Pedrosa Fernando de Araújo, Ximenes Ricardo Arraes de Alencar
Instituto de Ciências Biológicas e da Saúde, Universidade Federal de Alagoas, Prado, Maceió-AL, Brasil.
Am J Trop Med Hyg. 2009 Aug;81(2):195-201.
The multiplicity of factors involved in the transmission of the American cutaneous leishmaniasis (ACL) constitutes a challenge to its control. Thus, knowledge of such factors may contribute extremely toward redefining the control strategies. The aim of this study was to identify sociodemographic and environmental factors relating to ACL transmission in the State of Alagoas, Brazil. A case-control study with incident cases was conducted. Diagnostic criteria were the presence of compatible skin lesions, laboratory confirmation, and clinical cure after treatment. Two control groups were matched to cases by sex and age: one comprising neighbors and the other from a community-based draw; controls were individuals with no lesion and a negative Montenegro intradermal reaction. Between July 1, 2004 and February 1, 2007, 98 cases and the same number of controls per group were selected. In the multivariate analysis, for both control groups, ACL was associated with absence of a gas stove and forest less than 200 m away; for neighborhood controls with schooling of 4 years or less, family income greater than one minimum salary, birds inside the home, forest-related leisure activities, and rural work or school activities; and for community controls with non-durable wall material in the house, per capita income greater than US$ 28.31, animals inside the house, and absence of dogs and cats around the house. Specific control measures are recommended for areas with similar characteristics: protection for individuals undertaking forest-related leisure activities; distancing houses from forests by more than 200 m; and elimination of bird or other animal-rearing inside homes. General measures of improved housing and living conditions are also recommended.
美洲皮肤利什曼病（ACL）传播涉及多种因素，这对其防控构成了挑战。因此，了解这些因素对于重新定义防控策略可能极为有帮助。本研究的目的是确定与巴西阿拉戈斯州ACL传播相关的社会人口学和环境因素。开展了一项针对新发病例的病例对照研究。诊断标准为存在符合症状的皮肤病变、实验室确诊以及治疗后临床治愈。两组对照组按性别和年龄与病例进行匹配：一组由邻居组成，另一组通过社区抽签选取；对照组为无病变且蒙氏皮内反应阴性的个体。在2004年7月1日至2007年2月1日期间，每组选取了98例病例和相同数量的对照。在多变量分析中，对于两组对照组，ACL均与没有燃气灶具以及距离森林不到200米有关；对于邻居对照组，与受教育4年或以下、家庭收入高于一份最低工资、家中有鸟类、与森林相关的休闲活动以及农村工作或学校活动有关；对于社区对照组，与房屋墙壁材料不耐用、人均收入高于28.31美元、家中有动物以及房屋周围没有狗和猫有关。建议针对具有类似特征的地区采取特定防控措施：保护参与与森林相关休闲活动的个人；房屋与森林的距离超过200米；消除在家中饲养鸟类或其他动物的行为。还建议采取改善住房和生活条件的一般措施。
