Traoré K S, Sawadogo N O, Traoré A, Ouedraogo J B, Traoré K L, Guiguemdé T R
Centre Muraz, 01 BP 153, Bobo-Dioulasso 01, Burkina Faso.
Bull Soc Pathol Exot. 2001 Mar;94(1):52-5.
Since 1996, there have been reports of cases of cutaneous leishmaniasis in the town of Ouagadougou. The incidence has been on the rise but precise figures are not known. The object of the present study has been, first, to record cases of cutaneous leishmaniasis having occurred in private and public health centres in Ouagadougou from 1996 to 1998 and, second, to determine the progression of the disease in space and time. We wished also to confirm clinical cases in 1998 by parasitological examination, identify different clinical forms of the disease and map out cases in the town. We carried out a retrospective study from 1996 to 1998 and a prospective study in 1998. All cases recorded in this period in visited health centres were included. A total of 1845 cases of cutaneous leishmaniasis was identified, 50.3% of whom concerned women. The age of patients varied between 1 and 79 years for 356 patients, with a mean age of 26.7 years. Cases increased between 1996 and 1998 (1996 = 61 cases, 1997 = 552 cases, 1998 = 1218 cases). The months of highest incidence were August (13%), September (15%) and October (17%). Peripheral districts (28, 30, 29, 16, 15) in south-eastern areas of the town were the worst touched with 87% of cases. On average, patients seek care after 2 months of progression of the disease. The ulcero-crusted form (68.2%) was the most frequent clinical form observed for 327 patients, but almost half of the cases had more than one site of infection, (43.5%). Over half of the patients presented fewer than 10 lesions with an average of 6. The most common locations were on uncovered parts of the body, notably the superior (53%) and inferior limbs (49%). The parasite could be tested for by smear on 52 patients only in 1998 and 53.8% of cases tested were positive. Leishmania major, which is very prevalent in West Africa was identified in one patient. The vectors and main reservoirs of the parasite were not studied. Case management was generally incomplete; the most commonly prescribed drugs were antibiotics (70% of patients), but self-medication was frequent. Our recommendations after this preliminary study are: undertake multidisciplinary studies on cutaneous leishmaniasis in Ouagadougou in order to understand the local aetiology (vectors responsible for transmission, rodent and domestic animals involved in the epidemiological chain, parasite species); identify all other areas in the country where the disease is highly prevalent provide health care staff with a decisional algorithm and protocol therapy carry out and active control programme for cutaneous leishmaniasis in Burkina Faso.
自1996年以来,瓦加杜古市陆续有皮肤利什曼病病例的报告。发病率呈上升趋势,但确切数字尚不清楚。本研究的目的,其一,是记录1996年至1998年期间在瓦加杜古市私立和公立卫生中心发生的皮肤利什曼病病例;其二,是确定该疾病在空间和时间上的发展情况。我们还希望通过寄生虫学检查来确诊1998年的临床病例,识别该疾病的不同临床形式,并在该市绘制病例分布图。我们开展了一项1996年至1998年的回顾性研究以及1998年的前瞻性研究。纳入了在此期间到访卫生中心记录的所有病例。共确诊1845例皮肤利什曼病病例,其中50.3%为女性。356名患者的年龄在1岁至79岁之间,平均年龄为26.7岁。1996年至1998年病例数有所增加(1996年 = 61例,1997年 = 552例,1998年 = 1218例)。发病率最高的月份是8月(13%)、9月(15%)和10月(17%)。该市东南部的周边地区(28、30、29、16、15)受影响最严重,病例占87%。平均而言,患者在疾病发展2个月后才寻求治疗。溃疡结痂型(68.2%)是327名患者中最常见的临床类型,但几乎一半的病例有一个以上感染部位(43.5%)。超过一半的患者皮损少于10处,平均为6处。最常见的部位是身体暴露部位,尤其是上肢(53%)和下肢(49%)。1998年仅有52名患者可通过涂片检测寄生虫,检测病例中53.8%呈阳性。在一名患者中鉴定出在西非非常普遍的硕大利什曼原虫。未对该寄生虫的传播媒介和主要宿主进行研究。病例管理普遍不完整;最常开具的药物是抗生素(70%的患者),但自我用药很常见。经过这项初步研究后,我们的建议是:在瓦加杜古市开展关于皮肤利什曼病的多学科研究,以了解当地病因(负责传播的媒介、参与流行病学链的啮齿动物和家畜、寄生虫种类);识别该国其他所有疾病高度流行的地区;为医护人员提供决策算法和治疗方案;在布基纳法索开展皮肤利什曼病的积极防控项目。
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