美洲皮肤利什曼病的口腔表现
Oral manifestations in the American tegumentary leishmaniasis.
作者信息
da Costa Daniel Cesar Silva, Palmeiro Mariana Reuter, Moreira João Soares, Martins Ana Cristina da Costa, da Silva Aline Fagundes, Madeira Maria de Fátima, Quintella Leonardo Pereira, Confort Eliame Mouta, Schubach Armando de Oliveira, Silva Fátima da Conceição, Valete-Rosalino Cláudia Maria
机构信息
Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro-RJ, Brazil.
Laboratory of Immunoparasitology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro-RJ, Brazil.
出版信息
PLoS One. 2014 Nov 11;9(11):e109790. doi: 10.1371/journal.pone.0109790. eCollection 2014.
INTRODUCTION
American tegumentary leishmaniasis (ATL) can affect the skin or mucosa (mucocutaneous leishmaniasis - MCL) including the oral cavity. MCL oral lesions are often confused with other oral diseases, delaying diagnosis and specific treatment, and increasing the likelihood of sequelae. Thus, increasing the knowledge of the evolution of ATL oral lesions can facilitate its early diagnosis improving the prognosis of healing.
OBJECTIVES
Evaluate the frequency of ATL oral lesion and describe its clinical, laboratory and therapeutic peculiarities.
METHODS
A descriptive transversal study was carried out, using data from medical records of 206 patients with MCL examined at the outpatient clinics-IPEC-Fiocruz between 1989 and 2013. Proportions were calculated for the categorical variables and the association among them was assessed by the Pearson's chi-square test. Measures of central tendency and dispersion were used for the continuous variables and their differences were assessed by both parametric (t test) and non parametric (Mann-Whitney) tests. P-values <0.05 were considered as significant.
RESULTS
The most affected site was the nose, followed by the mouth, pharynx and larynx. Seventy eight (37.9%) have oral lesions and the disease presented a lower median of the evolution time than in other mucous sites as well as an increased time to heal. The presence of oral lesion was associated with: the presence of lesions in the other three mucosal sites; a smaller median of the leishmanin skin test values; a longer healing time of the mucosal lesions; a higher recurrence frequency; and a smaller frequency of treatment finishing and healing. When the oral lesion was isolated, it was associated with an age 20 years lower than when the oral lesion was associated with other mucosal sites.
CONCLUSION
Considering the worst therapy results associated with the presence of oral lesions, we suggest that lesions in this location represent a factor of worse prognosis for MCL.
引言
美洲皮肤利什曼病（ATL）可累及皮肤或黏膜（黏膜皮肤利什曼病 - MCL），包括口腔。MCL口腔病变常与其他口腔疾病混淆，延误诊断和特异性治疗，增加后遗症发生的可能性。因此，增加对ATL口腔病变演变的认识有助于早期诊断，改善愈合预后。
目的
评估ATL口腔病变的发生率，并描述其临床、实验室及治疗特点。
方法
开展一项描述性横断面研究，使用1989年至2013年间在Fiocruz - IPEC门诊接受检查的206例MCL患者的病历数据。计算分类变量的比例，并通过Pearson卡方检验评估它们之间的关联。对连续变量使用集中趋势和离散度测量方法，并通过参数检验（t检验）和非参数检验（Mann - Whitney检验）评估其差异。P值<0.05被视为具有统计学意义。
结果
最常受累部位是鼻子，其次是口腔、咽和喉。78例（37.9%）有口腔病变，该疾病的病程中位数低于其他黏膜部位，愈合时间延长。口腔病变的存在与以下因素相关：其他三个黏膜部位存在病变；利什曼原虫皮肤试验值中位数较小；黏膜病变愈合时间较长；复发频率较高；治疗完成和愈合频率较低。当口腔病变孤立存在时，与口腔病变与其他黏膜部位同时存在相比，患者年龄低20岁。
结论
考虑到与口腔病变相关的治疗效果较差，我们认为该部位的病变是MCL预后较差的一个因素。
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