Blaizot Romain, Lamine Mahaman Moustapha, Saout Mona, Issa Kadidia, Laminou Ibrahim Maman, Duvignaud Alexandre, Demar Magalie, Doutchi Mahamadou
Dermatology Department, Centre Hospitalier de Cayenne, Cayenne, French Guiana.
Tropical Biomes and Immunophysiopathology, UMR 1019, University of French Guiana, Cayenne, French Guiana.
BMC Infect Dis. 2025 Jul 1;25(1):871. doi: 10.1186/s12879-025-11229-2.
Cutaneous Leishmaniasis (CL) is underreported in Sub-Saharan Africa. Only a few studies reported the use of molecular diagnostic methods for CL in the region, whereas reports of therapeutic outcomes are scarce.
An international consortium was established between local teams in the Zinder region of Niger and a referral centre for leishmaniasis in French Guiana. Specific training on CL diagnostic was provided by the Guianese team to Nigerien health workers. All consenting patients with clinically suspected CL lesions were enrolled. Samples were made for parasitological smear and PCR on cotton swabs. Then, participants were treated as per local protocol with oral metronidazole for 14 days and were followed for 4 months.
In total, 59 clinically suspected CL cases were included, among whom 33 (56%) were confirmed by PCR and/or by microscopy, including 21 men and 22 women, 23 minors and 10 adults. 32 (97%) of them presented with ulcers (including 12 with ulcers and nodules). The median number of lesions was 2 [IQR 1-3]. The most frequent location of lesions was the lower limbs (21/33, 63.6%), followed by the upper limbs (14/33, 42.4%). One mucosal involvement was reported but unconfirmed with PCR. The efficacy of oral metronidazole was 90.9% (30/33) among confirmed cases and 76.3% (45/59) in the overall study population. The documented species was Leishmania major.
This is the first report of PCR-proven human CL in Niger, and the first report of a human CL case in the Zinder area for more than a century. Molecular techniques confirmed the circulation of L. major in this area, which until now had only been determined by isoenzymes analysis. Presenting CL patients were very young. Treatment outcomes with metronidazole were encouraging. This prompts for a formal evaluation of the efficacy of this drug, ideally in a randomized controlled trial.
皮肤利什曼病（CL）在撒哈拉以南非洲地区报告不足。该地区仅有少数研究报告了CL分子诊断方法的使用情况，而关于治疗结果的报告则很少。
在尼日尔津德尔地区的当地团队与法属圭亚那的利什曼病转诊中心之间建立了一个国际联盟。圭亚那团队为尼日尔卫生工作者提供了CL诊断方面的专门培训。所有临床疑似CL病变且同意参与的患者均被纳入。用棉签采集样本进行寄生虫涂片和PCR检测。然后，参与者按照当地方案口服甲硝唑治疗14天，并随访4个月。
总共纳入了59例临床疑似CL病例，其中33例（56%）通过PCR和/或显微镜检查得到确诊，包括21名男性和22名女性，23名未成年人和10名成年人。其中32例（97%）出现溃疡（包括12例既有溃疡又有结节）。病变的中位数为2[四分位间距1 - 3]。病变最常见的部位是下肢（21/33，63.6%），其次是上肢（14/33，42.4%）。报告了1例黏膜受累，但PCR未确诊。在确诊病例中口服甲硝唑的疗效为90.9%（30/33），在整个研究人群中为76.3%（45/59）。确诊的物种为硕大利什曼原虫。
这是尼日尔首例经PCR证实的人类CL报告，也是津德尔地区一个多世纪以来首例人类CL病例报告。分子技术证实了该地区硕大利什曼原虫的传播，此前该传播情况仅通过同工酶分析确定。就诊的CL患者非常年轻。甲硝唑的治疗效果令人鼓舞。这促使对该药物的疗效进行正式评估，理想情况下是在随机对照试验中进行评估。
