Rab M A, Evans D A
National Institute of Health, Islamabad, Pakistan.
Trans R Soc Trop Med Hyg. 1995 Jan-Feb;89(1):27-32. doi: 10.1016/0035-9203(95)90644-4.
Visceral leishmaniasis (VL) was first reported in Pakistan over 30 years ago from the remote north-eastern Himalayan region. Sporadic cases are now widely reported from the Northern Areas, part of North-West Frontier Province (NWFP) and Punjab Province, together with Azad Jammu and Kashmir (AJK). Two hundred and thirty-nine cases, mostly young children, have been reported in the last decade; 52% were under 2 years old, and 86% were aged less than 5 years; the male:female ratio was 3:1. In a cross sectional study of the population in 14 endemic villages, 1938 individuals of all ages were randomly skin-tested with leishmanin and 27.4% gave a positive result. The leishmanin response rate increased with age. In some areas, almost 70% of the adults over 40 years old were positive. Leishmanin positivity appeared to cluster among households (P = 0.0003), but clinical cases among households did not (P = 0.472). The leishmanin response pattern in the foci of Chilas and AJK reflected an endemic pattern of disease, whereas that seen in the Baltistan foci suggested interrupted transmission. Human sera collected in endemic villages were tested for anti-Leishmania antibodies, 580 by enzyme-linked immunosorbent assay and direct agglutination test (DAT), and another 1403, as blood samples on filter paper, were tested by DAT alone. Isolations of Leishmania were made from 15 patients, 11 from bone marrow, 3 from normal skin and one from spleen. The parasites were typed as Leishmania infantum zymodeme LON-49 (= MON-1).
内脏利什曼病（VL）于30多年前首次在巴基斯坦偏远的喜马拉雅东北地区被报道。如今，在北部地区、西北边境省（NWFP）的一部分、旁遮普省以及查谟和克什米尔自由邦（AJK）都广泛报道了散发病例。在过去十年中报告了239例病例，大多为幼儿；52%年龄在2岁以下，86%年龄小于5岁；男女比例为3:1。在对14个流行村庄的人群进行的横断面研究中，对1938名各年龄段的个体进行了利什曼原虫素皮肤试验，27.4%的人结果呈阳性。利什曼原虫素反应率随年龄增长而升高。在一些地区，40岁以上的成年人中近70%呈阳性。利什曼原虫素阳性似乎在家庭中聚集（P = 0.0003），但家庭中的临床病例并非如此（P = 0.472）。奇拉斯和AJK疫源地的利什曼原虫素反应模式反映了疾病的流行模式，而巴尔蒂斯坦疫源地的模式表明传播已中断。对流行村庄采集的人类血清进行了抗利什曼原虫抗体检测，其中580份通过酶联免疫吸附测定和直接凝集试验（DAT）检测，另外1403份作为滤纸上的血样仅通过DAT检测。从15名患者中分离出利什曼原虫，11份来自骨髓，3份来自正常皮肤，1份来自脾脏。这些寄生虫被鉴定为婴儿利什曼原虫酶株LON - 49（= MON - 1）。
