First Evidence for Two Independent and Different Leishmaniasis Transmission Foci in Sri Lanka: Recent Introduction or Long-Term Existence?
First Evidence for Two Independent and Different Leishmaniasis Transmission Foci in Sri Lanka: Recent Introduction or Long-Term Existence?
复制标题
斯里兰卡两个独立且不同的利什曼病传播源的初步证据：最近引入还是长期存在？
DOI：
10.1155/2019/6475939
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发表时间：
2019
影响因子：
2.2
通讯作者：
Karunaweera,NadiraD
中科院分区：
文献类型：
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作者：
Siriwardana,Yamuna;Deepachandi,Bhagya;Weliange,ShreenikadeS;Udagedara,Chandanie;Wickremarathne,Chandanie;Warnasuriya,Wipula;Ranawaka,RanthilakaR;Kahawita,Indira;Chandrawansa,PH;Karunaweera,NadiraD
皮肤利什曼病由L.自2001年以来，在斯里兰卡报告了donovaniis。研究了来自不同地理位置的患者（2001 - 2013年，来自北方或南方的600例患者和来自其他病灶的少数病例）。分析显示，在斯里兰卡北方和南方，利什曼病有两种不同的社会人口和临床特征。此外，自最近暴发以来，这些疫源地中存在相同的不同特征，并随着时间的推移在每个疫源地内独立传播。对北方焦点确定的14个参数的概况与其他地点进行了进一步的研究。岛的西北部（10/14）和中部（9/14）与北方病灶（14/14）更相似。感染可能起源于斯里兰卡北方的一个病灶，并扩散到其他两个病灶。南方病灶与其他病灶不同，且出现时间较早（2/14）。容纳大量流动人口的西部重点地区具有南北混合的特征（4/14）。北部的病变进展缓慢，非溃疡性（128/185，69.2%），而南部的病变进展迅速，非溃疡性病变较少（193/415，46.5%）。临床分析倾向于寄生虫病因学（相当大的菌株差异），而不是宿主病因学（年龄，性别或遗传学）。这两个疫源地自疫情爆发以来均表现出一年两次的季节性变化。在一年的早期和后期观察到两个高峰。此外，这些发现表明利什曼病在该国长期存在、最近时空扩展和检测，而不是最近引入和建立的。斯里兰卡几十年前就开展了强有力的抗疟活动，缺乏专业意识，以及最近的军事活动使人口与森林循环密切接触，这些活动分别在该国利什曼原虫的无声传播和随后的人类病例增加中发挥了作用。
Cutaneous leishmaniasis caused by a genetic variant ofL. donovaniis being reported from Sri Lanka since year 2001. Patients presented from different geographical locations (600 patients from North or South and a minority of cases from other foci, 2001‐2013) were studied. Analysis revealed two different sociodemographic and clinical profiles of leishmaniasis in Northern and Southern Sri Lanka. Also, the same different profiles were present in these foci since the onset of the recent outbreak and had independently propagated within each focus over the time. A profile of 14 parameters identified in the Northern focus was further examined with regard to other locations. Northwestern (10/14) and Central parts (9/14) of the island were more similar to Northern focus (14/14). Infection would have originated in one focus and spread to other 2 in Northern Sri Lanka. Southern focus was different from and appeared older than all others (2/14). Western focus that accommodates a large transient population had a mixed picture of North and South features (4/14). Lesions in North showed a slow progression and a nonulcerative nature (128/185, 69.2%), while those in South showed a rapid progression and less nonulcerative lesions (193/415, 46.5%). Clinical analysis favoured a parasite aetiology (considerable strain differences) rather than a host aetiology (age, gender, or genetics). Both foci demonstrated a biannual seasonal variation since the onset of the epidemic. Two peaks were observed during the early and latter parts of the year. Furthermore, long‐term existence and recent spatiotemporal expansion and detection of leishmaniasis in this country rather than a recent introduction and establishment were indicated by these findings. Vigorous antimalarial activities that existed in Sri Lanka until few decades ago, lack of professional awareness, and more recent military activities that brought human population in close contact with a sylvatic cycle would have played a role in silent propagation ofLeishmaniaparasites and subsequent increment in human cases, respectively, in this country.