Clinical and epidemiological characteristics of cutaneous leishmaniasis in Sri Lanka
Clinical and epidemiological characteristics of cutaneous leishmaniasis in Sri Lanka
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DOI：
10.1186/s12879-018-2999-7
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发表时间：
2018-03-06
影响因子：
3.7
通讯作者：
Wijekoon, Lanka
中科院分区：
文献类型：
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作者：
Iddawela, Devika;Vithana, Sanura Malinda Pallegoda;Wijekoon, Lanka
背景资料：利什曼病是一种由原生动物利什曼原虫引起的媒介传播的热带/亚热带疾病，通过白蛉媒介Phlebotomus和Lutzomyia传播给人类。在斯里兰卡发现的主要形式是皮肤利什曼病（CL），由杜氏利什曼原虫引起。最近在斯里兰卡观察到疾病流行率上升的趋势，该岛实际上是南亚最新的地方病重点。确定临床疑似CL患者之间的涂片阳性的患病率，确定风险因素和CL的具体临床表现，以实施预防和早期治疗策略是本study.Methods的目标：509例临床疑似CL病例转介到寄生虫科从2005年和2015年之间的斯里兰卡各地连续选择。通过显微镜下观察皮肤涂片中的利什曼原虫无鞭毛体确诊。结构式问卷被用来确定暴露相关的危险因素和临床检查进行，以确定病变characteristics.Results：出509例临床病例，41.5%（n = 211）是涂阳。研究人群的年龄范围为1至80岁（平均年龄= 34.76岁），受影响最大的年龄组为40-49岁。在涂片阳性者中，58.85%为男性。大多数人（47.86%）来自该国西北部地区（库鲁内加拉），生活在灌木丛林中。白蛉暴露（p = 0.04）和阳性接触史（p = 0.005）是涂片阳性的重要风险因素。红斑（p = 0.02）、无瘙痒（p = 0.02）和鳞状外观（p = 0.003）是涂片阳性的显著病变特征。病变常被发现在暴露的地区和最常见的形态类型是丘疹结节。结论：皮肤利什曼病从流行到非流行地区的传播呈上升趋势已变得明显。阳性接触史和白蛉暴露是涂片阳性的重要危险因素，提示人类宿主可能参与了感染传播。无瘙痒、鳞屑外观和红斑是与利什曼原虫阳性涂片相关的高度显著的病变特征，可用于CL的临床诊断。
Background: Leishmaniasis, a vector borne tropical/subtropical disease caused by the protozoan Leishmania is transmitted to humans by sandfly vectors Phlebotomus and Lutzomyia. The principal form found in Sri Lanka is cutaneous leishmaniasis (CL) and is caused by Leishmania donovani. A rising trend in disease prevalence has been observed recently in Sri Lanka and the island is in fact the newest endemic focus in South Asia. Determining the prevalence of smear positivity among clinically suspected CL patients, identifying risk factors and specific clinical presentations of CL in order to implement preventive and early treatment strategies were the objectives of this study.Methods: A sample of 509 clinically suspected cases of CL referred to the Department of Parasitology from all across Sri Lanka between 2005 and 2015 was selected consecutively. Diagnosis was confirmed by microscopic visualization of the Leishmania amastigote from the slit skin smear. A structured questionnaire was used to identify exposure related risk factors and a clinical examination was performed to identify lesion characteristics.Results: Out of 509 clinical cases, 41.5% (n = 211) were smear positive. The study population ranged from ages 1 to 80 years (mean age = 34.76) and the most affected age group was 40-49. Of the smear positives, 58.85% were males. Majority (47.86%) were from the North Western region (Kurunegala) of the country and were exposed to scrub jungles. Sand fly exposure (p = 0.04) and positive contact history (p = 0.005) were significant risk factors for smear positivity. Erythema (p = 0.02), lack of pruritus (p = 0.02) and scaly appearance (p = 0.003) were significant lesion characteristics in smear positivity. Lesions were commonly found in the exposed areas and the commonest morphological type was papulo-nodular.Conclusions: An increasing trend in the spread of cutaneous leishmaniasis from endemic to non-endemic areas has become evident. Positive contact history and sandfly exposure were significant risk factors for smear positivity which may indicate the possibility of human reservoir hosts in infection transmission. Lack of pruritus, scaly appearance and erythema were highly significant lesion characteristics associated with Leishmania positive smears which can be used for the clinical diagnosis of CL.