Epidemiological characteristics of cutaneous leishmaniasis in Fars Province, Southern Iran: A registry-based study, 2020-2024.

BACKGROUND: Cutaneous leishmaniasis (CL) is a neglected tropical parasitic disease endemic in many parts of Iran, and Fars Province is recognized as one of the most important foci. Timely and accurate epidemiological data are essential for effective disease control and prevention. Accordingly, this study was designed to investigate the demographic and clinical epidemiological status of CL in Fars Province between 2020 and 2024. METHODS: This retrospective registry-based surveillance study analyzed 12,183 laboratory-confirmed cases of cutaneous leishmaniasis (CL) recorded in the Fars Provincial Health Surveillance System between March 2020 and March 2024. Demographic, clinical, and parasitological variables including age, sex, occupation, nationality, place of residence, lesion count, anatomical location, and Leishmania species were extracted from the registry. RESULTS: The mean age was 30.02 ± 20.96 years (range: <1-99 years). Males accounted for 53.25% of cases (P < 0.001), and individuals aged ≤ 20 years represented the largest proportion of cases (P < 0.001). Urban residents comprised 67.3% of cases (P < 0.001). Two counties, Shiraz (37.81%) and Marvdasht (17.45%), accounted for more than half of all reported cases. Among the 4454 cases with available species data in the registry, Leishmania major was the predominant species (84.5%), while Leishmania tropica accounted for 15.5%. The proportion of cases recorded as L. tropica in the registry increased from 3.98% in 2022-27.20% in 2024. Housewives constituted the largest occupational group (26.9%). Most patients presented with a single lesion (44.32%), and the upper extremities were the most frequently affected anatomical site (38.33%). A significant association was observed between lesion count and sex (P = 0.003). CONCLUSIONS: Our findings reveal a disproportionate burden of reported CL cases among males and younger individuals, a substantial urban concentration of cases, and an increasing proportion of registry-recorded L. tropica cases among those with available species data. Shiraz and Marvdasht were identified as key transmission hotspots warranting immediate, targeted public health interventions. Collectively, these data offer a robust evidence base to guide resource allocation and stratified control efforts in high-risk areas.