Papers by Mohammad Shirzadi
Iranian Journal of Parasitology, Dec 15, 2020
Cutaneous leishmaniasis (CL) is an emergent public health concern, particularly in tropical and s... more Cutaneous leishmaniasis (CL) is an emergent public health concern, particularly in tropical and subtropical regions. Reports of pregnancy complications are scarce; however, as the endemic range of CL expands in Iran, there is concern of possible detrimental effects on fetal development amongst infected mothers through placental transmission of the parasite or enhanced maternal immune responses. We herein describe the first known case of persistent anthroponotic CL, plausibly responsible for pregnancy complications, preterm birth, and neonatal death in a healthy Iranian primigravida woman. Diagnosis was based on physical examinations of the lesions on the back of both calves of the patient and laboratory analyses including direct smear, culture, and PCR. During active CL infection, the patient gave birth to a premature female neonate who passed three days post-delivery due to immature lung development and subsequent respiratory distress syndrome. This report highlights the challenges associated with CL infection during pregnancy, exacerbation of lesions, and subsequent complications.
DOAJ (DOAJ: Directory of Open Access Journals), Mar 1, 2019
Background: Iran is among the first six countries in the world with the highest annual incidence ... more Background: Iran is among the first six countries in the world with the highest annual incidence of cutaneous leishmaniasis. This study aimed at estimating the incidence, burden, and trend of cutaneous leishmaniasis at the national level in Iran from 1977 to 2015. Methods: This study was conducted in 2017, used Disability Adjusted Life Years (DALYs) index, recommended by the WHO for assessing the Global Burden of Diseases, to estimate the burden of cutaneous leishmaniasis. The data on the incidence of the disease and the number of cases was obtained from the communicable diseases surveillance system (Center for Communicable Diseases Control (CCDC), Ministry of Health and Medical Education (MOHME) of Iran) that routinely collects data from all over the country; in addition, some data was extracted by reviewing the texts. Considering the views expressed in a panel of experts, to calculate the actual incidence of the disease, the number of registered cases was multiplied by 5. Results: The incidence of cutaneous leishmaniasis varied from approximately 50 to 250 cases per 100,000 population during the studied period. During these years, the incidence of the disease was higher in males than females. Moreover, the burden of cutaneous leishmaniasis varied between 1.18 and 5.7 DALYs per 100000 population during the studied period. The incidence and burden of cutaneous leishmaniasis have not significantly decreased in recent years. Conclusion: Despite the implementation of a program for controlling cutaneous leishmaniasis in Iran since 1977, the incidence and burden of the disease are still high in the country; it is seriously alarming for policy makers and managers of the health system in Iran, indicating the presence of some problems in controlling the disease.
Iranian Journal of Clinical Infectious Diseases, Jan 12, 2019
Background: Leishmaniasis is a parasitic infection caused by the Leishmania spp. and transmitted ... more Background: Leishmaniasis is a parasitic infection caused by the Leishmania spp. and transmitted via the bite of infected female Phlebotomine sand flies. Health education is one of the important approaches to increasing knowledge and awareness of the community about leishmaniasis health issues. Objectives: The aim of this study was to assess the effect of health education on knowledge, attitude and practice (KAP) of health volunteers about leishmaniasis in some areas endemic for cutaneous and visceral leishmaniasis. Methods: In this KAP study, 104 health workers (41 from East Azerbaijan, 41 from Khorasan Razavi and 21 from Ilam provinces) were participated in the study. For this purpose, a questionnaire containing 11 items on knowledge, 10 items on attitude and 13 items on practice was used before and after educational intervention. The results were analyzed by SPSS version 22 using Wilcoxon test, Kruskal-Wallis test, McNamar's test, and Fisher's exact test. The results showed a significant difference between pre and post-educational intervention scores. These results were reported for each province and for total subjects. KAP among the studied population was at a moderate level before the intervention, and it increased to high levels after the intervention; this difference was statistically significant (P < 0.01). After the intervention, there was a significant difference between the provinces. After the intervention, the level of knowledge in Ilam was significantly higher than Khorasan Razavi and Azerbaijan provinces (P < 0.01). Attitude scores were significantly lower in Khorasan Razavi Province compared to Ilam and East Azerbaijan provinces (P < 0.01), and practice had improved more significantly in Khorasan Razavi province compared to Ilam province (P < 0.01). Conclusions: Health education can be considered as a simple and inexpensive approach to increasing KAP among health volunteers, and it can play an important role in the prevention of leishmaniasis.
Background and Objectives: Anthroponotic cutaneous leishmaniasis (ACL) is restricted to humans; t... more Background and Objectives: Anthroponotic cutaneous leishmaniasis (ACL) is restricted to humans; thus, prompt diagnosis and early treatment are significant measures to control the disease. This study was conducted to determine the effect of direct active case-detection and early treatment on the control of ACL in Bam District. Methods: This retrospective cohort study was performed based on intervention and nonintervention. After the 2003 earthquake, an equipped treatment center was established to actively detect CL cases following the CL epidemic. This intervention was carried out in 2007 and the suspected cases were referred to the center for diagnosis and treatment Another comparable CL treatment center was selected as the control in Kerman. The recorded data of the patients were analyzed with statistical tests at p<0.05. The incidence rate steadily increased to 30% from 2003 to 2007 whereas the incidence gradually decreased to 1% after the intervention. However, by contrast, the incidence rate increased significantly in the control area. The treatment failure and relapse rate of ACL showed no significant difference with the control group before and after the intervention. The effectiveness of the intervention was calculated to be 85%. Active case-detection and early treatment of ACL could be an effective measure in controlling ACL, particularly during epidemics. Lessons learned from the 2003 Bam earthquake could be used as a suitable model for ACL endemic areas, nationally and globally.
PubMed, Sep 1, 2021
Background: Brucellosis is one of the most challenging health issues in many developing countries... more Background: Brucellosis is one of the most challenging health issues in many developing countries including Iran. The purpose of this study is to investigate the incidence and geographical distribution of brucellosis using Geographic Information System (GIS) and to predict its incidence in Iran in 2021. Method: This is a descriptive-analytical cross-sectional study, which contains spatial and climatic information along with the prevalence rate of brucellosis in Iran. Disease information was obtained from the National Center for Infectious Diseases Management during 2011-2015. Then, Arc GIS version 9.3 was used to plot the geographical maps for the incidence and frequency of the disease. Using the Raster calculator tool, the disease prediction map for the future was plotted. For proper spatial distribution of hot and cold spots, Getis-Ord-Gi statistic was employed. Findings: The highest incidence of brucellosis during 2009-2015 was observed in the western provinces of Iran (North Khorasan, South Khorasan and Razavi Khorasan provinces). The incidence of brucellosis in Iran decreased from 2009 to 2011 but it exhibited an increasing trend from 2011 to 2014. The provinces of Kurdistan, Lorestan, Ilam, Zanjan and Kermanshah may be among the hot spots in terms of brucellosis incidence in 2021. Conclusion: We predicted significant variations in brucellosis risk distribution in Iran in the coming years. In the western and northwestern provinces, which are among the high risk areas for the incidence of this disease in the future, this disease can pose a serious health threat to the residents of these areas.
Infectious Diseases of Poverty, May 15, 2023
Background Cutaneous leishmaniasis (CL) is a wide-reaching infection of major public health conce... more Background Cutaneous leishmaniasis (CL) is a wide-reaching infection of major public health concern. Iran is one of the six most endemic countries in the world. This study aims to provide a spatiotemporal visualization of CL cases in Iran at the county level from 2011 to 2020, detecting high-risk zones, while also noting the movement of high-risk clusters. Methods On the basis of clinical observations and parasitological tests, data of 154,378 diagnosed patients were obtained from the Iran Ministry of Health and Medical Education. Utilizing spatial scan statistics, we investigated the disease's purely temporal, purely spatial, spatial variation in temporal trends and spatiotemporal patterns. At P = 0.05 level, the null hypothesis was rejected in every instance. In general, the number of new CL cases decreased over the course of the 9-year research period. From 2011 to 2020, a regular seasonal pattern, with peaks in the fall and troughs in the spring, was found. The period of September-February of 2014-2015 was found to hold the highest risk in terms of CL incidence rate in the whole country [relative risk (RR) = 2.24, P < 0.001)]. In terms of location, six significant high-risk CL clusters covering 40.6% of the total area of the country were observed, with the RR ranging from 1.87 to 9.69. In addition, spatial variation in the temporal trend analysis found 11 clusters as potential high-risk areas that highlighted certain regions with an increasing tendency. Finally, five space-time clusters were found. The geographical displacement and spread of the disease followed a moving pattern over the 9-year study period affecting many regions of the country. Our study has revealed significant regional, temporal, and spatiotemporal patterns of CL distribution in Iran. Over the years, there have been multiple shifts in spatiotemporal clusters, encompassing many different parts of the country from 2011 to 2020. The results reveal the formation of clusters across counties that cover certain parts of provinces, indicating the importance of conducting spatiotemporal analyses at the county level for studies that encompass entire countries. Such analyses, at a finer geographical scale, such as county level, might provide more precise results than analyses at the scale of the province.
Eastern Mediterranean Health Journal, Nov 1, 2010
Visceral leishmaniasis (VL) is endemic in parts of Islamic Republic of Iran. A cross-sectional se... more Visceral leishmaniasis (VL) is endemic in parts of Islamic Republic of Iran. A cross-sectional seroprevalence study was carried out in children in Booyerahmad district in the southwest of the country. Serum samples were taken from 1628 children up to 10 years old from different areas in Booyerahmad in 2005-06. Anti-Leishmania antibody was detected in 50 out of 1628 children (3.1%) by direct agglutination test (antibody titre ≥ 1:3200). There was no significant difference in seropositivity between the sexes (2.8% males and 3.3% females). The highest rate of infection (5.2%) was in the age group 10 years. Further studies are needed to explore the reservoirs and vectors of the disease in this region.
Ecological Modelling, Feb 1, 2018
Rhombomys opimus (R. opimus), a social rodent, is the main reservoir host for zoonotic cutaneous ... more Rhombomys opimus (R. opimus), a social rodent, is the main reservoir host for zoonotic cutaneous leishmaniasis (ZCL) in most parts of the Middle East and central Asia. The difficulties in monitoring rodent population patterns have hindered the effective application of preventive measures of ZCL. This study presents a spatially explicit agent-based simulation model of R. opimus behaviors that is integrated with Geographic Automata System (GAS) and a heuristic optimization method, cuckoo search (CS). The model is used to explore the relationships among rodent population dynamics, ZCL incidence and authority interventions using statistical data generated from simulated rodent societies rather than observational data, which are difficult to obtain through field surveys. The model simulation considers three agent types: rodents, colonies and cell agents. The model components and overall approach are calibrated, investigated with sensitivity analysis and validated with empirical field data in a ZCL-endemic area in Isfahan, central Iran. The results suggest that unsupervised and sporadic preventive measures could cause rodent emigration towards human population centers and start new waves of infections.
Armaghane danesh, Oct 15, 2005
Journal of Parasitic Diseases, Mar 5, 2019
Cystic echinococcosis (CE), as a zoonotic helminthic infection, imposes a large socioeconomic bur... more Cystic echinococcosis (CE), as a zoonotic helminthic infection, imposes a large socioeconomic burden to societies throughout the world. This study aimed to analyze the demographic, clinical, diagnostic and therapeutic data of CE patients across all provinces in Iran. In this cross-sectional study, the mentioned data were routinely collected by provincial medical universities during the time from March 2016 to March 2017. The provincial population census was used to calculate the prevalence of CE per 1,000,000 populations for all provinces. T test and Chi squared test were used to compare variables between genders. Statistical analysis was done at 95% significant level using STATA 14 software. The overall prevalence of CE was 6.8 cases per 1,000,000 populations in Iran. The highest and lowest prevalence was reported for Northeast (15.2) and southeast (0.7) of Iran, respectively. There was a significant difference in the prevalence between male and female (5.8 vs. 7.9, p < 0.001). An increasing trend of the prevalence was found by age in both males and females. Abdominal pain was reported as the highest proportion of symptom (39.0%) and the liver was a commonly infected organ (62.7%). CT scan (39.0%) and MRI (1.9%) had the highest and lowest proportion among types of CE diagnosis, respectively. About 67% of the patients washed the vegetable by water without any disinfectant. Due to global efforts on the control and prevention of CE, it still remains endemic in many countries throughout the world. Incidence trend of CE in Iran showed being endemic for CE and more investigations are needed on all aspects of the disease.
Revista de Educação Continuada em Medicina Veterinária e Zootecnia do CRMV-SP, 2012
Journal of research in health sciences, Jun 29, 2023
Background: The increasing trend in animal bites and rabies in recent years makes the disease a p... more Background: The increasing trend in animal bites and rabies in recent years makes the disease a public health concern in Iran. The objectives of the current study were to investigate the epidemiologic aspects of the animal bite and determine the associated risk factors of the delay in initiation of post-exposure prophylaxis (PEP) against rabies in Iran. Study Design: National registry-based cross-sectional study. Methods: This study included all registered cases of animal bites between March 2021 and March 2022 at the Ministry of Health and Medical Education in Iran. We retrieved epidemiologic data on person, time, place, and PEP outcome. Results: A total of 260470 animal bite cases (approximately 334 per 100000 populations, and 11 deaths) were registered during the study period. About 77.2% of them were reported in males, 4.3% in children aged less than 5 years, 56.4% occurred in urban areas, 98% in domestic animals, and mostly in north and northeast areas of Iran. Additionally, 2.8% of cases had a delay of more than 48 hours in the initiation of PEP. Significant determinants of the increase in delay were female gender (OR=1.43, 95% CI: 1.36, 1.51, P&lt;0.001), foreign nationality (OR=1.19, 95% CI: 1.01, 1.12, P=0.001), rural residence (OR=1.07, 95% CI: 1.01, 1.12, P=0.010), and the wild animals (OR=1.22, 95% CI: 1.12, 1.34, P&lt;0.001). Conclusion: The observed frequency of animal bites in a year indicates a serious public health concern and the need for targeted interventions, especially in at-risk areas and vulnerable populations.
The International Archives of the Photogrammetry, Remote Sensing and Spatial Information Sciences, Dec 11, 2015
The most underdiagnosed water-borne bacterial zoonosis in the world is Leptospirosis which especi... more The most underdiagnosed water-borne bacterial zoonosis in the world is Leptospirosis which especially impacts tropical and humid regions. According to World Health Organization (WHO), the number of human cases is not known precisely. Available reports showed that worldwide incidences vary from 0.1-1 per 100 000 per year in temperate climates to 10-100 per 100 000 in the humid tropics. Pathogenic bacteria that is spread by the urines of rats is the main reason of water and soil infections. Rice field farmers who are in contact with infected water or soil, contain the most burden of leptospirosis prevalence. In recent years, this zoonotic disease have been occurred in north of Iran endemically. Guilan as the second rice production province (average=750 000 000 Kg, 40% of country production) after Mazandaran, has one of the most rural population (Male=487 679, Female=496 022) and rice workers (47 621 insured workers) among Iran provinces. The main objectives of this study were to analyse yearly spatial distribution and the possible spatial clusters of leptospirosis to better understand epidemiological aspects of them in the province. Survey was performed during the period of 2009-2013 at rural district level throughout the study area. Global clustering methods including the average nearest neighbour distance, Moran's I and General G indices were utilized to investigate the annual spatial distribution of diseases. At the end, significant spatial clusters have been detected with the objective of informing priority areas for public health planning and resource allocation.
Research and Reports in Tropical Medicine, Apr 1, 2019
The genus Leishmania includes a number of protozoan parasites that cause a wide range of infectio... more The genus Leishmania includes a number of protozoan parasites that cause a wide range of infections named leishmaniasis. Leishmaniasis may be appear in three clinical formscutaneous (CL), visceral, and mucocutaneous (MCL)with variation in their presentation and severity: diffuse CL and post-kala-azar dermal leishmaniasis). The prevalent signs of CL are nonhealing ulcers on exposed skin, but infected patients may have other dermatologic symptoms. In the 1960s, amphotericin B deoxycholate was introduced as a second-line therapy for CL and MCL. However, widespread administration of the agent was prevented, due to its renal and systemic toxicity, high price, and obstacles to intravenous use in leishmaniasis-endemic regions. Amphotericin B binds to ergosterol in the photogenic cell membranes and causes changes in membrane permeability, leakage of ions, and finally cell death. Compared to amphotericin B deoxycholate, a higher dose of liposomal amphotericin B should be administered to show the treatment effect. A high percentage of liposomal amphotericin B is "fastened" in the liposome and not biologically effective. Amphotericin B deoxycholate has some toxic effects, and liposomal amphotericin B is meaningfully less toxic compared to it. Treatment options for CL are limited, due to variation in species causing CL and pharmacokinetic issues. Amphotericin B is effective against some particular forms of CL.
Zoonoses and Public Health, Mar 1, 2014
Eastern Mediterranean Health Journal, Oct 1, 2015
Leishmaniasis has a long history in the Islamic Republic of Iran. This study aimed to show the tr... more Leishmaniasis has a long history in the Islamic Republic of Iran. This study aimed to show the trend in leishmaniasis incidence from 1983 to 2012 and to describe the epidemiological characteristics in 2012. In a retrospective cross-sectional study, data were extracted from th%e national leishmaniasis surveillance system for the 3 clinical types-cutaneous (zoonotic and anthroponotic) and visceral (zoonotic). The average annual number of cutaneous leishmaniasis cases was 18 884 (average annual incidence 32 cases per 100 000 inhabitants). In 2012 the highest incidences were in age groups 1-4 and 5-9-years (43 and 40 per 100 000), and more males (57%) than females (43%) were infected. The annual average number of zoonotic visceral leishmaniasis cases was 175 (average annual incidence 0.18 per 100 000). The incidences of cutaneous and zoonotic visceral leishmaniasis have decreased in recent years, which coincides with national leishmaniasis control efforts.
Methods: This review is based on a data that collected and evaluated in Center for communicable d... more Methods: This review is based on a data that collected and evaluated in Center for communicable diseases management in Ministry of Health in Iran dependent to surveillance system. Results: According to different epidemiologic studies, Iran has been considered an endemic area for cutaneous Leishmaniasis (CL) in the world. In 12 years ego dependent to activities for CL control the number of cases decreased from 23202 in 2008 (Incidence rate 32 per 100000) to 13124 in 2019 (Incidence rate 15.8 per 100000), more cases report from September to December, 46% of cases had one lesion and 21% had 2 lesions, the diameter of lesions were 3 centimeter and bellows in 85% of cases. Conclusions: This article shows one the main differential diagnosis of chronic skin diseases in Iran is CL, and physician have to attention to diagnosis the cases in early stage.
Journal of geomatics science and technology, 2023
International Journal of Infectious Diseases, Apr 1, 2014
Background: Enteric fever continues to remain a major cause of morbidity and mortality in Nepal. ... more Background: Enteric fever continues to remain a major cause of morbidity and mortality in Nepal. Likewise, S. Typhi and Paratyphi have developed resistance to antibiotics used so it is required to study the current pattern of resistance to antibiotics. Om hospital has been tracking the records of laboratory confirmed S. Typhi and Paratyphi cases of both male and female cases between the ages 5 years and 55 years to assess the trend in enteric fever. Methods & Materials: In the laboratory, the blood culture containers are immediately incubated at 37 • C for 48 hours using various media like Brain Heart Infusion Browth, Blood Agar base, Muller Hinton and Mac Conkey Agar. The disk diffusion method of Kirby and Bauer is used for sensitivity testing of S. Typhi and S. Paratyphi to antibiotics. Blood culture reports are followed up to 5 days. Subculture is done when there is obvious turbidity in the broth on any day. Results: Out of 6,978 blood culture performed, 306 (4.4%) were enteric fever cases. 110 (36%) cases were S. Typhi and 196 (64%) cases were S. Paratyphi. Among 306 cases of the total S. Typhi and Paratyphi cases, 32 (10.4%), 82 (26.8%), 86 (28.1%), 54 (17.65%) and 37 (12.09%) were from less than five years, five to fifteen years, fifteen to thirty years, thirty to fifty five years and above fifty five years respectively. Similarly, 150 (49.02%) and 156 (50.98%) cases were male and female respectively. 15% of the cases were resistant to azithromycin, cephalexin and amoxicillin and 5% cases were resistant to cefixime. Conclusion: The study of the enteric fever cases are consistent with other reports from Nepal showing high burden of enteric fever. However, we realized that the numbers come from a hospital based study and may not represent the population level estimates. Nevertheless, there are more cases of S. Paratyphi than S. Typhi which indicates the importance of needed intervention for control of S. Paratyphi through measures other than vaccines since there is no vaccine available for paratyphi infection. In addition it is imperative to make a case development of vaccines for preventing enteric fever.
PLOS ONE, May 25, 2021
Background Rabies is one of the oldest zoonosis viral diseases, which still remains as one of the... more Background Rabies is one of the oldest zoonosis viral diseases, which still remains as one of the most important threats to public health in the 21st century. Methods This cross-sectional study examined epidemiologic features of all 33,996 cases of persons bitten by animals and referred to the rabies prophylaxis centers in Golestan province between March 2017 and March 2020. Factors included demographic information of the victim (age, gender, and occupation), type of invasive animals (dog, cat, and other types), time of bite (year, month, and hour), place of residence (urban or rural), and injury and treatment statuses. We also obtained national and provincial animal bite incidence data for all of Iran and for Golestan province for the longer interval 2013-2020 to examine broader time trends. We used SPSS version 19, QGIS version 3.1, and Excel 2013 to generate frequency distributions and descriptive statistics. Results The incidence rates of animal bites in Golestan province and Iran as a whole both increased smoothly. The latest incidence rate of animal bites in Golestan was 652 per 100,000 people, almost three times the overall national figure for 2020. Most cases of animal bites (67.6%) occurred in rural areas, and 36% of the victims aged under 19 years old. Dog and cat bites accounted for the great majority of cases (89% and 8%, respectively). The highest rate of animal bites was reported in the spring (30.8%). The lower limb was the most commonly bitten area in these individuals (64.6%). Of note, 87% of the cases received incomplete prophylactic post-exposure treatment, and 18% received immunoglobulin.
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Papers by Mohammad Shirzadi