Findings of a community screening programme for human cystic echinococcosis in a non-endemic area.
Findings of a community screening programme for human cystic echinococcosis in a non-endemic area.
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DOI：
10.1371/journal.pgph.0000235
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发表时间：
2022
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囊性包虫病 (CE) 是一种人畜共患病，由细粒棘球绦虫复合体绦虫幼虫阶段感染引起。它在东非的游牧社区中很流行，包括居住在肯尼亚北部的社区。牲畜从这些高发病率地区转移到低发病率地区造成了疾病蔓延给人类的间接风险。为了评估已知流行区域之外CE生命周期的可能建立，我们使用便携式超声波扫描仪在肯尼亚西部的邦戈马县筛查人类CE的存在，该地区从邻近的牧区进口大量牛用于屠宰。根据距离处理从牧区引进的动物的屠宰场的距离，有目的地选择了八个哨点，并寻求进行研究的必要许可。进行回归分析以确定与腹部和囊性病变（CL）存在相关的危险因素。总共筛选了 1002 名参与者；其中，654 名（65.3%）为女性，中位年龄为 43 岁。农业（n = 403；43.4%）是最常见的职业，其次是专业（即固定工资）（n = 215；23.1%）和商业（n = 207；22.3%）类别。根据 WHO 分类，67 名参与者 (6.7%) 的超声检查结果异常，其中 7 名 (1.1%) 患有单纯性肝囊肿/CL。因此，他们的结果尚无定论，他们没有接受治疗，但建议他们到转诊医疗机构参加后续调查。其他异常发现包括脾肿大（n = 14）、卵巢囊肿（n = 14）、子宫肌瘤（n = 10）、多囊肾（n = 6）和良性前列腺增生（n = 6）。年龄与推定 CL 的存在无条件相关。这些结果有助于 CE 基线数据，同时提供有关在现场实施超声诊断的见解，正如世界卫生组织建议的到 2030 年有针对性地控制包虫病。
Cystic Echinococcosis (CE) is a zoonosis caused by infection with the larval stages of the taeniid cestodes of the species complex Echinococcus granulosus sensu lato. It is prevalent among transhumant communities in East Africa, including those residing in northern Kenya. The movement of livestock from these regions of high incidence to areas of low incidence creates an indirect risk of disease spill-over to humans. To assess possible establishment of the CE life cycle outside known endemic regions, we used a portable ultrasound scanner to screen for the presence of human CE in Bungoma County of western Kenya, an area which imports substantial numbers of cattle for slaughter from neighbouring pastoralist regions. Eight sentinel sites were purposively selected based on their proximity to slaughterhouses handling animals introduced from pastoralist regions, and necessary permissions to conduct the study were sought. Regression analyses were conducted to identify risk factors associated with the presence of abdominal and cystic lesions (CL). In total, 1002 participants were screened; of these, 654 (65.3%) were female and the median age was 43. Farming (n = 403; 43.4%) was the most frequent occupation, followed by professional (i.e. on regular salary) (n = 215; 23.1%), and business (n = 207; 22.3%) categories. Sixty-seven participants (6.7%) had abnormal ultrasound findings, of these, 7 (1.1%) had simple liver cysts/CL, as per WHO classification. As such, their outcome was inconclusive and they were not put on treatment but advised to attend follow-up investigations in a referral health facility. Other abnormal findings included splenomegaly (n = 14), ovarian cysts (n = 14), uterine fibroids (n = 10), polycystic kidneys (n = 6), and benign prostatic hyperplasia (n = 6). Age was unconditionally associated with the presence of presumptive CL. These results contribute to CE baseline data while providing insights on the implementation of ultrasound diagnosis in the field, as recommended by the WHO for targeted control of echinococcosis by 2030.