Cutaneous leishmaniasis in military areas of Iran and Middle East and its prevention, diagnosis and treatment methods- Narrative review

Background and Aim: Cutaneous leishmaniasis (CL) is the main vector-borne disease in Iran. There are two types of rural and urban CL which are transmitted by Phlebotomus papatasi and Phlebotomus sergenti. Military forces are more susceptible to this disease than other people due to their job conditions. In case of infection, according to the commune period, they can spread the disease to other parts of the country. In this review, the prevalence of the disease in Iran, especially in military areas as well as in a number of Middle Eastern countries, is addressed. In addition, the importance of awareness of military personnel with clinical symptoms and methods of prevention, diagnosis, and treatment of CL are mentioned. Methods: In this narrative review, 302 articles were selected (1980 to 2018) by searching scientific databases such as Science Direct, PubMed, Google Scholar, Iran Medex, Scopus, SID, and Magiran using different combination of keywords including CL, diagnosis and control, vector, reservoir, epidemiology, middle-east, Iran and military areas. Then, unrelated articles were removed and the necessary data was extracted from 113 articles. Results: In this review, clinical signs of the disease, sampling and diagnostic methods including direct, culture, molecular, histology, immunohistochemistry, isoenzymes and new methods such as High resolution melt (HRM) and Nucleic acid sequence based assay (NASBA), also therapeutic strategies and control of the reservoirs and carriers have been presented. Conclusion: Considering the increasing trend of CL in recent years in different parts of Iran and neighboring countries, it is necessary for the health authorities of the armed forces to have sufficient knowledge about the recognition of clinical signs, reservoirs, carriers, and methods of control and prevention, diagnosis and treatment of the disease. This knowledge enables military personnel to provide training in how to control the disease in the military and other areas of the country, and prevent the spread of the disease through accurate planning.