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      Epidemiological Study of Cutaneous Leishmaniasis in Some Iraqi Provinces

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          Background: Cutaneous leishmaniasis (CL) remains a serious public health concern in some parts of Iraq. The aims of this study to report of CL in some parts of Iraq, by different parasitological, cultural, and molecular methods and evaluate sex differences among infected patients. This is the first study conducted  to characterize Leishmania species causing CL among Iraqi patients using the sequence analysis of Internal Transcribed Spacer1 (ITS1).   Methods: A total of 700 cases of suspected CL who were referred to the Iraqi's clinics  and health centers and they checked for Leishmania amastigote using Giemsa-stained , however the NovyMacneal Nicolle (NNN) culture led to the growth of promastigotes in all samples, then the samples were examined using PCR and RFLP-PCR methods. Results: The present study indicated that the prevalence of CL in eight Iraqi provinces as follow: Diwaniya 88(15.1%) , Wasit 85(14.5%),Najaf 79(13.6%), Thi-Qar 76(13.1%), Basrah 67(11.5%), Baghdad 65(11.2%), Diyala 63(10.8%) and Salah-Adin province which recorded the lower infection 60(10.3%), and it appeared 83.3% by using Giemsa-smeared in eight Iraqi provinces. The highest infection (100 %) appeared using PCR while the lowest infection (68%) appeared by culture on NNN media. The present study was revealed that the highest infection (60 %) caused by L.major than L.tropica (40 %) . Our results showed that 368 (52.6 %) of CL patients were had single lesion and 215 (30.7 %) had multiple lesions, and the ulcerative wet type lesions were present in 49.6% , while the nodule dry type lesions were present in 33.7 %. The overall prevalence of cutaneous leishmaniasis in the study area was very high (83.3%) having a statistical significant association with sex; males are more prone (56.4%) to Cutaneous Leishmaniasis (CL) as compared to females(43.6%). Conclusions: A clear and reliable bias toward males exists in some tropical diseases, such as leishmaniasis. Cutaneous leishmaniasis is a major health problem in Iraq and CL caused by many countries including Iraq. Health authorities should be aware of the fact that war and terrorist activities induce expansion of the disease and increase incidence rate in the situation that access to medical treatment is not easy especially in poor conditions of leishmaniasis endemic areas.  

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          Chromosome and gene copy number variation allow major structural change between species and strains of Leishmania.

          Leishmania parasites cause a spectrum of clinical pathology in humans ranging from disfiguring cutaneous lesions to fatal visceral leishmaniasis. We have generated a reference genome for Leishmania mexicana and refined the reference genomes for Leishmania major, Leishmania infantum, and Leishmania braziliensis. This has allowed the identification of a remarkably low number of genes or paralog groups (2, 14, 19, and 67, respectively) unique to one species. These were found to be conserved in additional isolates of the same species. We have predicted allelic variation and find that in these isolates, L. major and L. infantum have a surprisingly low number of predicted heterozygous SNPs compared with L. braziliensis and L. mexicana. We used short read coverage to infer ploidy and gene copy numbers, identifying large copy number variations between species, with 200 tandem gene arrays in L. major and 132 in L. mexicana. Chromosome copy number also varied significantly between species, with nine supernumerary chromosomes in L. infantum, four in L. mexicana, two in L. braziliensis, and one in L. major. A significant bias against gene arrays on supernumerary chromosomes was shown to exist, indicating that duplication events occur more frequently on disomic chromosomes. Taken together, our data demonstrate that there is little variation in unique gene content across Leishmania species, but large-scale genetic heterogeneity can result through gene amplification on disomic chromosomes and variation in chromosome number. Increased gene copy number due to chromosome amplification may contribute to alterations in gene expression in response to environmental conditions in the host, providing a genetic basis for disease tropism.
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            Sex Hormones and Modulation of Immunity against Leishmaniasis

            Sex-associated hormones such as estradiol, testosterone and progesterone have all been shown to modulate immune responses, which can result in differential disease outcomes between males and females, as well as between pregnant and nonpregnant females. Most parasitic diseases, including leishmaniasis, usually result in more severe disease in males compared with females. This review highlights our current knowledge concerning the role of sex hormones in modulating leishmaniasis in both clinical settings and experimental disease models.
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              Emergence of a new focus of anthroponotic cutaneous leishmaniasis due to Leishmania tropica in rural communities of Bam district after the earthquake, Iran.

              To describe a new emerging focus of anthroponotic cutaneous leishmaniasis (ACL) due to Leishmania tropica in rural areas of Dehbakry county, south-eastern Iran, after the earthquake of 2003. House-to-house survey of 3884 inhabitants for active leishmaniasis lesions or scars. The diagnosis was confirmed by smears, cultures and identification of the parasite by polymerase chain reaction (PCR). All age groups were affected, although patients ≤10 years of age showed the highest rate of infection (P = 0.0001). The overall prevalence rate was 5.3%; 6.3% in females and 4.3% in males. Of 204 cases, 1.8% had active sores and 3.5% had scars, with a significant difference between the sexes (P = 0.005). 47% of the lesions were on the face and 77.9% had one lesion. The incidence rose gradually 2004-2005, but grew exponentially 2006-2008. Electrophoresis of PCR products indicated that L. tropica was the causative agent. The current emergence was unexpected in this rural locality, where no previous history of CL was recorded. According to our knowledge this is the first report of a gradually establishing new ACL focus in rural communities after the 2003 earthquake. © 2011 Blackwell Publishing Ltd.

                Author and article information

                Journal of Men's Health
                J Men's Health
                Dougmar Publishing Group, Inc.
                September 24 2018
                October 11 2018
                : 14
                : 4
                : e18-e24
                © 2018

                Copyright of articles published in all DPG titles is retained by the author. The author grants DPG the rights to publish the article and identify itself as the original publisher. The author grants DPG exclusive commercial rights to the article. The author grants any non-commercial third party the rights to use the article freely provided original author(s) and citation details are cited. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc/4.0/


                Geriatric medicine,Urology,Sports medicine,Sexual medicine
                Geriatric medicine, Urology, Sports medicine, Sexual medicine


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