尼泊尔内脏利什曼病后皮肤利什曼病（PKDL）的流行情况和 PKDL 患者的求医行为。
Prevalence of post kala-azar dermal leishmaniasis (PKDL) and treatment seeking behavior of PKDL patients in Nepal.
机构信息
Public Health and Infectious Disease Research Center (PHIDReC), Kathmandu, Nepal.
Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal.
出版信息
PLoS Negl Trop Dis. 2023 Feb 9;17(2):e0011138. doi: 10.1371/journal.pntd.0011138. eCollection 2023 Feb.
BACKGROUND
In Nepal, the burden of post kala-azar dermal leishmaniasis (PKDL) is not known since there is no active case detection of PKDL by the national programme. PKDL patients could pose a challenge to sustain visceral leishmaniasis (VL) elimination. The objective of this study was to determine the prevalence of PKDL and assess PKDL patients' knowledge on VL and PKDL, and stigma associated with PKDL.
METHODOLOGY/PRINCIPAL FINDINGS: Household surveys were conducted in 98 VL endemic villages of five districts that reported the highest number of VL cases within 2018-2021. A total of 6,821 households with 40373 individuals were screened for PKDL. Cases with skin lesions were referred to hospitals and examined by dermatologists. Suspected PKDL cases were tested with rK39 and smear microscopy from skin lesions. An integrated diagnostic approach was implemented in two hospitals with a focus on management of leprosy cases where cases with non-leprosy skin lesions were tested for PKDL with rK39. Confirmed PKDL patients were interviewed to assess knowledge and stigma associated with PKDL, using explanatory model interview catalogue (EMIC) with maximum score of 36. Among 147 cases with skin lesions in the survey, 9 (6.12%) were confirmed as PKDL by dermatologists at the hospital. The prevalence of PKDL was 2.23 per 10,000 population. Among these 9 PKDL cases, 5 had a past history of VL and 4 did not. PKDL cases without a past history of VL were detected among the "new foci", Surkhet but none in Palpa. None of the cases negative for leprosy were positive for PKDL. There was very limited knowledge of PKDL and VL among PKDL cases. PKDL patients suffered to some degree from social and psychological stigma (mean ± s.d. score = 17.89 ± 12.84).
CONCLUSIONS/SIGNIFICANCE: Strengthening the programme in PKDL case detection and management would probably contribute to sustenance of VL elimination. Awareness raising activities to promote knowledge and reduce social stigma should be conducted in VL endemic areas.
背景
在尼泊尔，由于国家规划没有对 PKDL 进行主动病例检测，因此尚不清楚 PKDL 的负担情况。PKDL 患者可能对维持内脏利什曼病（VL）消除构成挑战。本研究的目的是确定 PKDL 的流行率，并评估 PKDL 患者对 VL 和 PKDL 的认知，以及与 PKDL 相关的耻辱感。
方法/主要发现：在五个报告 2018-2021 年内 VL 病例数量最高的 VL 流行地区的 98 个 VL 流行村庄进行了家庭调查。对 6821 户家庭中的 40373 人进行了 PKDL 筛查。有皮肤损伤的病例被转介到医院，并由皮肤科医生检查。疑似 PKDL 病例用皮肤损伤处的 rK39 和涂片显微镜检查。在两家医院实施了综合诊断方法，重点是麻风病例的管理，其中非麻风性皮肤损伤的病例用 rK39 检查 PKDL。对确诊的 PKDL 患者进行访谈，使用解释模型访谈目录（EMIC）评估与 PKDL 相关的知识和耻辱感，EMIC 的最高得分为 36 分。在调查中，有 147 例有皮肤损伤的病例，其中 9 例（6.12%）在医院被皮肤科医生确诊为 PKDL。PKDL 的患病率为每 10000 人 2.23 例。在这 9 例 PKDL 病例中，有 5 例有 VL 的既往病史，有 4 例没有。在 Surkhet 的“新疫区”发现了无 VL 既往史的 PKDL 病例，但在 Palpa 没有发现。没有一例对麻风病阴性的病例对 PKDL 呈阳性。PKDL 病例对 PKDL 和 VL 的了解非常有限。PKDL 患者在一定程度上遭受社会和心理耻辱（平均±s.d.得分=17.89±12.84）。
结论/意义：加强 PKDL 病例检测和管理计划可能有助于维持 VL 消除。应在 VL 流行地区开展提高认识活动，以提高知识水平，减少社会耻辱感。
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