Bamorovat Mehdi, Sharifi Iraj, Aflatoonian Mohammad Reza, Sharifi Hamid, Karamoozian Ali, Sharifi Fatemeh, Khosravi Ahmad, Hassanzadeh Saeid
Leishmaniasis Research Center, Kerman University of Medical Sciences, Kerman, Iran.
Research Center of Tropical and Infectious Diseases, Kerman University of Medical Sciences, Kerman, Iran.
PLoS One. 2018 Feb 7;13(2):e0192236. doi: 10.1371/journal.pone.0192236. eCollection 2018.
Cutaneous leishmaniasis (CL) is a serious health challenge at the global level due to Leishmania tropica. This study was conducted to evaluate the risk factors associated with anthroponotic CL (ACL) in unresponsive (patient who does not heal and remains with an active lesion, despite receiving two courses of intra-lesional Glucantime along with cryotherapy and one cycle of systemic Glucantime) and responsive patients in a major focus in southeastern Iran. A case-control study was conducted from April 2015 to October 2016 in the southeast of Iran. Patients were recruited in a major ACL focus from unresponsive and responsive cases. These patients were compared for environmental, clinical, and demographic characteristic factors. Twenty-five risk related factors were analyzed using multivariate logistic regression and backward elimination stepwise models. P<0.05 was defined to be statistically significant. In general, 340 patients with ACL comprising 72 (21.2%) unresponsive cases and 268 (78.8%) responsive cases with active lesions or scars were analyzed by estimating odds ratio (OR). All isolates from 15 responsive and 15 unresponsive patients were characterized as Leishmania tropica based on the BLAST and phylogenic analyses by PCR sequences of the Hsp70 and ITS1 loci. Among the 25 variables, 4 major risk factors including poor interior housing conditions (OR = 1.99, confidence interval (CI) = 1-3.93, P<0.04), history of chronic diseases (OR = 6.22, CI = 2.51-15.44, P≤0.001), duration of lesion in the patients referred ≥13 months (OR = 74.99, CI = 17.24-326.17, P≤0.001), and 5-12 months (OR = 7.42, CI = 3.07-17.92, P≤0.001) than lesions with ≤4 months of age and age groups ≥51 years (OR = 3.85, CI = 1.04-14.22, P<0.04) than those ≤7 years, were significantly associated with unresponsive forms. Improving interior house construction protecting high risk individuals and those with debilitating diseases from being bitten by sand flies, together with the early detection and effective treatment of older age groups with history of chronic diseases are highly important measures for preventing unresponsive forms in patients with ACL in southeastern Iran.
由于热带利什曼原虫，皮肤利什曼病（CL）在全球范围内都是一项严峻的健康挑战。本研究旨在评估伊朗东南部一个主要疫源地中，无反应型（尽管接受了两疗程病灶内注射葡糖胺聚糖并结合冷冻疗法以及一疗程全身性葡糖胺聚糖治疗，但仍未愈合且有活动性病灶的患者）和有反应型皮肤利什曼病（ACL）患者的相关危险因素。2015年4月至2016年10月在伊朗东南部开展了一项病例对照研究。从无反应型和有反应型病例中招募主要ACL疫源地的患者。对这些患者的环境、临床和人口统计学特征因素进行比较。使用多变量逻辑回归和向后逐步排除模型分析25个风险相关因素。P<0.05被定义为具有统计学意义。总体而言，通过估计比值比（OR）分析了340例ACL患者，其中包括72例（21.2%）无反应型病例和268例（78.8%）有活动性病灶或疤痕的有反应型病例。根据Hsp70和ITS1基因座的PCR序列，通过BLAST和系统发育分析，将15例有反应型和15例无反应型患者的所有分离株鉴定为热带利什曼原虫。在这25个变量中，4个主要危险因素与无反应型显著相关，包括室内居住条件差（OR = 1.99，置信区间（CI） = 1 - 3.93，P<0.04）、慢性病病史（OR = 6.22，CI = 2.51 - 15.44，P≤0.001）、转诊患者病灶持续时间≥13个月（OR = 74.99，CI = 17.24 - 326.17，P≤0.001）以及5 - 12个月（OR = 7.42，CI = 3.07 - 17.92，P≤0.001）相比于≤4个月龄的病灶，年龄组≥51岁（OR = 3.85，CI = 1.04 - 14.22，P<0.04）相比于≤7岁的患者。改善室内房屋建设、保护高危个体和患有衰弱性疾病的人不被白蛉叮咬，以及对有慢性病病史的老年群体进行早期检测和有效治疗，是预防伊朗东南部ACL患者出现无反应型的非常重要的措施。
