Cayenne Hospital Center, Dermatology Department, Cayenne, French Guiana.
UMR TBIP 1019 Tropical Biomes and Immunophysiopathology, University of French Guiana, Cayenne, French Guiana.
PLoS Negl Trop Dis. 2023 Jun 14;17(6):e0011415. doi: 10.1371/journal.pntd.0011415. eCollection 2023 Jun.
BACKGROUND: The cutaneous leishmaniasis (CL) incubation period (IP) is defined as the time between parasite inoculation by sandfly bite and the onset of the first CL lesion. IP distribution is difficult to assess for CL because the date of exposure to an infectious bite cannot be accurately determined in endemic areas. IP current estimates for CL range from 14 days to several months with a median around 30-60 days, as established by a few previous studies in both New and Old Worlds. METHODOLOGY: We estimated CL incubation period distribution using time-to-event models adapted to interval-censored data based on declared date of travels from symptomatic military personnel living in non-endemic areas that were exposed during their short stays in French Guiana (FG) between January 2001 and December 2021. PRINCIPAL FINDINGS: A total of 180 patients were included, of which 176 were men (97.8%), with a median age of 26 years. When recorded, the parasite species was always Leishmania guyanensis (31/180, 17.2%). The main periods of CL diagnosis spread from November to January (84/180, 46.7%) and over March-April (54/180, 30.0%). The median IP was estimated at 26.2 days (95% Credible Level, 23.8-28.7 days) using a Bayesian accelerated failure-time regression model. Estimated IP did not exceed 62.1 days (95% CI, 56-69.8 days) in 95% of cases (95th percentile). Age, gender, lesion number, lesion evolution and infection date did not significantly modify the IP. However, disseminated CL was significantly associated with a 2.8-fold shortening of IP. CONCLUSIONS: This work suggests that the CL IP distribution in French Guiana is shorter and more restricted than anticipated. As the incidence of CL in FG usually peaks in January and March, these findings suggest that patients are contaminated at the start of the rainy season.
背景:皮肤利什曼病(CL)潜伏期(IP)定义为沙蝇叮咬后寄生虫接种与首次 CL 病变出现之间的时间。由于在流行地区无法准确确定暴露于传染性叮咬的日期,因此难以评估 CL 的 IP 分布。目前,通过几项在新旧世界进行的研究,CL 的 IP 估计范围为 14 天至数月,中位数约为 30-60 天。 方法:我们根据居住在非流行地区的有症状军人申报的旅行日期,使用适应于区间 censored 数据的事件时间模型来估计 CL 潜伏期分布。这些军人在 2001 年 1 月至 2021 年 12 月期间在法属圭亚那停留期间短暂逗留期间接触到感染。 主要发现:共纳入 180 例患者,其中 176 例为男性(97.8%),中位年龄为 26 岁。当记录寄生虫种类时,始终为利什曼原虫圭亚那型(31/180,17.2%)。CL 诊断的主要时期从 11 月到 1 月(84/180,46.7%)和 3 月至 4 月(54/180,30.0%)。使用贝叶斯加速失效时间回归模型估计的 IP 中位数为 26.2 天(95%可信区间,23.8-28.7 天)。在 95%的病例中(95%置信区间,56-69.8 天),估计的 IP 不超过 62.1 天(95%CI,56-69.8 天)。年龄、性别、病变数量、病变演变和感染日期均未显著改变 IP。然而,播散性 CL 与 IP 缩短 2.8 倍显著相关。 结论:这项工作表明,法属圭亚那的 CL IP 分布比预期的更短且更受限。由于 FG 中 CL 的发病率通常在 1 月和 3 月达到高峰,因此这些发现表明患者在雨季开始时受到感染。
PLoS Negl Trop Dis. 2023-6
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