TY - JOUR A2 - Dash, Aditya Prasad AU - Siriwardana, Yamuna AU - Deepachandi, Bhagya AU - Gunasekara, Chalukya AU - Warnasooriya, Wipula AU - Karunaweera, Nadira D. PY - 2019 DA - 2019/05/27 TI -杜氏利什曼虫诱导皮肤利什曼病:对斯里兰卡SP - 4538597 VL - 2019 AB -斯里兰卡的非典型临床变异的深入研究 杜氏利什曼虫诱发皮肤利什曼病(CL)为主要临床实体。本研究描述了CL profile中的一个单独的临床实体。对2002-2014年实验室确诊的CL病例(n= 950例)进行了分析。大多数病变表现为已知的典型的CL (CCL)发展阶段，而少数病例(13%，122/950)表现为非典型皮肤表现(ACL)。ACL的临床、地理和治疗反应模式与CCL不同。ACL主要发生在男性(68.0%)，21-40岁年龄组(51.6%)，并报告了延迟寻求治疗(23.5% vs 16.3%)，更多的非经典发病(痤疮以外的病变形成小于1cm大小的丘疹)，(12.1 vs 2.7%， P<0.05.)，更多的头颈部病变(41.5%。与CCL相比，病变更大(>4cm) (18.6 vs 9.9%)，实验室阳性率较低(65.6% vs 88.2%)。与报道典型起病的病变相比，报道非经典起病的病变更有可能在晚些时候发生ACL (50.1% vs 10.7%)。与四肢病变相比，头颈部和躯干病变发生ACL的可能性更大(分别为7.0%、16.3%和22.8%，P<0.05)。ACL特征与年龄或性别无关。 Highest proportion within ACL category (32.8%) and small proportion of CCL (10.1%) originated from less leishmaniasis prevalent areas (other regions) (P<0.05). North reported more ACL than South (15.9% vs 7.4%). A total of 95 CL cases with a significant travel history were further analyzed. Residents of other regions when acquired infection from North or South developed more ACL than residents in North or South (60.9% vs 15.9% and 42.9% vs 7.4% respectively). Patients in other regions when travelled to North developed more ACL than when they travelled to South (60.9%, 42.9%). ACL and CCL required an average of 18 doses over 16.7 months and 10 doses over 12 weeks, respectively, to achieve a complete clinical cure. Underlying host immunological factors, parasite strain variations and regional variations of both could be underlying etiologies. Established independent transmission within less leishmaniasis prevalent regions combined with an unusual clinical picture leading to poor clinical suspicion and low laboratory confirmation rate will pose potential difficulties in early case detection in these highly populated and commercialized areas. This in turn will further facilitate silent and high disease transmission. SN - 1687-9686 UR - https://doi.org/10.1155/2019/4538597 DO - 10.1155/2019/4538597 JF - Journal of Tropical Medicine PB - Hindawi KW - ER -