Padovese Valeska, Terranova Margherita, Toma Luigi, Barnabas Gebre Ab, Morrone Aldo
International Institute for Social, Medical and Anthropological Sciences (IISMAS), Rome, Italy.
Trans R Soc Trop Med Hyg. 2009 Jul;103(7):707-11. doi: 10.1016/j.trstmh.2009.02.023. Epub 2009 Apr 7.
Leishmaniasis is a worldwide disease, but due to the absence of surveillance systems is under-reported from low- and middle-income countries. In Ethiopia, the disease is found in the rural highlands and the incidence of Leishmania/HIV co-infection is increasing. Although some studies have been carried out in areas of the country with a similar disease/ecological profile this report is, to our knowledge, the first aimed at elucidating the clinical-epidemiological features of cutaneous and mucocutaneous leishmaniasis in Tigray, northern Ethiopia. This study enrolled 167 patients presenting different forms of cutaneous leishmaniasis over an 18 month period, of which 5.6% tested HIV positive. Patients were initially treated with meglumine antimonate and resistant cases with pentamidine isethionate. There was a high rate of resistance to meglumine antimonate (28%) and a less than optimal response to prolonged systemic treatment in relapsed cases. Eight patients affected by severe and resistant forms were treated with pentamidine isethionate, with a cure rate of 87.5% after 6 months. Many atypical and severe presentations were seen, and a poor response to first-line antileishmanial drugs was observed. Resistance to antimonials is of concern and cost-effective therapeutic schemes need to be developed. The cost-effectiveness of pentamidine isethionate has to be determined in a larger population.
利什曼病是一种全球性疾病，但由于缺乏监测系统，低收入和中等收入国家的病例报告不足。在埃塞俄比亚，该病见于农村高地，利什曼原虫/艾滋病毒合并感染的发病率正在上升。尽管该国一些具有相似疾病/生态特征的地区已开展了一些研究，但据我们所知，本报告是第一份旨在阐明埃塞俄比亚北部提格雷地区皮肤利什曼病和黏膜皮肤利什曼病临床流行病学特征的报告。本研究在18个月期间招募了167例表现出不同形式皮肤利什曼病的患者，其中5.6%检测出艾滋病毒呈阳性。患者最初接受葡甲胺锑酸盐治疗，耐药病例则使用乙磺半胱氨酸戊烷脒治疗。对葡甲胺锑酸盐的耐药率很高（28%），复发病例对延长的全身治疗反应欠佳。8例患有严重耐药型疾病的患者接受了乙磺半胱氨酸戊烷脒治疗，6个月后的治愈率为87.5%。观察到许多非典型和严重的表现，并且对一线抗利什曼病药物反应不佳。对锑剂的耐药性令人担忧，需要制定具有成本效益的治疗方案。必须在更大规模人群中确定乙磺半胱氨酸戊烷脒的成本效益。
