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Low Serum Levels of Selenium, Zinc, Iron, and Zinc/Copper Ratio in an Endemic Region of Cutaneous Leishmaniasis in Southwest Iran

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Abstract

Leishmaniasis is a widespread tropical infection; cutaneous leishmaniasis (CL) is the most common form of this disease known to cause significant morbidity. Trace metals, including selenium, zinc, iron, and copper, are required for the activity of several enzymes involved in immune system responses. The aim of this research was to measure the serum levels of selenium (Se), zinc (Zn), copper (Cu), iron (Fe), and Zn/Cu ratio in patients with CL. In this case-control study, 80 patients with CL and 80 healthy volunteers (not exposed to CL) from a CL endemic region in southwest Iran agreed to participate. Both clinical and parasitological verifications were made to include each subject as a CL-positive case. A questionnaire was completed for each participant which included the following criteria: age (year), height (cm), weight (kg), body mass index (kg/m2), and duration of disease (day). The biochemical assays were performed according to the standard protocols, and the values of Zn, Cu, Se, and Fe were expressed in micrograms per deciliter (μg/dl). All results were expressed as mean ± standard deviation (SD), and the statistical significance level was defined to be less than 0.05 (P < 0.05). There were no statistically significant differences in terms of mean values of age, body weight, height, and body mass index between CL patients and the control group (P > 0.05). The mean ± SD concentrations of Zn, Fe, and Se in the control group were found to be 118.87 ± 6.35 μg/dl, 123.00 ± 8.40 μg/dl, and 11.26 ± 1.88 μg/dl, respectively. These trace elements (TEs) were statistically lower (P < 0.001) in patients with CL (case group) with values of 83.05 ± 7.32 μg/dl for Zn, 86.51 ± 10.09 μg/dl for Fe, and 3.83 ± 1.20 μg/dl for Se. We have also observed that serum levels of Cu in CL-positive group were significantly higher than in the controls (P < 0.001). Furthermore, CL patients had significantly lower Zn/Cu ratio than controls (0.63 ± 0.05 μg/dl vs. 1.11 ± 0.10; P < 0.001). The alternation in serum levels of TEs may be a part of the defense strategy of the organism. Based on these results, it can be suggested that serum levels of these TEs can be a useful marker to estimate the prognosis of CL infection.

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Abbreviations

BMI:

Body mass index

CL:

Cutaneous leishmaniasis

Cu:

Copper

DALYs:

Disability adjusted life years

EMR:

Eastern Mediterranean Region

Fe:

Iron

GSH-Px:

Glutathione peroxidases

H2O2 :

Hydrogen peroxide

IFN-γ:

Interferon-γ

IL-1:

Interleukin 1

MCL:

Mucocutaneous leishmaniasis

MT:

Metallothionein

SD:

Standard deviation

Se:

Selenium

SOD:

Superoxide dismutase

SPSS:

Statistical Package for the Social Sciences

TEs:

Trace elements

TNF-α:

Tumor necrosis factor alpha

VL:

Visceral leishmaniasis

WHO:

World Health Organization

Zn:

Zinc

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Acknowledgments

The authors would like to thank all staff at the healthcare centers in Abadan and Khorramshahr cities. We are very grateful to Mrs. Fatemeh Maghsoudi (Abadan Faculty of Medical Sciences, Abadan, Iran) for her helpful consultation and comments on the manuscript.

Funding

This study was financially supported by Grant No. 98 U-591 from the Abadan Faculty of Medical Sciences, Abadan, Iran.

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Author notes

  1. Mehdi Sagha Kahvaz and Shahrzad Soltani contributed equally to this work.

Authors and Affiliations

  1. Abadan Faculty of Medical Sciences, P.O. Box 6313833177, Abadan, Iran

    Mehdi Sagha Kahvaz, Shahrzad Soltani, Sheyda Soltani & Masoud Foroutan

  2. Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Lisboa, Portugal

    Manuela Colla Carvalheiro

Authors
  1. Mehdi Sagha Kahvaz
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  4. Manuela Colla Carvalheiro
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  5. Masoud Foroutan
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Contributions

Conceptualization: Mehdi Sagha Kahvaz, Shahrzad Soltani, and Masoud Foroutan. Data curation: Mehdi Sagha Kahvaz. Formal analysis: Sheyda Soltani. Investigation: Shahrzad Soltani and Masoud Foroutan. Software: Sheyda Soltani. Methodology: Mehdi Sagha Kahvaz, Shahrzad Soltani, and Masoud Foroutan. Supervision: Mehdi Sagha Kahvaz and Shahrzad Soltani. Funding acquisition: Mehdi Sagha Kahvaz. Project administration: Mehdi Sagha Kahvaz and Shahrzad Soltani. Writing—original draft: Masoud Foroutan and Shahrzad Soltani. Writing—review and editing: Manuela Colla Carvalheiro, Shahrzad Soltani, and Masoud Foroutan.

Corresponding author

Correspondence to Masoud Foroutan.

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Conflict of Interest

The authors declare that they have no conflicts of interest.

Ethical statement

All subjects voluntarily agreed to participate. A written informed consent was obtained from adult persons and the parent or guardian of children less than 15 years old. This study received the approval from the Abadan Faculty of Medical Sciences Ethical Committee (IR.ABADANUMS.REC.1398.091). Ethical issues (including plagiarism, misconduct, data fabrication and/or falsification, double publication and/or submission, redundancy, etc.) have been completely observed by the authors.

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Kahvaz, M.S., Soltani, S., Soltani, S. et al. Low Serum Levels of Selenium, Zinc, Iron, and Zinc/Copper Ratio in an Endemic Region of Cutaneous Leishmaniasis in Southwest Iran. Biol Trace Elem Res 199, 1291–1296 (2021). https://doi.org/10.1007/s12011-020-02271-z

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