Martínez Dalila Y, Llanos-Cuentas Alejandro, Dujardin Jean-Claude, Polman Katja, Adaui Vanessa, Boelaert Marleen, Verdonck Kristien
Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru.
Departamento de Enfermedades Infecciosas, Tropicales y Dermatológicas, Hospital Cayetano Heredia, Lima, Peru.
Open Forum Infect Dis. 2020 May 12;7(5):ofaa155. doi: 10.1093/ofid/ofaa155. eCollection 2020 May.
Endemic regions of cutaneous leishmaniasis (CL) and intestinal helminthiasis overlap. CL treatment with systemic pentavalent antimonial drugs (Sb) fails in 10%-30% of patients. The study objective was to assess the etiological role of intestinal helminthiasis in CL treatment failure.
An unmatched case-control study was done in 4 CL treatment sites in Peru in 2012-2015. Cases were CL patients with Sb treatment failure; controls were CL patients with Sb treatment success. Patients with a parasitologically confirmed CL diagnosis who had received supervised Sb treatment and could be classified as cases or controls were eligible. The main exposure variables were intestinal helminthiasis and strongyloidiasis, diagnosed through direct examination, rapid sedimentation, Baermann, Kato-Katz, or agar culture of stool samples. Additional exposure variables were other infections (HIV, human T-lymphotropic virus 1, tuberculosis, hepatitis B, intestinal protozoa) and noninfectious conditions (diabetes, renal insufficiency, and immunosuppressive medication). Age, gender, CL history, probable exposure place, and species were treated as potential confounders in multiple logistic regression.
There were 94 case and 122 control subjects. Overall, infectious and noninfectious comorbidities were frequent both among cases (64%) and controls (71%). The adjusted odds ratio (OR) for the association between any intestinal helminth infection and CL treatment failure was 0.65 (95% confidence interval [CI], 0.30-1.38), and the adjusted OR for the association between strongyloidiasis and CL treatment failure was 0.34 (95% CI, 0.11-0.92).
In the Peruvian setting, high Sb treatment failure rates are not explained by intestinal helminthiasis. On the contrary, strongyloidiasis had a protective effect against treatment failure.
皮肤利什曼病（CL）和肠道蠕虫病的流行区域重叠。使用全身五价锑剂（Sb）治疗CL时，10%-30%的患者治疗失败。本研究的目的是评估肠道蠕虫病在CL治疗失败中的病因学作用。
2012年至2015年在秘鲁的4个CL治疗地点进行了一项非匹配病例对照研究。病例为接受Sb治疗失败的CL患者；对照为接受Sb治疗成功的CL患者。符合条件的患者为经寄生虫学确诊为CL且接受过监督下Sb治疗并可分类为病例或对照的患者。主要暴露变量为通过粪便样本的直接检查、快速沉淀、贝曼氏法、加藤-厚涂片法或琼脂培养诊断出的肠道蠕虫病和类圆线虫病。其他暴露变量为其他感染（HIV、人类嗜T淋巴细胞病毒1型、结核病、乙型肝炎、肠道原虫）和非感染性疾病（糖尿病、肾功能不全和免疫抑制药物）。年龄、性别、CL病史、可能的暴露地点和种类在多因素逻辑回归中被视为潜在混杂因素。
共有94例病例和122例对照。总体而言，病例组（64%）和对照组（71%）中感染性和非感染性合并症都很常见。任何肠道蠕虫感染与CL治疗失败之间关联的调整比值比（OR）为0.65（95%置信区间[CI]，0.30-1.38），类圆线虫病与CL治疗失败之间关联的调整OR为0.34（95%CI，0.11-0.92）。
在秘鲁的环境中，高Sb治疗失败率不能用肠道蠕虫病来解释。相反，类圆线虫病对治疗失败有保护作用。
