Bamorovat Mehdi, Sharifi Iraj, Agha Kuchak Afshari Setareh, Ghasemi Nejad Almani Pooya
Leishmaniasis Research Center, Kerman University of Medical Sciences, Kerman, Iran.
Medical Mycology and Bacteriology Research Center, Kerman University of Medical Sciences, Kerman, Iran.
Transbound Emerg Dis. 2023 Aug 26;2023:7814940. doi: 10.1155/2023/7814940. eCollection 2023.
Leishmaniasis is a neglected and old emerging/reemerging disease that has extremely increased and expanded in the different geographical areas. Cutaneous leishmaniasis (CL) is a common global public health concern in the tropics and subtropics reported from the Eastern Mediterranean Region, Africa, Latin America, and the Indian subcontinent. The presence of numerous epidemiological and clinical characteristics of the disease present a challenge in managing and controlling it. Despite wonderful efforts to control the disease in endemic areas, it appears that the burden of CL is still high. There is no comprehensive survey considering the interactive role of patients and medical services in the international CL control system. In the present study, the effective and mutual responsibility of the patients and the healthcare management in controlling the CL are reviewed, described, and discussed. Some patient-related factors that have a remarkable impact on the proper treatment and control strategies are low-socioeconomic condition, lack of sufficient knowledge about the disease, absence of personal protection, disregarding adherence to treatment, culture and incorrect beliefs about disease and therapy, depression, and lack of appropriate support from the family. On the other hand, some healthcare system-related factors that have an important effect on the suitable therapy and management of the disease are the economic burden of healthcare and drug preparation, unsuitable follow-up assessments, health education, early detection, and the right treatment, handling of unresponsive cases, active case detection, and monitoring/evaluation. Improving the socioeconomic conditions and living standards supports longstanding elimination approaches, and facilitates the wide-ranging control of the disease. Trained health staff and experienced clinicians should strengthen the building capacity for appropriate control programs throughout the healthcare system. These measures need sustained encouragement and appropriate multifunctional activities through all government segments including policymakers, the health system, clinical physicians, researchers, and also the private sector. In a suitable strategy, it is essential to understand precisely all the aspects of control strategies to respond correctly to the requests. Nevertheless, due to the complexity of the causative agent, major challenges/gaps remain, and vigorous conservative control plans should be continued until novel tools become available.
利什曼病是一种被忽视的古老的新发/再发疾病，在不同地理区域其发病率急剧上升且范围不断扩大。皮肤利什曼病（CL）是热带和亚热带地区常见的全球公共卫生问题，在地中海东部地区、非洲、拉丁美洲和印度次大陆均有报道。该疾病众多的流行病学和临床特征给其管理和控制带来了挑战。尽管在流行地区为控制该疾病付出了巨大努力，但皮肤利什曼病的负担似乎仍然很高。在国际皮肤利什曼病控制系统中，尚未有考虑患者与医疗服务相互作用的全面调查。在本研究中，对患者和医疗保健管理在控制皮肤利什曼病方面的有效和相互责任进行了回顾、描述和讨论。一些对正确治疗和控制策略有显著影响的患者相关因素包括社会经济状况低下、对疾病缺乏足够了解、缺乏个人防护、不遵守治疗、对疾病和治疗的文化及错误观念、抑郁以及缺乏家庭的适当支持。另一方面，一些对该疾病的适当治疗和管理有重要影响的医疗保健系统相关因素包括医疗保健和药物制备的经济负担、不适当的随访评估、健康教育、早期检测、正确治疗、处理无反应病例、主动病例检测以及监测/评估。改善社会经济状况和生活水平有助于长期消除疾病的方法，并促进对该疾病的广泛控制。训练有素的卫生工作人员和经验丰富的临床医生应加强整个医疗保健系统中适当控制项目的建设能力。这些措施需要通过包括政策制定者、卫生系统、临床医生、研究人员以及私营部门在内的所有政府部门持续鼓励并开展适当的多功能活动。在合适的策略中，准确理解控制策略的所有方面以正确响应需求至关重要。然而，由于病原体的复杂性，主要挑战/差距仍然存在，在新工具可用之前应继续实施有力的保守控制计划。
