Identification of medicinal plants effective in infectious diseases in Urmia，northwest of Iran

Mahmoud Bahmani，Kourosh Saki，Somayeh Shahsavari，Mahmoud Rafieian-Kopaei，Reza Sepahvand，Ahmad AdinehFood and Beverages Safety Research Center，Urmia University of Medical Sciences，Urmia，Iran

2Shahid Beheshti University of Medical Sciences，Tehran，Iran

3Young Researchers and Elite Club，Khorramabad Branch，Islamic Azad University，Khorramabad，Iran

4Medical Plants Research Center，Shahrekord University of Medical Sciences，Shahrekord，Iran

5Razi Herbal Medicines Research Center，Lorestan University of Medical Sciences，Khorramabad，Iran

6Department of Pharmacology and Toxicology，Faculty of Pharmacy，Pharmaceutical Sciences Branch，Islamic Azad University，Tehran，Iran

Identification of medicinal plants effective in infectious diseases in Urmia，northwest of Iran

Mahmoud Bahmani1，Kourosh Saki2，Somayeh Shahsavari3，Mahmoud Rafieian-Kopaei4*，Reza Sepahvand5，Ahmad Adineh6
1Food and Beverages Safety Research Center，Urmia University of Medical Sciences，Urmia，Iran

2Shahid Beheshti University of Medical Sciences，Tehran，Iran

3Young Researchers and Elite Club，Khorramabad Branch，Islamic Azad University，Khorramabad，Iran

4Medical Plants Research Center，Shahrekord University of Medical Sciences，Shahrekord，Iran

5Razi Herbal Medicines Research Center，Lorestan University of Medical Sciences，Khorramabad，Iran

6Department of Pharmacology and Toxicology，Faculty of Pharmacy，Pharmaceutical Sciences Branch，Islamic Azad University，Tehran，Iran

ARTICLE INFO

Article history：

form 15 Jun 2015

Accepted 20 Jun 2015

Available online 6 Aug 2015

Medicinal plants

Infectious diseases

Urmia

Iran

Objective：To identify the medicinal plants effective in infectious diseases.

Methods：Initially，we obtained a list of herbalists and traditional healers from Food and Drug Deputy.Direct observations and interviews as well as collection of herbarium specimens of indigenous medicinal plants effective in infectious diseases of urinary tract，reproductive，digestive，respiratory and skin systems were performed.This study was conducted through questionnaires and interviews；the questionnaires were distributed among traditional healers and simultaneous interviews were also run.The plants were herbariumized，herbarium specimens were authenticated，and their species were determined by using reliable flora and other sources.Finally，the data were input into Excel 2010 and analyses were performed.

Results：Out of the studied plants，35 native medicinal plants belonging to 17 families were effective in the treatment of various diseases and infections.In this study，the Lamiaceae family had the highest frequency of plants for the treatment of infections. Traditional healers of Urmia in 24%of cases used the leaves of medicinal herb to treat patients.In 68%of cases，they prescribed medicinal herbs in the boiled forms.Most medicinal herbs showed therapeutic effect on the digestive system.

Conclusions：Traditional medicinal sources，valuable knowledge of traditional healers in Urmia，the scientific investigation of the effects of the herbs offered in this study and their effects in traditional medicine may provide a good source for new drugs in modern medicine.

Original articlehttp://dx.doi.org/10.1016/j.apjtb.2015.06.004

1.Introduction

One of the most important challenges in human health is infectious diseases due to their high incidence and outbreak rate［1］.One of the most common human infections is urinary tract infection（UTI）which requires urgent and continuous treatment［2］.UTI is an infection involving the kidneys，ureters，bladder or urethra.These are the structures through which urine passes before being discarded from the body.If the disease develops with no effective treatment，its complications progress and may result in kidney failure.The most common pathogens causing UTIs are Escherichia coli（E.coli）and other Enterobacteriacae bacteria such as Klebsiella［3］.About 250 million people are estimated to suffer from UTIs annually.In addition，20%-50% of adult women are projected to have had at least one symptomatic UTI［4］.

The significant reasons for UTIs may include the possibility of septicemia，congenital anomalies of the urinary tract such as posterior urethral valve，ureteropelvic junction obstruction，ureterocele，and other obstructive uropathies as predisposing factors for frequent infection，damage of kidney tissue or vesicoureteral reflux which can cause kidney-induced hypertension，growth failure，and renal failure.

Bacterial vaginosis is the most common vaginitis in women of reproductive age.Bacterial vaginosis is caused by a complex alteration in vaginal flora in which hydrogen peroxide-producing lactobacillidecreaseandanaerobicpathogensovergrow. Although one half of bacterial vaginosis patients are asymptomatic，the symptoms include a gray，thin，fishy-smelling vaginal discharge and itching.Diagnosis is confirmed by testing vaginal secretions.Bacterial vaginosis appears to increase the risk of pelvic inflammatory diseases，postabortion and postpartum endometritis，post-hysterectomy vaginal cuff infection，chorioamnionitis，premature rupture of membranes，preterm labor，and preterm birth［5］.

The incidence of invasive fungal infections has been increased during the past three decades.One of these infections is vulvovaginal candidiasis infection.This disease is considered as the second most common vaginal infection involving approximately 75%of women in lifetime.Moreover，in 50%of patients，the infection occurs at age of 25 years.The most common symptom is vaginal itching that may be severe.Other symptoms include burning urination，white and thick vaginal discharge with typically no bad smell，painful intercourse，and redness around the vagina［6］.

In recent years，yeasts and particularly candidate species have emerged as one of the most common pathogens isolated from human infections［7］.

Diarrheal diseases，after respiratory infections，are the second leading cause of mortality worldwide.Diarrhea is one of the most common diseases in children，especially in developing countries with poor sanitation and/or poor personal hygiene standards.Globally，there are nearly 500 million pediatric cases of diarrheal disease under the age of 5 years every year，of whom two million die.Gastroenteritis or infectious diarrhea is a medical condition from inflammation of both stomach and small intestine.It causes some combination of diarrhea，vomiting，dehydration，abdominal pain，and cramping.Gastroenteritis has been referred to as gastro，stomach bug，and stomach virus. Globally，most cases in children are caused by rotavirus，whereas in adults norovirus and campylobacter are more common.Less common causes include other bacteria and parasites. Generally，the Enterobacteriaceae family，rotavirus and Giardia lamblia are the main bacteria，virus，and parasite，respectively that can cause diarrhea.Transmission may occur via consumption of improperly prepared food or contaminated water or due to close contact with the infected［8］.

Most synthetic drugs are produced by imitating the herbal medicines，but they are produced artificially in pharmaceutical laboratories.At least one third of all used products have plant origin.The use of plants as natural，safe，accessible and inexpensive materials，compared to synthetic antibiotics，has been growing for the treatment of bacterial infections.Also，herbal medicines have more popularity to the people compared with chemical ones［9］.

Medicinal plants have been shown as a good source for development of new drugs［10-15］.They have demonstrated promising effects in a wide variety of diseases such as cancer［16，17］，diabetes［18，19］，atherosclerosisandcardiovascular diseases［20-23］，learning and cognitive complications［24-26］，and wounds［27-29］.Furthermore，medicinal herbs are also effective in prevention and treatment of the toxicity induced by other drugs or toxins［30-37］.Medicinal plants are a rich source of bioactive substances，antioxidants，flavonoids，andphenolicsubstancesandhavemultiplehealth effects［12，38-55］.

With pristine nature and unique flora，Urmia is one of the most significant regions in Iran with widespread and rich source of medicinal plants frequently used for treatment of various infectious diseases.In this study，we seek to identify medicinal plants that are used for treatment of various infections.

2.Materials and methods

This study was conducted via questionnaires and interviews from November，2013 to February，2014 in Urmia，Iran.Initially，we obtained a list of traditional healers of Urmia from Food and Drug Deputy.Direct observation and interviews as well as collectionofherbariumspecimensofindigenousmedicinalplants effective in the treatment of infectious diseases of urinary tract，reproductive，digestive，respiratory，and skin systems were performed.The questionnaires were distributed among traditional healers and simultaneous interviews were also run.

After collection of traditional and therapeutic data about the plants mentioned in each questionnaire，different plant specimens were collected，dried and herbariumized.Herbarium specimens were identified and their species were determined by using reliable sources and flora such as Ghahreman，flora of Iranica，flora of Turkey［56］，and flora of Iraq［57］.Finally，the data obtained from the questionnaires were input into Excel 2010 and the frequency of family，used plant parts，traditional usage form，and frequency of the treated diseases were analyzed.

3.Results

After finalizing and analyzing the collected data from questionnaires and interviews，comprehensive information such as scientific name，local name，the used parts and different ways of application，and anti-infective therapeutic effects in various body systems was derived.

Overall，35 medicinal plants were identified for the effective antibacterial and anti-infectious properties in urinary tract，reproductive，digestive，respiratory，andskinsystems（Table 1）.

The analysis results of 35 traditionally medicinal plants with anti-infectious and antimicrobial property used in the present study showed 17 plant families in Urmia carried antimicrobial and anti-infectious effects.Based on the data of the studied medicinal plants，Lamiaceae family demonstrated the most frequency out of other plant families（Figure 1）.

Data analyses showed that traditional healers of Urmia in 24% of cases already knew that the leaves of medicinal herb had therapeuticeffects.In68%ofcases，theyprescribedmedicinalherbsin the boiled form.The results also revealed that most of medicinal herbs showed therapeutic effect on the digestive system.

Details about used parts，the ways of usage，and the percentage of medicinal plants effective in different body systems were illustrated in Figures 2-4.

Table 1 Medicinal plants effective against infectious diseases of various body systems and their traditional therapeutic effects.

4.Discussion

Iran has a long history of application of traditional medicine and medicinal plants for treatment of various diseases［58］.The rich flora in Iran，Iranians'valuable knowledge of the use of medicinal plants，presence of prestigious academic centers in Isfahan，Shiraz，and Ray，existence of credible scientific sources such as Ibn Sina's Ghanoon book and also other famous scientists such as Rhazes that introduced medicine with herbs among Iranians，along with the Iranians'interest in medicinal plants，highlight the significance of further attention to this field［59］.Different regions of the country have different cultures and traditions in the use of medicinal plants.Hence，the ethnobotanical investigation of medicinal plants in Urmia and recognition of their therapeutic effects have led to a context for understanding the therapeutic effects of these plants and developing new ideas for producing new drugs.

In the present study，after finalizing and analyzing the collected data from questionnaires and interviews，a total of 35 medicinal plants belonging to 17 families were identified for effective antibacterial and anti-infectious properties.

In traditional medicine，sweat camel's thorn in boiled form has different properties or Manna of Hedysarum（“Toranjabin”in Persian）has a cold humor and is used for bile excretion and treatment of kidney and bladder stones.It is also known to have diuretic，anti-pertussis，and anti-age activities with no special side effect［60-62］.A study conducted on camel's thorn（Alhagi maurorum）reported the protective effect of its aqueous extract（not its sweat）on preventing gastric ulcer caused by stress and alcohol in rats［63］.Mallow plant flowers contain anthocyanins and mucilage and all parts of the plant，especially the flowers，exhibit softening effect on the respiratory tract，which may be due to its high mucilage content［64］.

The therapeutic effects of Mentha longifolia L.have been demonstratedinimprovingdigestivedisorders，vomiting，anorexia，ulcerative colitis，and liver disorders.In addition，the antimicrobial and antioxidant properties of several species of this plant have been reported［65，66］.

Preuss et al.investigated the inhibitory and cytotoxic effects of oregano and some other essential oils with monolaurin on Staphylococcus aureus（S.aureus），Bacillus anthracis，E.coli，KlebsiellapneumoniaeandHelicobacterpylori.Oregano essential oil showed inhibitory activity against all studied microorganisms except for Bacillus anthracis［67］.The antibacterial effect of pulegone as the main component of oregano essential oil has been demonstrated［68］.Gulluce et al.reported that the antimicrobial effect of oregano essential oil was greater than that of its extract［66］.

Since the antimicrobial active component of Mentha is pulegone，the extraction of this secondary compound can help to introduce stronger anti-infection and antimicrobial drugs.

In another study，the cumin oil was demonstrated to be effective against four types of bacteria including S.aureus，Bacillus cereus，E.coli and Listeria monocytogenes［69］.The antimicrobial effects of the cumin oil have been demonstrated on the growth of Vibrio parahaemolyticus［70］.

The chemical composition of Plantago major includes mucilage，organic acids，polysacharides，flavonoids，carotenoids，saponins，sorbitols，minerals，vitamins，tannins，resins，gum，etc. Plantain has been tested by the Commission E of Germany and its use was suggested for treatment of cough and respiratory infections and skin inflammation，as well.

umerous

on the antimicrobial effects of medicinalplants nativetoIran includingthe antibacterialeffect of Scrophularia against S.aureus and Pseudomonas aeruginosa［71］.Also，decoctedandbrewedformsofScrophulariastriata and Scrophularia deserti，in Western Iran，are traditionally used for treatment of deep，superficial，and internal infections［72］. Phenolic，flavonol，and flavonoid compounds have already been determined in the ethanol extract of Scrophularia striata［73］.

The extract of Teucrium polium consists of diterpenoids，5-7-glycoside，thymols，carvacrols，and volatile essences［74，75］.The results obtained in a study showed that Teucrium chamaedrys exhibitedantibacterialactivityagainstPseudomonas aeruginosa，Salmonella typhimurium，E.coli，and Bacillus cereus as well as antifungal activity against Candida albicans and Aspergillus niger［64］.

A species of thyme，Zataria multiflora Boiss，is used as a flavoring agent in many foods in Iran with antioxidant，antibacterial and disinfecting effects［76］.The main components of Iranian thyme（Zataria multiflora Boiss）essential oil are carvacrols，linalools，and parasmine［77］.Thymus vulgaris has antibacterial effect due to the presence of phenolic compounds［78］.The higher levels of phenols in essence，will achieve the moreantimicrobialproperties.Thephenoliccompounds consist of carvacrols，eugenols，and thymols［78，79］.

The main component of essential oil of a number of plants belonging to Lamiaceae such as Ziziphora tenuior is pulegone［80-82］.Pulegone has already shown antimicrobial activity against different strains of Salmonella and strong antimicrobial effect against Candida albicans and Salmonella typhimurium［82，83］.

The action mechanisms of essential oils are related to their chemical compositions and antimicrobial activity，but the mechanisms are not similar in all cases.However，the effect of herbal extracts on cell wall structure has been confirmed in most cases［84］.Toxic effects of plant extracts or essential oils on membrane structure and function have been generally used to explain the antimicrobial action of essential oils and their phenolic and monoterpenoid compounds［85］.Because of the anti-lipophilic properties of essential oils，their monoterpenes will preferentially partition from an aqueous phase into membrane structures.This process results in membrane expansion，increased membrane fluidity and permeability，disturbance of membrane-embedded proteins，inhibition of respiration，and alteration of ion transport processes［85，86］.The antibacterial actions of medicinal plants have also been attributed to their phenolic compounds［85］.Therefore，other medicinal plants containing phenolic compounds could possess antibacterial activity which deserves investigation.Furthermore，infections are associated with oxidative stress and there are a lot of herbal medicines with antioxidant activity［32，87-110］.

Therefore，the use of these plants，beyond contributing to reduction of infectious diseases，may have additional benefits for reduction of oxidative stress.

Conflict of interest statement

We declare that we have no conflict of interest.

Acknowledgments

This research was funded by the grant No.918/996 by Deputy for Research and Technology of Urmia University of Medical Sciences.

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13 Mar 2015

Mahmoud Rafieian-Kopaei，Medical Plants Research Center，Shahrekord University of Medical Sciences，Shahrekord，Iran.

Tel:+98 381 334 6692，+98 913 1811842

Fax:+98 381 3330709

E-mail:rafieian@yahoo.com

Peer review under responsibility of Hainan Medical University.

Foundation Project:Supported by the grant No.918/996 by Deputy for Research and Technology of Urmia University of Medical Sciences.

inrevisedform24Mar，2nd revised form 25 May，3rd revised