Fundación Misión Cristiana de Salud, Hospital Shell, Shell, Ecuador.
Laboratory for Experimental Parasitology, Department of Medical Microbiology and Infection Prevention, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.
BMC Infect Dis. 2022 Sep 24;22(1):748. doi: 10.1186/s12879-022-07733-4.
BACKGROUND: Yearly, up to 1 million patients worldwide suffer from cutaneous leishmaniasis (CL). In Ecuador, CL affects an estimated 5000 patients annually. CL leads to reduced Health Related Quality of Life (HRQL) as a result of stigma in the Asian and Mediterranean contexts, but research is lacking for Ecuador. The objective of this study was to explore the influence of CL suspected lesions on the quality of life of patients in the Pacific and Amazon regions. METHODS: Patients for this study were included in the Amazonian Napo, Pastaza, and Morona Santiago provinces and the Pacific region of the Pichincha province. Participating centers offered free of charge CL treatment. All patients suspected of CL and referred for a cutaneous smear slide microscopy examination were eligible. This study applied the Skindex-29 questionnaire, a generic tool to measure HRQL in patients with skin diseases. All statistical analysis was done with SPSS Statistics version 28. RESULTS: The skindex-29 questionnaire was completed adequately by 279 patients who were included in this study. All patient groups from the Amazon scored significantly (P < 0.01) higher (indicating worse HRQL) on all the dimensions of the Skindex-29 questionnaire than Mestizo patients from the Pacific region. The percentage of patients with health seeking delay of less than a month was significantly (P < 0.01) lower in the Amazon region (38%) than in the Pacific (66%). CONCLUSIONS: The present study revealed that the influence of suspected CL lesions on the HRQL of patients in the Ecuadorian Amazon and Pacific depends on the geographic region more than on patient characteristics such as gender, age, number of lesions, lesion type, location of lesions, health seeking delay, or posterior confirmation of the Leishmania parasite. The health seeking delay in the Amazon might result from a lack of health infrastructure or related stigma. Together, the impaired HRQL and prolonged health seeking delay in the Amazon lead to prolonged suffering and a worse health outcome. Determinants of health seeking delay should be clarified in future studies and CL case finding must be improved. Moreover, HRQL analysis in other CL endemic regions could improve local health management.
背景：全球每年有多达 100 万人患有皮肤利什曼病（CL）。在厄瓜多尔，每年估计有 5000 名患者受到影响。在亚洲和地中海地区，由于耻辱感的存在，CL 会导致健康相关生活质量（HRQL）下降，但厄瓜多尔缺乏这方面的研究。本研究的目的是探讨在太平洋和亚马逊地区，CL 疑似病变对患者生活质量的影响。
方法：本研究纳入了亚马逊的纳波、帕斯塔萨和莫罗纳圣地亚哥省以及皮钦查省的太平洋地区。参与中心提供免费的 CL 治疗。所有疑似 CL 并被转诊进行皮肤涂片镜检的患者均符合条件。本研究应用了 Skindex-29 问卷，这是一种衡量皮肤病患者 HRQL 的通用工具。所有统计分析均使用 SPSS Statistics 版本 28 进行。
结果：本研究共纳入了 279 名完成 Skindex-29 问卷的患者。所有来自亚马逊的患者群体在 Skindex-29 问卷的所有维度上的评分均显著（P < 0.01）高于太平洋地区的梅斯蒂索人患者（表明 HRQL 更差）。在亚马逊地区，寻求医疗的时间少于一个月的患者比例明显（P < 0.01）低于太平洋地区（66%）（38%）。
结论：本研究表明，厄瓜多尔亚马逊和太平洋地区 CL 疑似病变对患者 HRQL 的影响更多地取决于地理位置，而不是患者特征，如性别、年龄、病变数量、病变类型、病变位置、寻求医疗的时间延迟或寄生虫利什曼原虫的后续确认。亚马逊地区寻求医疗的时间延迟可能是由于卫生基础设施缺乏或相关耻辱感造成的。亚马逊地区 HRQL 受损和寻求医疗的时间延长导致患者遭受更长时间的痛苦和更差的健康结局。未来的研究应明确寻求医疗的时间延迟的决定因素，并改善 CL 病例发现。此外，在其他 CL 流行地区进行 HRQL 分析可以改善当地的卫生管理。
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