Niba Rawlings Ngwa, Bailey Mark, Courtenay Orin
Department of Environmental Health, Defence Medical Services, Ministry of Defence, London, United Kingdom.
School of Life Sciences, University of Warwick, Warwick, United Kingdom.
PLoS Negl Trop Dis. 2025 Mar 10;19(3):e0012680. doi: 10.1371/journal.pntd.0012680. eCollection 2025 Mar.
Leishmaniasis affects military personnel deployed to endemic areas following exposure to sand flies infected with the protozoa Leishmania. This systematic review and meta-analysis of data specific to military populations aims to identify knowledge gaps to mitigate sand fly exposure and Leishmania transmission during deployments. The review was registered on PROSPERO (CRD42023463687). Random-effects meta-analyses and narrative synthesis were performed. Thirty-six studies were included, most of which reported on cutaneous leishmaniasis (CL), showing a mean cumulative incidence of 10% (95% CI: 5-16), suggesting higher rates in the Eastern Mediterranean region (14% [95% CI: 12-16]) compared to the African region (8%) and American region (9%). Asymptomatic Leishmania infection had a cumulative incidence of 11% (95% CI: 6-17), with higher rates in Eastern Mediterranean countries (20% [95% CI: 14-25]). Diagnosis involved parasitological, serological, and molecular methods, with L. (L) mexicana and L. (V.) braziliensis identified as the predominant CL pathogens in deployed troops in the Americas. Visceral leishmaniasis cases were less frequent, all reported from the Eastern Mediterranean and associated with the Leishmania donovani/infantum complex; whereas CL cases in the Old World were due predominantly to L. major and L. tropica. Regular use of long-lasting insecticidal nets to mitigate sand fly exposure demonstrated high potential effectiveness than other reported personal protective measures (PPMs) which yielded mixed or inconclusive results. In summary, the systematic review revealed the substantial variability between study designs and statistical integrity. There is need for more consistent and robustly designed studies including well-define controls and replication. Future studies would be advised to explore the long-term effectiveness and practicality of PPMs, both individually and in combination, across diverse deployment settings.
利什曼病影响部署到流行地区的军事人员，这些人员在接触感染了利什曼原虫的白蛉后会患病。本系统评价和对军事人群特定数据的荟萃分析旨在找出知识空白，以减少部署期间白蛉暴露和利什曼原虫传播。该评价已在国际系统评价注册库（PROSPERO，注册号：CRD42023463687）登记。进行了随机效应荟萃分析和叙述性综合分析。纳入了36项研究，其中大多数报告了皮肤利什曼病（CL），平均累积发病率为10%（95%置信区间：5%-16%），表明东地中海地区（14%[95%置信区间：12%-16%]）的发病率高于非洲地区（8%）和美洲地区（9%）。无症状利什曼原虫感染的累积发病率为11%（95%置信区间：6%-17%），东地中海国家的发病率更高（20%[95%置信区间：14%-25%]）。诊断涉及寄生虫学、血清学和分子方法，墨西哥利什曼原虫和巴西利什曼原虫被确定为美洲部署部队中主要的皮肤利什曼病病原体。内脏利什曼病病例较少见，均报告来自东地中海地区，且与杜氏利什曼原虫/婴儿利什曼原虫复合体有关；而旧世界的皮肤利什曼病病例主要由大型利什曼原虫和热带利什曼原虫引起。定期使用长效杀虫网以减少白蛉暴露显示出比其他报告的个人防护措施（PPM）更高的潜在有效性，其他个人防护措施的结果不一或无定论。总之，系统评价揭示了研究设计和统计完整性之间的巨大差异。需要进行更一致、设计更完善的研究，包括明确界定对照组和进行重复研究。建议未来的研究探索个人防护措施单独或联合使用在不同部署环境中的长期有效性和实用性。
