A retrospective study on demographic and clinical characteristics of cutaneous leishmaniasis suspected cases in southern Israel, 2013-2016: Comparison between confirmed and negative cases
A retrospective study on demographic and clinical characteristics of cutaneous leishmaniasis suspected cases in southern Israel, 2013-2016: Comparison between confirmed and negative cases
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DOI：
10.4103/0972-9062.263723
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发表时间：
2019-04-01
影响因子：
0.5
通讯作者：
Ben-Shimol, Shalom
中科院分区：
文献类型：
--
作者：
Bufman, Hila;Sagi, Orli;Ben-Shimol, Shalom
背景与目的：皮肤利什曼病（CL）的临床诊断有很高的误诊率。本研究评估了CL疑似发作，试图区分确诊的CL和非CL diagnosis.Methods：在这项回顾性病例对照研究中，收集了2013年至2016年期间通过Leislunania-PCR活检检测的CL疑似发作的医疗档案，并进行了统计分析。结果：在324例疑似CL发作中，48.8%为PCR证实的CL（96.2%为重型利什曼原虫），51.2%为非CL（57.1%为细菌感染）。总体而言，59.3%的发作发生在男性中。至诊断的平均（+/- SD）持续时间为3.7 +/- 7.2个月。病变（平均每次发作2.9 +/- 3.8）大部分（60.8%）从9月至2月采样。溃疡、疼痛、瘙痒、脓性分泌物和发热分别占55.2%、47%、42.9%、18.2%和4.7%。单因素分析显示，男性、多发性病变、溃疡、诊断前病程>1个月、季节性与CL相关。经验性CL治疗分别记录在63.4%和16%的CL确诊和非CL发作中（p <1个月，直至诊断。多因素分析中，季节性因素（OR = 2.144）、经验性CL治疗（OR = 5.144）和溃疡（OR = 2.459）与CL相关。经验性CL治疗与犹太种族（OR = 2.446）和诊断前病程>1个月（OR = 3.304）相关。解释与结论：CL诊断应经实验室证实，因为临床表现往往具有误导性。季节性、溃疡外观和性别可能有助于正确识别和治疗CL病例。
Background & objectives: Clinical diagnosis of cutaneous leishmaniasis (CL) may bear a high rate of false diagnosis. This study assessed CL-suspected episodes, in an attempt to differentiate confirmed CL and non-CL diagnoses.Methods: In this retrospective, case-control study, medical files of CL-suspected episodes, tested by a biopsy for Leislunania-PCR, from 2013 to 2016, were collected and analysed statistically.Results: Of 324 suspected CL episodes, 48.8% were PCR-confirmed CL (96.2% Leishmania major) and 51.2% were non-CL (57.1% bacterial infections). Overall, 59.3% episodes were in males. Mean (+/- SD) duration until diagnosis was 3.7 +/- 7.2 months. Lesions (mean 2.9 +/- 3.8 per episode) were mostly (60.8%) sampled from September through February. Ulcer, pain, itching, purulent discharge and fever were recorded in 55.2, 47, 42.9,18.2 and 4.7% of episodes, respectively. Univariate analysis showed that male gender, multiple lesions, ulcer, >1-month duration until diagnosis, and seasonality were associated with CL. Empiric CL treatment was recorded in 63.4 and 16% of CL-confirmed and non-CL episodes, respectively (p 1-month until diagnosis. In multivariate analysis, seasonality (odds ratio, OR = 2.144), empiric CL treatment (OR = 5.144) and ulcer (OR = 2.459) were associated with CL. Empiric CL treatment was associated with Jewish ethnicity (OR = 2.446) and duration of >1-month until diagnosis (OR = 3.304).Interpretation & conclusion: CL diagnosis should be laboratory confirmed, as clinical appearance is often misleading. Seasonality, ulcer appearance and gender may aid in correct identification and treatment of CL cases.