旅行者输入性利什曼病：法国巴黎一家医院的 7 年回顾性研究。
Imported leishmaniasis in travelers: a 7-year retrospective from a Parisian hospital in France.
机构信息
Laboratoire de Parasitologie et de Mycologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), 1 Avenue Claude Vellefaux, 75475, Paris, France.
Université de Paris, Paris, France.
出版信息
BMC Infect Dis. 2021 Sep 15;21(1):953. doi: 10.1186/s12879-021-06631-5.
BACKGROUND
Leishmaniases are regularly seen in non-endemic areas due to the increase of international travels. They include cutaneous leishmaniases (CL) and mucocutaneous (MC) caused by different Leishmania species, and visceral leishmaniases (VL) which present with non-specific symptoms.
METHODS
We reviewed all consecutive leishmaniasis cases seen between September 2012 and May 2020. The diagnostic strategy included microscopy after May-Grünwald-Giemsa staining, a diagnostic quantitative PCR (qPCR) assay, and species identification based on sequencing of the cytochrome b gene.
RESULTS
Eighty-nine patients had a definitive leishmaniasis diagnosis. Nine patients had VL with Leishmania infantum. Eighty patients had CL. Twelve patients acquired CL after trips in Latin America (7 Leishmania guyanensis, 2 Leishmania braziliensis, 2 Leishmania mexicana, and 1 Leishmania panamensis). Species could be identified in 63 of the 68 CLs mainly after travel in North Africa (59%) with Leishmania major (65%), Leishmania tropica/killicki (24%), and L. infantum (11%), or in West Sub-Saharan Africa (32%), all due to L. major. The median day between appearance of the lesions and diagnosis was 90 [range 60-127].
CONCLUSIONS
Our diagnostic strategy allows both positive diagnoses and species identifications. Travelers in West Sub-Saharan Africa and North Africa should be better aware of the risk of contracting leishmananiasis.
背景
由于国际旅行的增加，非流行地区经常出现利什曼病。它们包括由不同利什曼原虫引起的皮肤利什曼病（CL）和黏膜皮肤利什曼病（MC），以及表现为非特异性症状的内脏利什曼病（VL）。
方法
我们回顾了 2012 年 9 月至 2020 年 5 月间连续出现的所有利什曼病病例。诊断策略包括梅格-格伦瓦尔德-吉姆萨染色后的显微镜检查、诊断定量 PCR（qPCR）检测，以及基于细胞色素 b 基因测序的种属鉴定。
结果
89 例患者被明确诊断为利什曼病。9 例患者患有婴儿利什曼原虫引起的 VL。80 例患者患有 CL。12 例患者在拉丁美洲旅行后感染 CL（7 例为利什曼原虫圭亚那型，2 例为利什曼原虫巴西型，2 例为利什曼原虫墨西哥型，1 例为利什曼原虫巴拿马型）。在 68 例 CL 中，有 63 例在旅行后（59%在北非，24%在北非）可鉴定出种属，主要为利什曼原虫 major（65%）、利什曼原虫 tropica/killicki（24%）和 L. infantum（11%），或在西撒哈拉以南非洲（32%），均为 L. major。病变出现到诊断的中位天数为 90 [范围 60-127]。
结论
我们的诊断策略既能进行阳性诊断，也能进行种属鉴定。来自撒哈拉以南非洲和北非的旅行者应更好地意识到感染利什曼病的风险。
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