Belli A, García D, Palacios X, Rodriguez B, Valle S, Videa E, Tinoco E, Marín F, Harris E
Infectious Diseases Unit, Division of Public Health Biology and Epidemiology, School of Public Health, University of California, Berkeley 94720-7360, USA.
Am J Trop Med Hyg. 1999 Sep;61(3):380-5. doi: 10.4269/ajtmh.1999.61.380.
Leishmania chagasi, the causative agent of visceral leishmaniasis (VL) in the Americas, has recently been associated with atypical cutaneous leishmaniasis (ACL) in Central America; however, little comprehensive information about this disease is available. Clinical, epidemiologic, and parasitologic characteristics of 252 ACL cases and 44 VL cases in Nicaragua were analyzed. Visceral leishmaniasis is primarily associated with malnourished children less than five years of age, whereas ACL is found predominantly in children greater than five years of age and young adults. Genetically similar parasites are associated with both disease manifestations. The sand fly Lutzomyia evansi, in addition to Lu. longipalpis, may be involved in transmission of L. chagasi to humans. Our results indicate that ACL is more prevalent than previously thought, affecting up to 10% of a local population. The fact that the same parasite appears to cause both ACL and the potentially fatal visceral disease suggests that the host immune response is critical in determining the outcome of L. chagasi infection. The public health implications of the wide-spread presence of L. chagasi are discussed.
恰加斯利什曼原虫是美洲内脏利什曼病（VL）的病原体，最近它被认为与中美洲的非典型皮肤利什曼病（ACL）有关；然而，关于这种疾病的全面信息却很少。对尼加拉瓜252例ACL病例和44例VL病例的临床、流行病学及寄生虫学特征进行了分析。内脏利什曼病主要与五岁以下营养不良的儿童有关，而ACL主要见于五岁以上儿童和年轻人。遗传相似的寄生虫与这两种疾病表现相关。除了长须罗蛉外，伊凡斯罗蛉可能也参与了恰加斯利什曼原虫向人类的传播。我们的结果表明，ACL比之前认为的更为普遍，影响到当地多达10%的人口。同一种寄生虫似乎既能引发ACL，又能导致潜在致命的内脏疾病，这一事实表明宿主免疫反应在决定恰加斯利什曼原虫感染的结果方面至关重要。文中讨论了恰加斯利什曼原虫广泛存在对公共卫生的影响。
