A KILLING DISEASE EPIDEMIC AMONG DISPLACED SUDANESE POPULATION IDENTIFIED AS VISCERAL LEISHMANIASIS
A KILLING DISEASE EPIDEMIC AMONG DISPLACED SUDANESE POPULATION IDENTIFIED AS VISCERAL LEISHMANIASIS
复制标题
DOI：
10.4269/ajtmh.1991.44.283
复制
发表时间：
1991-03-01
影响因子：
3.3
通讯作者：
VANGROOTHEEST, M
中科院分区：
文献类型：
--
作者：
DEBEER, P;ELHARITH, A;VANGROOTHEEST, M
一场致命的流行病影响了苏丹南部的本提乌地区，导致努尔部落大规模迁移，寻求治疗。最初获得的资料显示，由于可能发生肺结核、疟疾、肠热病或内脏利什曼病，死亡率很高。在酶联免疫吸附试验（ELISA）或改进的直接凝集试验（DAT）中，对53名最严重受影响的患者进行血清学筛查，结果显示VL阳性。其中39例患者通过淋巴结或骨髓穿刺液中杜氏利什曼原虫无鞭毛体的鉴定确诊。在总共观察的2714例患者中，1195例（44.0%）有临床症状，提示VL：DAT阳性滴度（1：3200-大于或等于1：12800），其中654例（24.1%），其中325例经寄生虫学证实。42例VL患者在治疗前或治疗期间死亡，死亡率为6.4%。在VL人群（654例）中诊断的并发感染中，呼吸系统受累（31.7%）和疟疾（10.7%）最常见。除4例（0.6%）外，所有其他VL患者（509例）均对葡萄糖酸锑钠反应良好。并对引发暴发的因素进行了讨论。营养不良和游牧运动到潜在的VL流行区似乎是最重要的。考虑到在东非发生的VL的临床和流行病学相似性、DAT中的充分体液应答以及对特异性抗利什曼原虫化疗的立即阳性应答，HIV感染作为可能的易感性似乎很遥远。
A fatal disease epidemic affected the Bentiu area in southern Sudan and led to a mass migration of the Nuer tribe searching for treatment. The initially available information revealed a high mortality rate due to a possible occurrence of tuberculosis, malaria, enteric fever or visceral leishmaniasis (VL). Serological screening of 53 of the most severely affected patients in an enzyme-linked immunosorbent assay (ELISA) or an improved direct agglutination test (DAT) revealed positivity for VL. In 39 of those patients, diagnosis was confirmed by identification of Leishmania donovani amastigotes in lymph node or bone-marrow aspirates. In a total of 2714 patients observed, 1195 (44.0%) had clinical symptoms suggesting VL: DAT positive titers (1:3200-greater-than-or-equal-to 1:12800) were obtained in 654 (24.1%), of whom 325 were confirmed parasitologically. Forty-two VL cases died before or during treatment, giving a mortality rate of 6.4%. Among the intercurrent infections diagnosed in the VL population (654), respiratory involvements (31.7%) and malaria (10.7%) were most prevalent. With the exception of four (0.6%), all other VL patients (509) responded readily to sodium stibogluconate. The factors initiating the outbreak are discussed. Malnutrition and nomadic movements to potential VL endemic areas appeared to be the most important. HIV infection as a possible predisposition seemed remote considering the clinical and epidemiological similarity to VL occurring in East Africa, adequate humoral response in DAT, and immediate positive response to specific anti-Leishmania chemotherapy.