Doğan Nihal, Bör Ozcan, Dinleyici Ener Cağri, Töz Seray Ozensoy, Ozbel Yusuf
Osmangazi Universitesi Tip Fakültesi, Mikrobiyoloji Anabilim Dali, Eskişehir.
Mikrobiyol Bul. 2008 Jan;42(1):103-11.
Human visceral leishmaniasis (VL) caused by Leishmania infantum in Mediterranean region is still an important public health problem in those countries including Turkey. The asymptomatic presentation of the infection in most of the cases leads to difficulties in the diagnosis and prevention of the spread of infection. The aim of this study was to investigate the seroprevalence of anti-Leishmania antibodies in children inhabiting in the northwestern part of Turkey. A total of 572 healthy children (260 girls, 312 boys) aged between 1-17 years old (mean age: 8.1 years) inhabiting in Eskisehir, Bilecik, Kutahya and Afyon provinces and their counties were included to the study with the informed consent obtained from their families. All serum samples were screened by a commercial ELISA (Leishmania Ab Panel, Cypress Diagnostics, Belgium), two in-house ELISA (with whole antigens and rK39 antigen) tests and an in-house indirect fluorescent antibody test (IFAT). The sera yielding a positive result by commercial ELISA, have been re-evaluated with rK39 dipstick test. Of 572 children, 5.2% (n = 30) were found positive with commercial ELISA, 3.8% (n = 22) with IFAT, 4.7% (n = 27) with in-house whole ELISA, and 3.6% (n = 21) with in-house rK39 ELISA. Of 30 commercial ELISA positive sera, 19 (63.3%) gave positive result also by dipstick test. This difference was attributed to the use of multiple antigens belonging to different Leishmania species in commercial ELISA test. The number of children who were seropositive with all of the tests were 15 (2.6%) and with at least three of the tests were 24 (4.2%). Most (76.7%) of the 30 seropositive children with commercial ELISA were found to be inhabiting in Iscehisar town of Afyon province (n = 16) and Sogut town of Bilecik province (n = 7) where canine VL was also endemic. Our results also indicated that 93.3% (28/30) of seropositive children were living in the rural parts of the study region. Thirty seropositive children were followed-up for one year, but none of them have exhibited clinical findings of VL. As a result, the rate of anti-Leishmania seropositivity (5.2% with at least one test, and 4.2% with at least three tests) in healthy children in the study area should not be ignored, and prevention strategies should be undertaken since our previous study have also showed that the rate of VL in dogs was high and the vector Phlebotomus species were determined in these areas of Turkey.
由婴儿利什曼原虫引起的人类内脏利什曼病（VL）在地中海地区仍然是包括土耳其在内的那些国家的一个重要公共卫生问题。在大多数病例中，感染的无症状表现导致诊断困难和预防感染传播存在困难。本研究的目的是调查居住在土耳其西北部的儿童中抗利什曼原虫抗体的血清流行率。共有572名年龄在1至17岁（平均年龄：8.1岁）的健康儿童（260名女孩，312名男孩）居住在埃斯基谢希尔、比莱吉克、屈塔希亚和阿菲永省及其县，在获得其家人知情同意后被纳入研究。所有血清样本均通过商业酶联免疫吸附测定法（Leishmania Ab Panel，Cypress Diagnostics，比利时）、两种内部酶联免疫吸附测定法（使用全抗原和rK39抗原）测试以及一种内部间接荧光抗体测试（IFAT）进行筛查。通过商业酶联免疫吸附测定法得出阳性结果的血清，已用rK39试纸条测试重新评估。在572名儿童中，商业酶联免疫吸附测定法检测出5.2%（n = 30）呈阳性，IFAT检测出3.8%（n = 22）呈阳性，内部全酶联免疫吸附测定法检测出4.7%（n = 27）呈阳性，内部rK39酶联免疫吸附测定法检测出3.6%（n = 21）呈阳性。在30份商业酶联免疫吸附测定法阳性血清中，19份（63.3%）通过试纸条测试也得出阳性结果。这种差异归因于商业酶联免疫吸附测定法中使用了属于不同利什曼原虫物种的多种抗原。所有测试均呈血清阳性的儿童有15名（2.6%），至少三项测试呈阳性的儿童有24名（4.2%）。在30名商业酶联免疫吸附测定法血清阳性儿童中，大多数（76.7%）被发现居住在阿菲永省的伊斯切希萨尔镇（n = 16）和比莱吉克省的索古特镇（n = 7），犬内脏利什曼病在这些地方也是地方病。我们的结果还表明，93.3%（28/30）的血清阳性儿童生活在研究区域的农村地区。对30名血清阳性儿童进行了一年的随访，但他们中没有一人表现出内脏利什曼病的临床症状。结果，研究区域健康儿童中抗利什曼原虫血清阳性率（至少一项测试为5.2%，至少三项测试为4.2%）不容忽视，并且应该采取预防策略，因为我们之前的研究也表明土耳其这些地区犬内脏利什曼病的发病率很高，并且已确定存在白蛉属传播媒介。
