydatidosis presentations makes it difficult to differentiate from similar symptoms.

Impacts of flood on health of Iranian population: Infectious diseases with an emphasis on parasitic infections.

BACKGROUND: Outbreaks of infectious diseases are the major concern after flooding. Flood makes people displacement which would be more complicated with inadequate sanitation. Settling in crowded shelters in absence of clean water and inaccessibility to health care services makes people more vulnerable to get infection. This review aimed to discuss about potential undesirable outcomes of flooding occurred in 2019 in Iran. METHODS: A comprehensive search was carried out in databases including PubMed, Google scholar, Scopus, Science Direct, Iran medex, Magiran and SID (Scientific information database) from 2000 to 2019. All original descriptive articles on flood were concerned. Related articles on flood disturbance were considered. Also, publication of red cross society was considered as only reliable reference in evaluation of consequences of flood occurred in 2019 in Iran. RESULTS: Flooding in Iran, was started in March 2019 and lasted to April 2019. Flood affected 31 provinces and 140 rivers burst their banks, and southwestern Iran being hit most severely. According the reports of international federation of red cross society, 3800 cities and villages were affected by the floods with 65,000 destroyed houses and 114,000 houses partially damaged. Also 70 hospitals or health care centers with 1200 schools were damaged along with many infrastructures including 159 main roads and 700 bridges. CONCLUSIONS: Considering 365,000 displaced persons and estimation of mentioned damages, it was one of the greatest natural disaster during the last 20 years. Various risk factors in favor of infectious diseases such as overcrowding, disruption of sewage disposal, poor standards of hygiene, poor nutrition, negligible sanitation and human contact among refugees provide suitable conditions for increased incidence of infectious diseases after flooding and also cause epidemics.More attention is needed to provide hygienic situation for people after natural disasters including flood.

Visceral leishmaniasis in an adult case in Northeast of Iran: A case report and literature review.

Leishmaniasis is a rare complication in adult cases even in endemic areas. Here, the first report of visceral leishmaniasis in a young woman in northeast of Iran has been described.

Repurposing azole antifungals into antileishmanials: Novel 3-triazolylflavanones with promising in vitro antileishmanial activity against Leishmania major.

Previously, we have described a series of azole antifungals namely 3-(1,2,4-triazol-1-yl)flavanones (TFs) containing an N-(phenethyl)azole framework required for sterol 14α-demethylase (CYP51) inhibitory activity. Similar mechanism of action of azoles in fungi and protozoan parasites prompted us to investigate the potential effects of TFs against promastigote and amastigote forms of Leishmania major (L. major), as well as their toxicity against macrophages, apoptosis induction and in silico interactions with the target enzyme. All compounds showed more potent anti-parasitic activity against L. major in comparison with reference azole drug fluconazole and standard antileishmanial agent glucantime. Among the tested compounds, the 4-chloro derivative (TF-2) was found to be the most potent one, being about 13 times more potent than fluconazole against promastigotes. TF-2 decreased both mean infection rate of macrophages (MIR) and mean number of amastigotes per macrophages (MNAPM), significantly more than fluconazole (P < .001). Furthermore, the cytotoxicity assay against J774.A.1 macrophages revealed that this compound displays high selectivity against amastigotes over macrophages (SI = 30.21). The in silico study showed that TF-2 can properly accommodated in the active site of parasitic CYP51 and coordinated to the heme. The SAR analysis showed that the introduction of 4-chloro on 2-phenyl moiety results in the best profile of activity and selectivity. Accordingly, the compound TF-2 prototype can be considered as promising candidate for development of new antileishmanial agents.

Status of Linguatula serrata infection in livestock: A systematic review with meta-analysis in Iran.

OBJECTIVES: The present systematic review attempted to determine the prevalence of Linguatula serrata (L. serrata) infection among Iranian livestock. The L. serrata known as tongue worm belongs to the phylum pentastomida and lives in upper respiratory system and nasal airways of carnivores. Herbivores and other ruminants are intermediate hosts. METHODS: MEDLINE, Embase, Web of Science, Google Scholar, and the Cochrane Library were searched from Nov 1996 to 22 Apr 2019 by searching terms including "Linguatula serrata", "linguatulosis", "pentastomida", "bovine", "cattle", "cow", "buffalo", "sheep", "ovine", "goat", "camel", "Iran", and "prevalence" alone or in combination. The search was conducted in Persian databases of Magiran, Iran doc, Barakatkns (Iran medex) and Scientific Information Database (SID) with the same keywords. After reviewing the full texts of 133 published studies, 50 studies had the eligibility criteria to enter our review. RESULTS: By random effects model analysis, the pooled prevalence of linguatulosis was 25% (95%CI: 18.0-33.0, I 2 = 98.67 % , P < 0.001) in goats; 15.0% (95%CI: 10.0-20.0, I 2 = 97.95 % , P < 0.001) in sheep; 12.0% (95%CI: 7.0-18.0, I 2 = 98.05 % , P < 0.001) in cattle; 7% (95%CI: 2.0-16.0, I 2 = 97.52%) in buffalos and 11.0% (95%CI: 6.0-16.0%, I 2 = 96.26 % , P < 0.001) in camels. The overall prevalence in livestock was estimated to be 25%. The highest infection rate was recorded in West Azerbaijan Province (68%) and the lowest rate was in Khuzestan Province (0.23%) (P < 0.05). CONCLUSIONS: We concluded that the high prevalence of L. serrata infection in livestock (mainly ovine linguatulosis) show the endemic status of linguatulosis in several parts of Iran and will pose a risk for inhabitants. Control strategies to reduce the parasite burden among these animals are needed.

Ultrastructural Investigation of Leishmania major Promastigotes Treated with A New Potent Antileishmanial Azole Using Scanning Electron and Atomic Force Microscopes.

AIM AND BACKGROUND: Azoles as antifungal drugs have been used to treat leishmaniasis for many years. Several evidences suggesting that the primary target of azoles is the heme protein, which co-catalyzes cytochrome P-450-dependent 14α-demethylation of lanosterol. Little is known about the structural changes caused by azoles with atomic force microscopy (AFM) or scanning electron microscopy (SEM). In the current work, several patented antileishmanial agents reviewed (US8809555) (US 0269803 A1) (TW201802093 A). The present study aimed to determine ultrastructural damage in Leishmania major (L.major) induced by the newly synthesized azole. METHODS: In this study, we investigated the morphological alterations of the parasite treated with our new synthesized azole namely trans-2-(4-chlorophenyl)-2,3-dihydro-3-(1Himidazol- 1-yl)-4H-1-benzopyran-4-one (IF-2) against L.major promastigotes stage using two high-resolution microscopic techniques: atomic force microscopy and scanning electron microscopy. RESULTS: The results showed remarkable topographical and morphological alterations in the cell membrane at promastigote stage of L. major treated with the potent investigated azole (IF-2) ( IC50 values ≤8.9 µg/mL). Both techniques revealed membrane damage and also losing the flagellum in the observed cells. CONCLUSION: Our results strongly confirm the Leishmania cell wall as a potent target for the new synthesized azole (IF-2). Accordingly, focus on membrane integrity and glycoconjugates of Leishmania parasite to design new therapeutic agents is recommended.

Promising antileishmanial activity of novel imidazole antifungal drug luliconazole against Leishmania major: In vitro and in silico studies.

OBJECTIVES: Pentavalent antimonials have been used for the treatment of leishmaniasis for over 70 years, however they are limited by their toxicity. Unfortunately, the efficacy of first-line drugs for the treatment of leishmaniasis has decreased and resistance is noticeable. Luliconazole is a new azole with unique effects on fungi that has not yet been tested on Leishmania parasites. METHODS: In this study, the cytotoxicity and antileishmanial activity of luliconazole were evaluated in vitro against promastigotes and intracellular amastigotes of Leishmania major. The docking simulation with the target enzyme, sterol 14α-demethylase (CYP51) was performed using AutoDock 4.2 program. RESULTS: The IC50 (concentration of test compound required for 50% inhibition) against promastigotes revealed that luliconazole (IC50=0.19µM) has greater potency than ketoconazole (KET), meglumine antimoniate (MA) and amphotericin B (AmB) (IC50 values of 135, 538 and 2.52µM, respectively). Against the amastigote stage, luliconazole at a concentration of 0.07µM decreased the mean infection rate and the mean number of amastigotes per macrophage more effectively than MA (P<0.004) and KET (P<0.043), but there was no difference compared with AmB (P>0.05). A docking study of luliconazole with the cytochrome P450 enzyme sterol 14α-demethylase (CYP51) revealed that this azole drug can properly interact with the target enzyme in Leishmania mainly via coordination with heme and multiple hydrophobic interactions. CONCLUSION: These results show the potent activity of luliconazole at extremely low concentrations against L. major. It may therefore be considered as a new candidate for treatment of leishmaniasis in the near future.

Canine visceral leishmaniasis in Iran: A systematic review and meta-analysis.

Visceral leishmaniasis is considered an endemic zoonosis in some parts of Iran and dogs are main reservoirs, which play role in the transmission cycle of human leishmaniasis. This systematic review and meta-analysis was performed to determine the prevalence of canine visceral leishmaniasis (CVL) in Iran. Data were systematically collected from 1982 to 2015 in Iran on the following electronic databases: PubMed, Google Scholar, Science Direct, Scopus, Web of Science, Magiran, Irandoc, Iran medex and Scientific Information Database (SID). A total of 39 articles concerning dogs, 6 articles on jackals, 4 articles on wolves and 4 articles on foxes, reporting the prevalence of CVL from different regions of Iran fulfilled our eligibility criteria. Totally, 19903 dogs, 151 jackals, 42 wolves and 44 foxes were examined and the overall prevalence rate of CVL in Iran was estimated to be as following: in dogs 16% (95% CI: 13-19%), in jackals 10% (95% CI: 5-15%), in wolves 10% (95% CI: 5-15%) and in foxes 10% (95% CI: 1k19%), respectively. There was a significant difference in infection rate between male and female dogs, the infection in males 9% (95% CI: 8.8-10.5%) was more than females 7% (95% CI: 5.5-7.5%) (p=0.024). Also, the rate of infection was significantly higher in older dogs than younger ones (p<0.047) while in dogs younger than 1year was 12% (95% CI: 6-18%), in 1-2 years 10% (95% CI: 6-14%), in 3-5 years 16% (95% CI: 9-22%) and in those which were over 7 years 31% (95% CI: 19-44%), respectively. Our meta- regression analysis revealed the significant correlation between stray and owned dogs: the infection rate in stray 10% (95% CI: 5-4%) was higher than those owned 6% (95% CI: 3- 8%) (p=0.037). Also, the prevalence of infection in rural dogs 36% (95% CI: -1-72%) is significantly higher than urban dogs, 19% (95% CI:-1-40%) (p=0.013). Although most (81%) of infected dogs had no clinical signs (asymptomatic), meta-regression analysis showed that the infection rate in asymptomatic dogs was 14% (95% CI: 11-18%) and in those with clinical signs 3% (95%CI: 2-4%), and the correlation is statistically significant (p=0.001). The present systematic review and meta-analysis indicates that CVL is common at least in some districts of more than half of provinces of Iran. Further investigation and monitoring will be required to improve the surveillance and control strategies to reduce the incidence of CVL in Iran.