Department of Epidemiology and Public Health, University of Veterinary and Animal Sciences, Lahore, Pakistan.
Department of Clinical Medicine and Surgery, University of Veterinary and Animal Sciences, Lahore, Pakistan.
BMC Infect Dis. 2021 Jun 30;21(1):622. doi: 10.1186/s12879-021-06327-w.
Cutaneous Leishmaniasis (CL) is a neglected tropical disease, which mainly affects poor communities. It is one of the major vector-borne disease and endemic in Pakistan.
A case-control study to evaluate potential risk factors of human-CL was conducted in Khewra region, District Jhelum, Pakistan from January-April 2014. Case data about 90 cases registered during October 2012 to November 2013 was retrieved from Municipal Hospital. Controls were matched (1,1 ratio) on the date of registration with cases from same hospital. Both cases and controls were invited to participate and data was collected in a face-to-face interview. A prospective study of canine leishmaniasis (canine-CL) was also conducted at Civil Veterinary Hospital in the same area. Suspected dogs with skin ulceration signs were included in the study and blood samples were collected. Statistical analyses were conducted to determine association between various parameters and outcome of interest.
The ages of cases ranged from 1 to 76 years (median = 15 years) and proved to be protective factor i.e. increase in each year in age reduced the likelihood of being infected with human-CL [Odds Ratio (OR) = 0.4, 95% Confidence Interval (CI) = 0.25-0.76]. People sleeping outsides in an open area were more likely to become a case (OR = 8.7, 95% CI = 2.90-26.37) than a control. Poor sanitary condition inside the house (OR = 3.3, 95% CI 1.03-10.56) and presence of other animals in house (livestock, poultry) (OR = 3.6, 95% CI = 1.07-12.12) also identified as risk factors of high significance. The proportion of positive dogs with canine-CL was 21.05% and was significantly associated with human-CL cases in the same area (p < 0.05).
We concluded that adopting self-protections measures against sand-fly, and maintaining good hygiene may lower the risk of human-CL. One-Health Strategy is suggested to control leishmaniasis in human and dog population.
皮肤利什曼病（CL）是一种被忽视的热带病，主要影响贫困社区。它是主要的虫媒病之一，在巴基斯坦流行。
2014 年 1 月至 4 月，在巴基斯坦杰赫勒姆区 Khewra 地区进行了一项病例对照研究，以评估人类 CL 的潜在危险因素。从 2012 年 10 月至 2013 年 11 月期间从市立医院检索了 90 例病例的数据。对照病例按登记日期与同一医院的病例匹配（1:1 比例）。邀请病例和对照参加，并进行面对面访谈收集数据。还在同一地区的民用兽医医院进行了犬利什曼病（犬 CL）的前瞻性研究。将有皮肤溃疡迹象的可疑犬纳入研究，并采集血样。进行统计分析以确定各种参数与研究结果之间的关系。
病例的年龄范围为 1 至 76 岁（中位数= 15 岁），并被证明是保护性因素，即每年增加一岁可降低感染人类 CL 的可能性[比值比（OR）= 0.4，95％置信区间（CI）= 0.25-0.76]。在露天区域睡觉的人比对照组更有可能成为病例（OR= 8.7，95％CI = 2.90-26.37）。房屋内部卫生条件差（OR= 3.3，95％CI 1.03-10.56）和房屋内存在其他动物（牲畜、家禽）（OR= 3.6，95％CI = 1.07-12.12）也被确定为高度显著的危险因素。犬 CL 阳性犬的比例为 21.05％，与同一地区的人类 CL 病例显著相关（p <0.05）。
我们得出的结论是，采取针对沙蝇的自我保护措施并保持良好的卫生条件可能会降低人类 CL 的风险。建议采用“One-Health”策略来控制人类和犬类人群中的利什曼病。
