格鲁吉亚第比利斯新出现内脏利什曼病焦点的流行病学方面。
Epidemiologic aspects of an emerging focus of visceral leishmaniasis in Tbilisi, Georgia.
机构信息
National Center for Disease Control and Public Health, Tbilisi, Georgia.
出版信息
PLoS Negl Trop Dis. 2011 Dec;5(12):e1415. doi: 10.1371/journal.pntd.0001415. Epub 2011 Dec 13.
BACKGROUND
Over the last 15 years, visceral leishmaniasis (VL) has emerged as a public health concern in Tbilisi, the capital of Georgia.
METHODOLOGY/PRINCIPAL FINDINGS: Seroepidemiological surveys were conducted to determine the prevalence and incidence of infection in children and dogs within the main focus of VL, and to identify risk factors associated with human infection. Of 4,250 children investigated, 7.3% were positive by direct agglutination test in a baseline survey; an apparent incidence rate of 6.0% was estimated by one year follow-up. None of the seropositive children progressed to VL during the survey. Increased seropositivity at one year was predicted by presence at baseline of clustered flying insects (OR = 1.49; P = 0.001), perceived satisfactory sanitation (OR = 1.65; P<0.001), stray dogs (OR = 1.33; P = 0.023), and by persistent fever during the 6 months prior to baseline survey (OR = 14.2; P<0.001). Overall, 18.2% (107/588) of domestic and 15.3% (110/718) of stray dogs were seropositive by the rk39 dipstick test. Clinical VL signs were found in 1.3% of domestic and 2.9% of stray, seropositive dogs. Parasites isolated from human and dog samples were identified by PCR and phylogenetic analysis of the Leishmania 70 kDa heat-shock protein (HSP70) gene as Leishmania infantum.
CONCLUSIONS/SIGNIFICANCE: There is an active focus of L. infantum transmission in Tbilisi with a high prevalence of human and canine infections.
背景
在过去的 15 年中，内脏利什曼病（VL）已成为格鲁吉亚首都第比利斯的一个公共卫生关注点。
方法/主要发现：进行血清流行病学调查，以确定 VL 主要焦点内儿童和狗的感染流行率和发病率，并确定与人类感染相关的危险因素。在 4250 名接受调查的儿童中，基线调查中有 7.3％通过直接凝集试验呈阳性；通过一年随访估计，其显性感染率为 6.0％。在调查过程中，没有一个血清阳性儿童发展为 VL。在一年时，增加的血清阳性预测因子为基线时存在成群的飞虫（OR=1.49；P=0.001），感知到令人满意的卫生条件（OR=1.65；P<0.001），流浪狗（OR=1.33；P=0.023），以及在基线调查前 6 个月持续发热（OR=14.2；P<0.001）。总体而言，18.2％（107/588）的家养狗和 15.3％（110/718）的流浪狗通过 rk39 试纸检测呈血清阳性。在患有 VL 临床症状的家养狗和流浪狗中，血清阳性率分别为 1.3％和 2.9％。从人和狗样本中分离出的寄生虫通过 PCR 和 70 kDa 热休克蛋白（HSP70）基因的系统发育分析鉴定为婴儿利什曼原虫。
结论/意义：第比利斯存在婴儿利什曼原虫传播的活跃焦点，人与犬的感染率都很高。
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