Emergence of visceral leishmaniasis in Sri Lanka: a newly established health threat.
Emergence of visceral leishmaniasis in Sri Lanka: a newly established health threat.
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斯里兰卡内脏利什曼病的出现：一种新的健康威胁。
DOI：
10.1080/20477724.2017.1361564
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发表时间：
2017
影响因子：
3.4
通讯作者：
Karunaweera,ND
中科院分区：
文献类型：
--
作者：
Siriwardana,HVYD;Karunanayake,P;Goonerathne,L;Karunaweera,ND
背景：斯里兰卡是人类皮肤利什曼病的新病源地，由通常内脏寄生虫杜氏利什曼原虫的基因变异引起。在过去的20年里，仅我们机构就报告了3000多例病例。最近出现的内脏利什曼病令人担忧。方法：对120例疑似内脏利什曼病的患者进行临床流行病学、免疫学和血液学指标的研究，这些患者至少满足六项标准中的两项(发热2周、体重减轻、疲倦影响日常功能、脾肿大、肝肿大和贫血)。7例患者(4例进展性治疗(A组)和3例非进展性、潜在无症状和观察者(B组)被确认。所有病例均在科伦坡大学利什曼病门诊随访3年，其中1例获9年随访。结果：所有病例抗利什曼治疗效果良好。复发没有被注意到。所有非进展性病例的临床特征均消退，未出现提示的临床特征或实验室参数的改变。内脏利什曼病病例来自该国不同地区。大多数人有皮肤利什曼病局部病源地的旅行史。结论：内脏利什曼病是斯里兰卡新出现的健康威胁。至少有一定比例的本地鉴定的OfL菌株。多诺瓦尼有内脏的能力。明显的抗利什曼敏感性令人鼓舞。在疾病控制方面的时间努力将是重要的，其中包括准确了解传播特征、提高专业人员和社区意识、改进诊断和提供适当的治疗方案。
Background:Sri Lanka is a new focus of human cutaneous leishmaniasis caused by a genetic variant of usually visceralizing parasiteLeishmania donovani.Over 3000 cases have been reported to our institution alone, during the past two decades. Recent emergence of visceral leishmaniasis is of concern.Methods:Patients suspected of having visceral leishmaniasis (n= 120) fulfilling at least two of six criteria (fever > 2 weeks, weight loss, tiredness affecting daily functions, splenomegaly, hepatomegaly and anemia) were studied using clinic-epidemiological, immunological and haematological parameters. Seven cases (four progressive, treated (group A) and 3 non- progressive, potentially asymptomatic and observed (group B) were identified. Clinical cases were treated with systemic sodium stibogluconate or amphotericin B and all were followed up at the leishmaniasis clinic of University of Colombo for 3 years with one case followed up for 9 years.Results:All treated cases responded well to anti leishmanial treatment. Relapses were not noticed. Clinical features subsided in all non-progressive cases and did not develop suggestive clinical features or change of laboratory parameters. Visceral leishmaniasis cases have been originated from different districts within the country. Majority had a travel history to identified local foci of cutaneous leishmaniasis.Conclusion:Visceral leishmaniasis is recognized as an emerging health threat in Sri Lanka. At least a proportion of locally identified strains ofL. donovanipossess the ability to visceralize. Apparent anti leishmanial sensitivity is encouraging.Timely efforts in disease containment will be important in which accurate understanding of transmission characteristics, increased professional and community awareness, improved diagnostics and availability of appropriate treatment regimens.