Department of Microbiology, Kohat University of Science and Technology, Kohat, Pakistan; Department of Oral and Maxillofacial Surgery, Khyber College of Dentistry, Peshawar, Pakistan.
Institute of Pathology and Diagnostic Medicine, Khyber Medical University, Peshawar, Pakistan.
J Infect Public Health. 2022 Nov;15(11):1175-1179. doi: 10.1016/j.jiph.2022.09.010. Epub 2022 Sep 27.
Leishmaniasis is the second and fourth highest cause of mortality and morbidity respectively among all tropical diseases. Recurrence in the onset of leishmaniasis is a major problem that needs to be addressed to reduce the case fatality rate and ensure timely clinical intervention. Here we are investigating the association of risk factors with recurrent cutaneous leishmaniasis to address this issue.
Patients received by Nasser Ullah Khan Babar Hospital in Peshawar, Pakistan from March 2019 to July 2020 were enrolled in this study. Those patients who developed symptoms after completion of treatment were included in Group-A while those who had atypical scars like leishmaniasis but were negative for cutaneous leishmaniasis were included in the comparison group tagged as Group B. All those individuals who had completed six weeks of treatment for CL but had normal complete blood counts (CBC) were included to avoid other underlying immunological pathologies, while we excluded those participants who had co-morbidities like diabetes, liver disease, cardiac disease, and pregnant and lactating women through their history Association was tested between Group-A and Group-B with other explanatory variables through chi-square test. The regression model was proposed to determine the predictors.
A total of 48 participants of both sexes were included in the study with a mean age of 32.2 ± 15.10. The data suggest that females are overrepresented among the patients with recurrent leishmaniasis [21(53.8 %,); p = 0.07]. Compared to patients; healthy participants had a higher proportion of adults (19-59 years) versus adolescents (13-18 years) [26(66.7 %) vs 07(17.9), p = 0.004]. Multivariate logistic regression analysis shows that females are 2.1 times more prone to infections among cases as compared to healthy individuals [unadjusted OR 2.20, 95 % confidence interval (CI) 1.5-10.6, p = 0.02; adjusted OR 2.1, 95 % CI 1.50-10.69, p = 0.02]. We propose that patients receiving intradermal were less likely to be infected as compared to those receiving intralesional injections [unadjusted OR 0.07.0, 95 % confidence interval (CI) 1.18-3.37, p = 0.03; adjusted OR 0.06, 95 % CI 1.18-3.38, p = 0.03].
Old age (adults) and sex (females) were the strongest predictors to be associated with recurrent leishmaniasis. Similarly, the choice of intradermal as compared to intralesional injection and the prolonged treatment duration were strongly associated with greater chances of recurrence.
利什曼病是所有热带病中第二和第四高的死亡率和发病率原因。利什曼病的复发是一个需要解决的主要问题，以降低病死率并确保及时进行临床干预。在这里，我们正在调查与复发性皮肤利什曼病相关的风险因素，以解决这个问题。
本研究纳入了 2019 年 3 月至 2020 年 7 月在巴基斯坦白沙瓦的纳赛尔·乌拉·汗·巴巴尔医院接受治疗的患者。那些在完成治疗后出现症状的患者被纳入 A 组，而那些有类似利什曼病的非典型疤痕但皮肤利什曼病检测为阴性的患者被纳入比较组，标记为 B 组。所有那些接受了 6 周 CL 治疗但完全血细胞计数 (CBC) 正常的患者都被纳入，以避免其他潜在的免疫病理学问题，而我们则通过病史排除了那些患有糖尿病、肝病、心脏病和孕妇和哺乳期妇女等合并症的患者。通过卡方检验对 A 组和 B 组与其他解释变量之间的关系进行了检验。提出了回归模型以确定预测因素。
本研究共纳入了 48 名男女患者，平均年龄为 32.2±15.10 岁。数据表明，女性在复发性利什曼病患者中占比过高[21(53.8%）；p=0.07]。与患者相比，健康参与者中成年人（19-59 岁）的比例高于青少年（13-18 岁）[26(66.7%) vs 07(17.9%)；p=0.004]。多变量逻辑回归分析显示，与健康个体相比，女性感染的可能性是其 2.1 倍[未调整的优势比 2.20，95%置信区间（CI）1.5-10.6，p=0.02；调整后的优势比 2.1，95%CI 1.50-10.69，p=0.02]。我们提出，与接受病灶内注射的患者相比，接受皮内注射的患者感染的可能性较小[未调整的优势比 0.07，95%CI 1.18-3.37，p=0.03；调整后的优势比 0.06，95%CI 1.18-3.38，p=0.03]。
年龄（成年人）和性别（女性）是与复发性利什曼病相关的最强预测因素。同样，与病灶内注射相比，选择皮内注射和延长治疗时间与更大的复发几率密切相关。
