Lawn S D, Whetham J, Chiodini P L, Kanagalingam J, Watson J, Behrens R H, Lockwood D N J
Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT.
QJM. 2004 Dec;97(12):781-8. doi: 10.1093/qjmed/hch127.
Mucosal leishmaniasis (ML) is an important complication of new world cutaneous leishmaniasis (CL) caused by species of the Leishmania Viannia subgenus. Previous reports of ML among travellers to Latin America are few.
To determine the annual number of cases of CL due to L. Viannia species diagnosed at this institution and to correlate this with changing patterns of travel. Secondly, to document the clinical presentation, diagnosis, treatment and outcome of ML at this institution.
Retrospective observational study.
Data were collected from a clinical database, laboratory records, patient case notes and an international passenger survey.
Between 1995 and 2003, the annual number of cases of CL (total 79) steadily increased from 4 per year to 18 per year; the estimated number of travellers from the UK to Latin America increased 3.5-fold. Six cases of ML were diagnosed among British travellers in 1995 (1), 1997 (1) and 2002 (4). These infections were acquired in Bolivia (3), Colombia (2) and Belize (1). Nasopharyngeal symptoms developed 0-15 months after returning to the UK. Four patients had concurrent CL at diagnosis. Diagnosis of ML was delayed up to 6 months from the onset of symptoms. Mucosal biopsies from all 6 patients were PCR-positive for L. (Viannia) DNA; microscopy and culture were less sensitive. ML relapsed in one patient following treatment.
Increasing travel to Latin America from the UK was associated with an increasing number of diagnoses of L. Viannia CL. ML is likely to emerge as a more frequently imported infection among such travellers. Familiarity with these diseases is important for prompt diagnosis and optimal management.
黏膜利什曼病（ML）是由维安亚利什曼原虫亚属的物种引起的新大陆皮肤利什曼病（CL）的一种重要并发症。此前关于前往拉丁美洲的旅行者中ML的报道很少。
确定该机构诊断出的由维安亚利什曼原虫物种引起的CL的年病例数，并将其与旅行模式的变化相关联。其次，记录该机构ML的临床表现、诊断、治疗及结果。
回顾性观察研究。
从临床数据库、实验室记录、患者病历及国际乘客调查中收集数据。
1995年至2003年期间，CL的年病例数（共79例）从每年4例稳步增加至每年18例；从英国前往拉丁美洲的旅行者估计人数增加了3.5倍。1995年（1例）、1997年（1例）和2002年（4例）在英国旅行者中诊断出6例ML。这些感染分别发生在玻利维亚（3例）、哥伦比亚（2例）和伯利兹（1例）。回国后0至15个月出现鼻咽部症状。4例患者在诊断时同时患有CL。ML的诊断从症状出现起延迟了长达6个月。所有6例患者的黏膜活检经聚合酶链反应检测利什曼原虫（维安亚）DNA呈阳性；显微镜检查和培养的敏感性较低。1例患者治疗后ML复发。
从英国前往拉丁美洲旅行人数的增加与维安亚利什曼原虫CL诊断病例数的增加相关联。ML很可能会成为这类旅行者中更常见的输入性感染。熟悉这些疾病对于及时诊断和优化管理很重要。
