Visceral Leishmaniasis Relapse in Southern Sudan (1999-2007): A Retrospective Study of Risk Factors and Trends
Visceral Leishmaniasis Relapse in Southern Sudan (1999-2007): A Retrospective Study of Risk Factors and Trends
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DOI：
10.1371/journal.pntd.0000705
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发表时间：
2010-06-01
影响因子：
3.8
通讯作者：
Davidson, Robert N.
中科院分区：
文献类型：
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作者：
Gorski, Stanislaw;Collin, Simon M.;Davidson, Robert N.
背景：与L. donovani内脏利什曼病（VL黑热病）复发的特点很差。方法：我们调查了患者的特点和药物治疗方案与VL复发无国界医生组织，荷兰（无国界医生组织）在苏丹南部的治疗中心的数据。我们使用无国界医生的手术数据，调查VL复发的趋势和相关的风险factors.Results：我们获得了1999年至2007年期间治疗的8,800名原发性VL和621名复发性VL患者的数据。166例VL复发患者（26.7%）的既往治疗记录与7，924例无后续复发记录的原发性VL患者进行了比较。复发的原发性VL患者在入院时（Hackett分级>= 3 vs 0，复发的比值比（OR）= 3.62（95% CI 1.08，12.12））和出院时（Hackett分级>= 3 vs 0，OR = 5.50（1.84，16.49））脾脏较大。年龄、性别、营养不良、活动能力和治疗并发症与复发风险无关，也没有随时间变化的趋势。17天葡萄糖酸锑钠/巴龙霉素（SSG/PM）联合治疗与30天SSG单药治疗相比，复发风险增加（OR = 2.08（1.21，3.58）），但死亡风险降低（OR = 0.27（0.20，0.37）），尽管这些估计可能存在残余混淆。无国界医生组织的运营数据显示，VL复发患者比例呈粗略上升趋势（年百分比变化（APC）= 11.4%（-3.4%，28.5%）），死亡率呈下降趋势（APC = -18.1%（-22.5%，-13.4%））。结论：脾肿大和17天SSG/PM与30天SSG与VL复发风险增加有关。苏丹南部VL复发的粗略上升趋势可能归因于SSG/PM联合治疗改善了治疗途径和降低了死亡率。
Background: Risk factors associated with L. donovani visceral leishmaniasis (VL; kala azar) relapse are poorly characterized.Methods: We investigated patient characteristics and drug regimens associated with VL relapse using data from Medecins Sans Frontieres-Holland (MSF) treatment centres in Southern Sudan. We used MSF operational data to investigate trends in VL relapse and associated risk factors.Results: We obtained data for 8,800 primary VL and 621 relapse VL patients treated between 1999 and 2007. Records of previous treatment for 166 VL relapse patients (26.7%) were compared with 7,924 primary VL patients who had no record of subsequent relapse. Primary VL patients who relapsed had larger spleens on admission (Hackett grade >= 3 vs0, odds ratio (OR) for relapse = 3.62 (95% CI 1.08, 12.12)) and on discharge (Hackett grade >= 3 vs 0, OR = 5.50 (1.84, 16.49)). Age, sex, malnutrition, mobility, and complications of treatment were not associated with risk of relapse, nor was there any trend over time. Treatment with 17-day sodium stibogluconate/paromomycin (SSG/PM) combination therapy vs 30-day SSG monotherapy was associated with increased risk of relapse (OR = 2.08 (1.21, 3.58)) but reduced risk of death (OR = 0.27 (0.20, 0.37)), although these estimates are likely to be residually confounded. MSF operational data showed a crude upward trend in the proportion of VL relapse patients (annual percentage change (APC) = 11.4% (-3.4%, 28.5%)) and a downward trend in deaths (APC = -18.1% (-22.5%, -13.4%)).Conclusions: Splenomegaly and 17-day SSG/PM vs 30-day SSG were associated with increased risk of VL relapse. The crude upward trend in VL relapses in Southern Sudan may be attributable to improved access to treatment and reduced mortality due to SSG/PM combination therapy.