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2020 年法属圭亚那军人中皮肤利什曼病的爆发:临床、系统发育、个体和环境方面。

Outbreak of Cutaneous Leishmaniasis among military personnel in French Guiana, 2020: Clinical, phylogenetic, individual and environmental aspects.

机构信息

Laboratory of Parasitology-Mycology, Centre Hospitalier de Cayenne, Cayenne, French Guiana.

French Military Health Service-Armed Forces Epidemiology and Public Health Center, Marseille, France.

出版信息

PLoS Negl Trop Dis. 2021 Nov 19;15(11):e0009938. doi: 10.1371/journal.pntd.0009938. eCollection 2021 Nov.


DOI:10.1371/journal.pntd.0009938
PMID:34797836
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8641862/
Abstract

BACKGROUND: Cutaneous Leishmaniasis (CL) is endemic in French Guiana but cases are usually sporadic. An outbreak signal was issued on May 15th 2020 with 15 suspected cases after a military training course in the rainforest. An outbreak investigation was carried out. METHODOLOGY/PRINCIPAL FINDINGS: Thirty cases were confirmed. Leishmania guyanensis was the most frequent species (90%). The most frequent presentation was ulcerative (90%). Lesions on the face and hands were frequent (40% each). Eight cases (26%) presented a poor outcome after treatment with pentamidine and required a second line with amphotericin B. Three of them required further treatments with meglumine antimoniate or miltefosine. Two spots within the training area were deemed as likely sites of contamination, due to illegal logging. The isolated Leishmania strains did not form a separate cluster. Participation in Week 13 of year 2020 was associated with infection (OR = 4.59 [1.10-19.83]; p = 0.016) while undergoing only the "Fighting" exercise was protective (OR = 0.1 [0-0.74]; p = 0.021). There was no association between infection and other risk factors at the individual level. The attack rate of Regiment B (14/105 = 13.3%) was significantly higher (OR = 4.22 [1.84-9.53], p = 0.0001) compared to Regiment A (16/507 = 3.2%). The attack rate during this training course (30/858 = 3.5%) was significantly higher (OR 2.29 [1.28-4.13]; p = 0.002) than for other missions in French Guiana during the same period (22/1427 = 1.5%). CONCLUSIONS: This outbreak could be explained by a combination of factors: climatic conditions around week 13, at-risk activities including night trainings, absence of impregnation, a lesser experience of rainforest duties in Regiment B and illegal logging attracting sandflies on military training grounds.

摘要

背景:法属圭亚那流行皮肤利什曼病(CL),但病例通常为散发性。2020 年 5 月 15 日,在雨林中的一次军事训练课后,出现了 15 例疑似病例,发出了暴发信号。进行了暴发调查。

方法/主要发现:确诊了 30 例病例。最常见的物种是利什曼原虫圭亚那株(90%)。最常见的表现为溃疡性(90%)。面部和手部的病变很常见(各占 40%)。8 例(26%)在使用喷他脒治疗后结果不佳,需要使用两性霉素 B 进行二线治疗。其中 3 例需要进一步使用葡甲胺锑或米替福新治疗。由于非法伐木,训练区内的两个地点被认为是可能的污染地点。分离的利什曼菌株未形成单独的聚类。参加 2020 年第 13 周的活动与感染相关(OR=4.59[1.10-19.83];p=0.016),而仅进行“战斗”练习则具有保护作用(OR=0.1[0-0.74];p=0.021)。在个体水平上,感染与其他危险因素之间没有关联。B 团的发病率(14/105=13.3%)明显高于 A 团(16/507=3.2%)(OR=4.22[1.84-9.53],p=0.0001)。在这次训练中,发病率(30/858=3.5%)明显高于同期法属圭亚那其他任务的发病率(22/1427=1.5%)(OR 2.29[1.28-4.13];p=0.002)。

结论:此次暴发可能是由多种因素共同作用的结果:第 13 周左右的气候条件、包括夜间训练在内的高危活动、缺乏浸渍、B 团在雨林任务方面的经验较少以及非法伐木吸引了训练场上的沙蝇。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a7b5/8641862/e0d18289c601/pntd.0009938.g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a7b5/8641862/52b7ba5d9737/pntd.0009938.g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a7b5/8641862/cdc7b988d32e/pntd.0009938.g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a7b5/8641862/fbca65b7dcb3/pntd.0009938.g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a7b5/8641862/2fb5b83e8054/pntd.0009938.g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a7b5/8641862/f61ac6f3932f/pntd.0009938.g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a7b5/8641862/e0d18289c601/pntd.0009938.g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a7b5/8641862/52b7ba5d9737/pntd.0009938.g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a7b5/8641862/cdc7b988d32e/pntd.0009938.g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a7b5/8641862/fbca65b7dcb3/pntd.0009938.g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a7b5/8641862/2fb5b83e8054/pntd.0009938.g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a7b5/8641862/f61ac6f3932f/pntd.0009938.g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a7b5/8641862/e0d18289c601/pntd.0009938.g006.jpg

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[1]
Cutaneous Leishmaniasis Outbreak Investigation in Hajjah Governorate, Yemen, in 2018: Case-Control Study.

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[2]
Validation of Swab Sampling and SYBR Green-Based Real-Time PCR for the Diagnosis of Cutaneous Leishmaniasis in French Guiana.

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Leishmania naiffi and lainsoni in French Guiana: Clinical features and phylogenetic variability.

PLoS Negl Trop Dis. 2020-8-14

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