Visceral leishmaniasis (VL) has been found as an endemic disease in some areas in northwest and south parts of Iran during recent two decades. The species of the Leishmania has been characterized as L.infantum and the main sources of human infection in the endemic areas is dog. The majority of kala-azar cases are found among children in the age group of 1-4 years. As the delay in diagnosis and treatment of kala-azar cause high mortality in the patients, serological surveillance, using direct agglutination test (DAT), and treatment of seropositive cases who have clinical symptoms are carrying out with cooperation of Provincial Health Services in the endemic foci of Ardebil and East Azerbaijan Provinces in the northwest and Bushehr in the south parts of Iran since 1997.
DAT Leishmania antigen is made in the Protozoology Unit of the School of Public Health with the strain of L.infantum isolated from an infected dog in Iran. The finger prick blood samples are collected by trained Health Workers (Behwarz) from suspected kala-azar patients in the Rural Health Houses. The collected samples are transferred to the near district kala-azar laboratory and tested (using DAT) by the trained technicians. The sero -positive patients are referred to pediatricains or trained general physicians in district hospital or health center for clinical examination and treatment of the seropositive cases (DAT titers of 1:3200 or higher) with kala-azar clinical symptos. For the treatment, usually, meglomine antimongtc (Glucantime) is used via intra-muscular in dosss of 20mg/kg/day for 20 days.
In kala-azar case finding in the serological surveyed areas of Ardebil, East-Azerbaijan and Bushehr provinces during 1997-2001, altogether, 19693 blood samples were collected from suspected kala-azar patients and tested by DAT. Totally , 1274 cases (6.74%) were seropositive in titers of 1:3200 or higher. In the clinical examination of seropositive cases 690 patients (54.16% of sero-positive cases and 3.50% of the total samples) had kala-azar clinical symptoms and therefore they were treated.
This seroloeical surveillance of kala-azar in the endemic area as have detected high number of kala-azar patients among children up to 12 years old, who were subsequently treated on time . This ptoject has prevented the mortality of the disease in the studied areas.