Objective: To represent a new geographical record, Phlebotomus (Adlerius) kabulensis (P. kabulensis), which is suspected to be a potential vector of visceral leishmaniasis. Methods: For the first time, P. kabulensis specimens were collected using the sticky paper traps method in outdoor places in mountainous areas with vegetation coverage of three provinces in Iran. Identification of males was based on ecological, morphological, morphometric and molecular (mtDNA cytochrome b gene sequences) criteria. Generally, males have two ascoids on the 8

To determine the spatial distribution and infection rate of sand flies as vectors of Leishmania parasite in Ardabil province, northwest of Iran. Methods: This was a descriptive cross-sectional study. The sand flies were collected from 30 areas in all 10 districts of Ardabil province during 2017. The specimens were caught using the sticky traps. The head and genitalia of sand flies were separated and mounted in Berlese solution for microscopic identification. The Geographical Information System ArcMap10.4.1 software was used to provide the spatial maps. Results: A total of 2 794 sand flies specimens were collected and 22 species of sand flies were identified from the two genera: Phlebotomus and Sergentomyia from Ardabil province. The highest frequency was found in Phlebotomus papatasi (23.7%) followed by Phlebotomus kandelakii (13.0%). The promastigote form of Leishmania infantum parasite has been reported from the three main vectors of visceral leishmaniasis (Phlebotomus kandelakii, Phlebotomus perfiliewi and Phlebotomus tobbi) from Ardabil province, where the spatial distribution map of these visceral leishmaniasis vectors was prepared. Some important species of sand flies such as Phlebotomus kandelakii, Phlebotomus perfiliewi and Phlebotomus tobbi were reported and identified as main and probable vectors of visceral leishmaniasis in Ardabil. Conclusions: According to the Geographic Information System based maps, the frequency of the sand flies as leishmaniasis vectors, the leishmania parasite infection rate and the prevalence of the disease in the central areas of Ardabil province are higher than in other areas in Ardabil province.

Rationale: Rabies, as an acute viral disease of the mammal's central nervous system (CNS), with a high mortality rate, is transmitted to humans through the bite of a rabid animals, especially canine and feline. Patient concerns: An Afghan man, aged 50 years was bitten by a fox in a farm around the Qom-Tehran road, Central Iran in 2018. The patient visited the doctor after the bite, however the period between incidence and hospital visit was not established and no indication was given whether the bite site injury was thoroughly washed. The patient was neither referred to the health center for vaccination (post-exposure prophylaxis) nor an effective therapeutic measures was applied. Forty-five days post-exposure, the patient presented with symptoms such as headache, fever, tingling and burning sensation and was referred to the Centers for Disease Control and Prevention (CDC) unit of Qom Provincial Health Center. Diagnosis: Rabies infection. Interventions: Forty-five days after the animal bite, in CDC of Qom Health Center, he received rabies post-exposure prophylaxis treatment was referred to an infectious diseases physician. Based on the history of animal bites, the patient was classified as probable case of rabies. The clinical symptoms of rabies appeared in patient after hospitalization. Outcomes: Ultimately the patient died in hospital 4 days after hospitalization (50 days after the occurrence of animal bite). After referring the patient to the CDC, the patient's saliva (0.5-1 mL) was sampled three times every 3-6 hours and tested by PCR. Human rabies was confirmed by Department of Virology in the Pasteur Institute of Iran. Lessons: Physicians and clinicians have responsibilities to be critical in observations and take prompt actions in case of animal bites, as rabies usually develops within 7 to 14 days, and delayed intervention after the onset of symptoms, vaccine and serum injections cannot lead to the survival of the patient.

OBJECTIVETo identify the scorpion fauna and classify the epidemiological aspects of scorpionism in an endemic region, Southeast Iran.

METHODSScorpionism data were collected from health centers and hospitals in Sistan-Baluchestan Province during 2010-2011. Specimens were collected at night, using UV light, between May and October 2012.

RESULTSIn total, 246 scorpions were collected from two families (Buthidae and Scorpionidae). Five species including Odontobuthus odonturus, Hottentotta (Buthotus) jayakari, Compsobuthus matthiesseni, Scorpio maurus and Orthochirus scrobiculosus are reported for the first time from this area. Androctonus crassicauda was the dominant species. In total, 3 638 scorpion sting cases were recorded by health system, the majority of which were females. Stings mostly occurred in July and the age group of 15-24 years presented the highest frequency. Scorpionism decreased during 2011 compared with that in 2010 (68.2%).

CONCLUSIONSBased on the results, scorpionism is a serious health problem in this area and increasing knowledge of residents regarding the prevention methods of scorpion stings is recommended. Additional research on the scorpion fauna, their ecological and molecular variety in this part of the country is needed as well as the correlation between scorpions' species and the clinical signs and symptoms.

Objective: To determine the effect of climatic and environmental factors on the incidence of cutaneous leishmaniasis in Qom province in 2018. Methods: In this cross-sectional study, the data on cutaneous leishmaniasis incidence were collected from the Disease Control and Prevention Center in Qom province. Climatic and environmental data including Normalized Difference Vegetation Index (NDVI), Land Surface Temperature (LST), and soil moisture were extracted using satellite images. Data of altitude and sunny hours were provided based on shuttle radar topography mission digital elevation model and hemispherical viewshed algorithm, respectively. The associations of climatic and environmental variables with the incidence of the disease were analyzed by Pearson correlation method. The ArcGIS 10.3 software was used to determine the geographical distribution of these factors. Results: There were positive correlations between cutaneous leishmaniasis incidence and the two climatic factors: LST and sunny hours per day (P=0.041, P=0.016), and it had weak negative correlations with the digital elevation model (P=0.27), soil moisture (P=0.54), and NDVI (P=0.62). The time delay analysis showed that in one-, two-, and three month periods, the correlations increased with a 95% confidence interval. Accordingly, the correlation with the three-month time delay was positive and relatively strong between the cutaneous leishmaniasis incidence and LST and sunny hours (P=0.027, P=0.02); nevertheless, there were negative correlations between the cutaneous leishmaniasis incidence and the soil moisture (P=0.27) and NDVI (P=0.62). Conclusions: As Qom is located in one of the semi-arid climate zones, topography and solar energy are important factors affecting the incidence of cutaneous leishmaniasis in autumn. Therefore, appropriate disease control programs are recommended.

Objective: To determine spatial distribution of sand flies (Diptera: Psychodidae; Larroussius group), the vectors of visceral leishmaniasis in Ardabil province, Northwest of Iran. Methods: Sand flies were collected using sticky traps from the 30 selected points in Ardabil province, during May-November 2017. The MaxEnt model in GIS software was used for modeling. Results: A total of 2 794 specimens of sand flies were collected, of which 33% were Larroussius subgenus sand flies. Phlebotomus kandelakii and Phlebotomus wenyoni were the highest and lowest collected species respectively. Based on the modeling, four areas in the province were identified with more than 70% probability of the presence of Larroussius group vectors which were at risk of visceral leishmaniasis disease transmission. Conclusions: The distribution of Larroussius subgenus sand flies was observed in all parts of Ardabil. But the northern parts of the province (Germi and Bilesavar counties) as well as central part (Ardabil and Meshkinshahr counties) were of great importance in terms of the presence of Larroussius subgenus sand flies and the possibility of transmission of the visceral leishmaniasis.