Cutaneous leishmaniasis

皮肤利什曼病
  • 文章类型: Journal Article
    皮肤利什曼病(CL),一种被忽视的热带病,是也门主要的公共卫生问题,热带利什曼原虫被确定为主要病原体。本研究旨在调查也门西部高地CL流行区家畜和野生动物中利什曼原虫寄生虫的发生和分布。在也门西部的Utmah区进行了一项横断面研究。从122只家畜和野生动物中收集血液和皮肤刮擦标本,并使用内部转录间隔区1(ITS1)嵌套聚合酶链反应测试利什曼原虫DNA。对从本研究中的动物获得的20个热带乳杆菌序列和从GenBank检索的来自人类分离物(同时从同一研究区域收集)的34个序列进行系统发育分析。总的来说,在16.4%(20/122)的受检动物中检测到热带乳杆菌,包括11只山羊,两只狗,两只公牛,一头母牛,一头驴,一只兔子,一只老鼠和一只蝙蝠。检查的猫和羊都不是阳性的。将动物序列分为四种不同的热带乳杆菌单倍型,大多数动物(15/20)和人类(32/34)序列由一个显性单倍型/基因型组成。这些发现代表了也门西部不同种类的家养和野生动物中天然热带乳杆菌感染的第一个确证,这表明这些动物可能在也门的CL传播中起作用。因此,a需要采取“一个健康”方法,以便在流行人群中有效预防和控制这种破坏性疾病。
    Cutaneous leishmaniasis (CL), a neglected tropical disease, is a major public health concern in Yemen, with Leishmania tropica identified as the main causative agent. This study aims to investigate the occurrence and distribution of Leishmania parasites in domestic and wild animals in CL endemic areas in the western highlands of Yemen. A cross-sectional study was conducted in the Utmah District of western Yemen. Blood and skin scraping specimens were collected from 122 domestic and wild animals and tested for the Leishmania DNA using internal transcribed spacer 1 (ITS1) nested polymerase chain reaction. Phylogenetic analyses were performed on 20 L. tropica sequences obtained from animals in this study and 34 sequences from human isolates (collected concurrently from the same study area) retrieved from the GenBank. Overall, L. tropica was detected in 16.4% (20/122) of the examined animals, including 11 goats, two dogs, two bulls, one cow, one donkey, one rabbit, one rat and one bat. None of the examined cats and sheep was positive. The animal sequences were segregated into four different L. tropica haplotypes, with the majority of the animal (15/20) and human (32/34) sequences composed of one dominant haplotype/genotype. These findings represent the first confirmed evidence of natural L. tropica infections in different kinds of domestic and wild animals in western Yemen, suggesting these animals potentially have a role in the transmission of CL in Yemen. Therefore, a One Health approach is required for the effective prevention and control of this devastating disease among endemic populations.
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  • 文章类型: Journal Article
    利什曼病,由利什曼原虫(L.)物种,这是一种被忽视的感染。治疗性疫苗接种为其治疗提供了有希望的策略。在这项研究中,我们的目标是使用包封在聚乳酸-羟基乙酸共聚物(PLGA)纳米颗粒(NP)中的利什曼抗原(SLA)和Toll样受体(TLR)7/8激动剂(R848)开发治疗性疫苗候选物.此外,将TLR1/2激动剂(Pam3CSK4)加载到NP上。在L.major感染的BALB/c小鼠中评价这些NP的治疗效果。脚垫肿胀,寄生虫负荷,细胞和体液免疫反应,分析了一氧化氮(NO)的产生。结果表明,PLGANP(SLA-R848-Pam3CSK4)治疗性疫苗有效刺激Th1细胞反应,诱导的体液反应,促进NO生产,和限制寄生虫负担和病变大小。我们的发现表明,在PLGANP中使用SLA与TLR1/2和TLR7/8激动剂联合接种作为治疗性疫苗可提供对L的强大保护。主要感染。这些结果代表了针对旧世界皮肤利什曼病的新型微粒治疗性疫苗。
    Leishmaniasis, caused by Leishmania (L.) species, remains a neglected infection. Therapeutic vaccination presents a promising strategy for its treatment. In this study, we aimed to develop a therapeutic vaccine candidate using Leishmaniaantigens (SLA) and Toll-like receptor (TLR) 7/8 agonist (R848) encapsulated into the poly (lactic-co-glycolic acid) (PLGA) nanoparticles (NPs). Moreover, TLR1/2 agonist (Pam3CSK4) was loaded onto the NPs. The therapeutic effects of these NPs were evaluated in L. major-infected BALB/c mice. Footpad swelling, parasite load, cellular and humoral immune responses, and nitric oxide (NO) production were analyzed. The results demonstrated that the PLGA NPs (SLA-R848-Pam3CSK4) therapeutic vaccine effectively stimulated Th1 cell responses, induced humoral responses, promoted NO production, and restricted parasite burden and lesion size.Our findings suggest that vaccination with SLA combined with TLR1/2 and TLR7/8 agonists in PLGA NPs as a therapeutic vaccine confers strong protection againstL. majorinfection. These results represent a novel particulate therapeutic vaccine against Old World cutaneous leishmaniasis.
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  • 文章类型: Journal Article
    我们报告了啮齿动物控制计划对伊朗流行地区人畜共患皮肤利什曼病发病率的影响。啮齿动物控制中断1年导致人畜共患皮肤利什曼病的发病率增加2年。重新控制啮齿动物导致人畜共患皮肤利什曼病的减少。
    We report the effect of a rodent control program on the incidence of zoonotic cutaneous leishmaniasis in an endemic region of Iran. A 1-year interruption in rodent control led to 2 years of increased incidence of zoonotic cutaneous leishmaniasis. Restarting rodent control led to a decline of zoonotic cutaneous leishmaniasis.
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  • 文章类型: Journal Article
    背景:在亚临床(SC)或无症状感染巴西乳杆菌的个体中介导免疫保护的机制在很大程度上是未知的。中性粒细胞(PMNs)与进行性症状性皮肤利什曼病(CL)有关,但它们在维持亚临床感染方面的潜在参与尚未被探索。这项研究的目的是比较SC感染患者与由于巴西乳杆菌引起的有症状CL患者的PMN的表型和功能特征。
    方法:受试者在CortedePedra流行区招募,巴伊亚,巴西。通过流式细胞术表征定义活化状态的表面标志物。PMN的功能反应,包括吞噬能力,氧化物质的产生,体外研究了细胞内寄生虫的氧化杀伤作用。
    结果:来自SC感染个体的PMN比来自CL患者的PMN表现出更活化的表型和更强的控制感染的能力。相比之下,与SC感染受试者的PMN相比,CL患者的PMN表现出更高的HLA-DR表达和更高的氧化物质产生。
    结论:来自SC感染个体的PMNs比来自CL患者的PMNs更有效地控制感染,尽管氧化剂的产量较低。我们的观察结果表明,巴西乳杆菌可能会逃避CL患者PMN的杀菌机制,有助于寄生虫传播和疾病的建立。
    BACKGROUND: The mechanisms that mediate immune protection in individuals with subclinical (SC) or asymptomatic infection with L. braziliensis are largely unknown. Neutrophils (PMNs) have been implicated in progressive symptomatic cutaneous leishmaniasis (CL), but their potential participation in maintenance of subclinical infection is unexplored. The aim of this study was to compare the phenotypic and functional profiles of PMNs in individuals with SC infection versus patients with symptomatic CL due to L. braziliensis.
    METHODS: Subjects were recruited in the endemic region of Corte de Pedra, Bahia, Brazil. Surface markers to define activation status were characterized by flow cytometry. Functional responses of PMNs including phagocytic capacity, production of oxidative species, and oxidative killing of intracellular parasites were studied in vitro.
    RESULTS: PMNs from individuals with SC infection displayed a more activated phenotype and greater ability to control the infection than PMNs from patients with CL. In contrast, PMNs from patients with CL exhibited higher expression of HLA-DR and higher production of oxidative species than PMNs from subjects with SC infection.
    CONCLUSIONS: PMNs from individuals with SC infection can control the infection more efficiently than PMNs from patients with CL, despite the lower production of oxidants. Our observations suggest that L. braziliensis may evade microbicidal mechanisms of PMNs from patients with CL, contributing to parasite dissemination and the establishment of disease.
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  • 文章类型: Journal Article
    了解不同时期的包膜利什曼病(TL)的分布情况,可以在公共卫生层面采取适当的行动。本研究分析了巴西各市TL发病率的时空演变,并确定了2001年至2020年的优先领域。使用时空扫描统计数据和空间关联的本地指标分析了新病例的通知。由于大多数巴西城市的TL发病率呈下降趋势,在该系列的第一个十年中,高相对风险(RR)的时空集群更为频繁。这些集群集中在北部和东北地区,主要在合法亚马逊地区。在不同地区的城市中发现了最近的高RR地区。巴西的优先城市数量显示出稳定的趋势。在阿克雷州有很多这样的城市,马托格罗索,朗多尼亚,帕拉,和阿马帕,以及罗赖马的大片地区,亚马逊,Maranhão,还有Tocantins,以及戈亚州较小的地区,Ceará,巴伊亚,米纳斯吉拉斯州,圣保罗,和巴拉那。本研究有助于了解巴西TL的历史演变,并为抗击该疾病的行动提供资助。
    Understanding the distribution of tegumentary leishmaniasis (TL) in different periods enables the adequate conduction of actions at the public health level. The present study analyzes the spatiotemporal evolution of TL incidence rates in the municipalities of Brazil and identifies priority areas from 2001 to 2020. Notifications of new cases were analyzed employing space-time scan statistics and Local Indicators of Spatial Association. As TL incidence rates presented a downward trend in most Brazilian municipalities, spatiotemporal clusters of high relative risks (RR) were more frequent in the first decade of the series. There was a concentration of those clusters in the North and Northeast regions, mainly in the Legal Amazon area. More recent high-RR areas were identified in municipalities of different regions. The number of priority municipalities showed a stable trend in Brazil. There was a great concentration of such municipalities in the states of Acre, Mato Grosso, Rondônia, Pará, and Amapá, as well as large areas in Roraima, Amazonas, Maranhão, and Tocantins, and smaller areas in the states of Goiás, Ceará, Bahia, Minas Gerais, São Paulo, and Paraná. The present study contributes to the understanding of the historical evolution of TL in Brazil and subsidizes actions to combat the disease.
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  • 文章类型: Journal Article
    背景:我们在这项研究中的目的是确定在sanlüurfa省诊断的皮肤利什曼病(CL)患者的非典型临床表现。
    方法:这项回顾性研究包括2019年10月至2022年8月间在CL流行地区的sanlüurfaOrientalBoil诊断和治疗中心诊断为CL的1751例患者中213例临床表现不典型的患者。
    结果:我们发现非典型CL的患病率为12.1%。最常见的不典型病变为21号(9.8%),丹毒16(7.5%),脓疱性16(7.5%),累犯15(7%),湿疹15(7%),湿疹样13例(6.1%),坏疽样脓皮病12(5.6%),和孢子囊12(5.6%)。其他有不典型临床表现的病变:查耳松样,疣状,牙窦状,psoriasiform,zosteriform,淋巴瘤样,幼年黄色肉芽肿样,火山般的,牙旁,基底细胞癌样,鳞状细胞癌样,唇疱疹样,角化棘皮瘤样,chancriform,环形,苔藓样,乳腺细胞瘤样,瘢痕疙瘩,表皮样囊肿样,卡波西肉瘤样,瘢痕利什曼病,肉芽肿性唇炎样,菌丝瘤样,传染性软疣,盘状红斑狼疮样,和皮肤纤维瘤一样.
    结论:除了先前报道的非典型临床表现外,我们还定义了皮肤纤维瘤样,卡波西肉瘤样,牙窦状,幼年黄色肉芽肿样,肥大细胞瘤样,和表皮样囊肿.应该记住,CL可以在临床上模仿许多传染性疾病,炎症,和肿瘤疾病,这在长期不愈合的病变的鉴别诊断中应该考虑,尤其是在流行地区。关键信息关于这个主题的已知信息:CL被称为皮肤病学中的伟大模仿者疾病。这项研究补充说:除了以前报道的非典型临床表现外,我们还定义了皮肤纤维瘤样,卡波西肉瘤样,牙窦状,幼年黄色肉芽肿样,肥大细胞瘤样,和表皮样囊肿.这项研究如何影响研究,实践,或策略:CL可以在临床上模仿许多传染性,炎症和肿瘤疾病,这在长期不愈合的病变的鉴别诊断中应该考虑,尤其是在流行地区。
    BACKGROUND: Our objective in this study is to determine the atypical clinical presentations of cutaneous leishmaniasis (CL) patients diagnosed in Şanlıurfa province.
    METHODS: This retrospective study included 213 patients with atypical clinical presentations among 1751 patients diagnosed with CL between October 2019 and August 2022 in Şanlıurfa Oriental Boil Diagnosis and Treatment Center located in an endemic region for CL.
    RESULTS: We found the prevalence of atypical CL to be 12.1%. The most common atypical lesions were lupoid 21 (9.8%), erysipeloid 16 (7.5%), impetiginous 16 (7.5%), recidivan 15 (7%), eczematous 15 (7%), ecthyma-like 13 (6.1%), pyoderma gangrenous-like 12 (5.6%), and sporotrichoid 12 (5.6%). Other lesions with atypical clinical presentations: chalazion-like, verrucous, dental sinus-like, psoriasiform, zosteriform, lymphoma-like, juvenile xanthogranuloma-like, volcano-like, paronychial, basal cell carcinoma-like, squamous cell carcinoma-like, herpes labialis-like, keratoacanthoma-like, chancriform, annular, lichenoid, mastocitoma-like, keloidal, epidermoid cyst-like, kaposi sarcoma-like, scar leishmaniasis, granulomatous cheilitis-like, mycetoma-like, molluscum contagiosum-like, discoid lupus erythematosus-like, and dermatofibroma-like.
    CONCLUSIONS: In addition to the atypical clinical presentations previously reported, we also defined dermatofibroma-like, Kaposi sarcoma-like, dental sinus-like, juvenile xanthogranuloma-like, mastocytoma-like, and epidermoid cyst-like. It should be kept in mind that CL can clinically mimic many infectious, inflammatory, and neoplastic diseases, which should be considered in the differential diagnosis of long-term non-healing lesions, especially in endemic areas. Key message What is already known on this subject:  CL is known as the great imitator disease in dermatology. What this study adds:  In addition to the atypical clinical presentations previously reported, we also defined dermatofibroma-like, Kaposi sarcoma-like, dental sinus-like, juvenile xanthogranuloma-like, mastocytoma-like, and epidermoid cyst-like. How this study might affect research, practice, or policy:  CL can clinically mimic many infectious, inflammatory and neoplastic diseases, which should be considered in the differential diagnosis of long-term non-healing lesions, especially in endemic areas.
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  • 文章类型: Journal Article
    背景:皮肤利什曼病(CL)是由称为利什曼原虫的原生动物寄生虫引起的。它在全球100多个国家流行。尽管它普遍存在并影响生活质量,它是最被忽视的热带皮肤病之一。CL负担通常是基于疾病引起的身体毁容来表示的。然而,考虑到这种疾病的影响不仅仅是身体损伤和患者外表的变化,将有助于更好地理解这种疾病是一个公共卫生问题。本研究确定了CL对患者生活质量的影响。
    方法:使用标准为期一周的皮肤病学生活质量指数(DLQI)问卷收集与生活质量相关的数据。这些问题分为七个领域:症状和感觉,日常活动,工作和学校,休闲,个人关系,和治疗。每个问题都按三分制评分:非常多(3),很多(2)一点点(1),未定(0),一点也不(0)。分数的总和介于0和48之间。分数越高,生活质量越差。使用社会科学统计软件包23输入和分析数据。使用频率和比例来描述数据。在p<0.05时,认为差异具有统计学意义。
    结果:大多数CL患者(60.7%)的生活受到CL的显著影响。25%的CL患者的生活质量受到CL的中度影响。在32.1%的CL患者中,CL对患者生活质量的影响非常大。一名CL患者的生活质量受到极大影响。该疾病对32.1%的CL患者影响较小。人际关系是受影响最大的领域,其次是症状,感觉和治疗。未来的研究包括农村地区是必需的。
    结论:皮肤病学生活质量指数表明,CL对患者的生活质量有很小到非常大的负面影响。
    BACKGROUND: Cutaneous Leishmaniasis (CL) is caused by protozoan parasite called Leishmania. It is endemic in more than 100 countries globally. Despite its vast prevalence and impact on quality of life, it is one of the most neglected tropical dermatological diseases. The CL burden has often been expressed based on the physical disfigurement caused by the disease. However, considering the impact of the disease beyond physical impairment and changes in patients\' appearance would help to better understand the disease as a public health problem. The effect of CL on patients\' quality of life was determined in this study.
    METHODS: The data that were related to quality of life were collected using Standard one-week Dermatology Life Quality Index (DLQI) questionnaire. The questions were categorized under seven domains: symptoms & feelings, daily activities, work and school, leisure, personal relationships, and treatment. Each question was scored on a three-point scale: Very much (3), A lot (2), A little (1), Undecided (0), and Not at all (0). The sum of the scores lied between 0 and 48. A higher score shows worse quality of life. The data were entered and analysed using Statistical Package for Social Science 23. Frequencies and proportions were used to describe the data. Differences were considered statistically significant at p < 0.05.
    RESULTS: The lives of the majority of CL patients (60.7%) were significantly affected by CL. The quality of life of patients was moderately impacted by CL in 25% of the CL patients. In 32.1% of the CL patients, the effect of CL on patients\' quality of life was very large. The quality of one CL patient\'s life was extremely largely affected. The disease had a small effect on 32.1% of the CL patients. Personal relationship was the most affected domain followed by symptoms and feelings and treatment. Future study including rural regions is required.
    CONCLUSIONS: The Dermatology Life Quality Index demonstrates that CL has a small to extremely very large negative effect on the quality of life of patients.
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  • 文章类型: Journal Article
    皮肤利什曼病(CL)是一种由蚊子传播的疾病,在世界许多地区和伊朗都很流行,每年给卫生系统带来巨大负担。本研究旨在基于BASNEF模型在伊朗西北部流行地区确定CL预防行为的有效因素。这项横断面研究是在Bileh-Savar进行的,Ardabil省的流行地区,伊朗\',从2022年6月到2022年10月。通过多阶段抽样方法将200名非患者纳入研究。采用基于BASNEF模型的标准问卷进行数据收集。使用SPSS版本25对数据进行分析。计算平均值和标准偏差来描述连续变量,多元线性回归分析用于确定模型结构对意图和行为的预测。BASNEF构建预测了27%的行为意图变化。在这些结构中,态度对预测变化的贡献更大(R2=0.27,p<0.01)。此外,结果表明,BASNEF构建体预测23%的行为变化。在这些结构中,使能因素对预测变化的贡献更大(R2=0.23,p<0.01)。这一发现表明,行为更多地受到环境因素的影响,以及基于行为改变模型的教育干预,在提供环境条件的同时,可以促进行为改变。
    Cutaneous leishmaniasis (CL) is a disease transmitted by mosquitoes and is endemic in many regions of the world and Iran, and annually imposes a large burden on the health system. This study was conducted to identify the effective factors in the preventive behaviors of CL based on the BASNEF model in endemic areas in the northwest of Iran. This cross-sectional study was conducted in Bileh-Savar, \'endemic areas of Ardabil Province, Iran\', from June 2022 to October 2022. 200 non-patients were included in the study by a multi-stage sampling method. A standard questionnaire based on the BASNEF model was applied for data collection. The data were analyzed using SPSS version 25. Means and standard deviations were calculated to describe the continuous variables, and multivariate linear regression analysis was used to determine the prediction of intention and behavior by the model structures. The BASNEF constructs predict 27% of behavioral intention changes. Among the constructs, attitude has a greater contribution in predicting changes (R2 = 0.27, p < 0.01). Also, the results showed that the BASNEF constructs predict 23% of behavior changes. Among the constructs, enabling factors have a greater contribution to predicting changes (R2 = 0.23, p < 0.01). This finding shows that behavior is more influenced by environmental factors, and educational interventions based on behavior change models, along with providing environmental conditions, can facilitate behavior change.
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  • 文章类型: Journal Article
    背景:位于鼻腔区域的皮肤利什曼病(CL)病变的临床表现可能与许多炎症或肿瘤疾病相混淆。在这项研究中,我们的目的是确定鼻腔受累的频率和位于鼻区的CL病变的形态学变异.
    方法:在这项回顾性研究中,我们包括了那些到我们的皮肤和性病诊所就诊的患者,位于土耳其安纳托利亚东南部地区,2022年9月至2023年10月,被诊断为鼻腔累及CL。从我们诊所鼻腔受累的CL患者的记录来看,我们评估了临床(病变位置,病变类型,病变直径,病变持续时间,治疗)和人口统计学特征(年龄,性别)。
    结果:在使用显微镜检查诊断为CL的患者(n=278)中,34人鼻腔受累,鼻腔受累率为12.2%。19例(55.8%)鼻腔受累患者为男性,15人(44.2%)为女性。在28例患者中检测到急性CL(16例干型病变,12例湿型病变),在6例患者中检测到慢性CL(4例lupoid患者和2例复发型病变患者)。根据临床表现的频率分布,最常见的病变是湿疹样病变,丹毒样病变,鼻癣样病变,和淋巴瘤样病变。
    结论:在CL流行区工作的医师应在鼻腔病变的鉴别诊断中严格考虑CL。CL的早期诊断和治疗可以防止可能的瘢痕形成和粘膜扩散。
    BACKGROUND: The clinical appearance of cutaneous leishmaniasis (CL) lesions located in the nasal area can be confused with many inflammatory or tumoral diseases. In this study, we aimed to determine the frequency of nasal involvement and the morphological variants of CL lesions located in the nasal region.
    METHODS: In this retrospective study, we included patients who presented to our Skin and Venereal Diseases Clinic in the province of Şanlıurfa, located in the Southeastern Anatolia region of Turkey between September 2022 and October 2023, and were diagnosed with CL with nasal involvement. From the records of CL patients with nasal involvement in our clinic, we evaluated the clinical (lesion location, lesion type, lesion diameter, lesion duration, treatment) and demographic characteristics (age, gender).
    RESULTS: Of the patients (n = 278) diagnosed with CL using microscopic examination, 34 had nasal involvement, and the nasal involvement rate was 12.2%. Nineteen (55.8%) of the patients with nasal involvement were male, and 15 (44.2%) were female. Acute CL was detected in 28 patients (16 patients with dry-type lesions, 12 patients with wet-type lesions), and chronic CL was detected in six patients (four patients with lupoid and two patients with recidivant type lesions). According to the frequency distribution of clinical appearance, the most common lesions were eczema-like lesions, erysipeloid-type lesions, rhinophyma-like lesions, and lymphoma-like lesions.
    CONCLUSIONS: Physicians working in CL-endemic regions should strictly consider CL in the differential diagnosis of nasal lesions. Early diagnosis and treatment of CL might prevent possible scarring and mucosal spread.
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  • 文章类型: Journal Article
    皮肤利什曼病是一种新兴的热带病,在巴基斯坦仍然是一个严重的公共卫生问题,特别是在北瓦济里斯坦。目前的研究是为了调查该地区皮肤利什曼病的存在。
    这项前瞻性观察性研究于2018年10月至2020年12月在北瓦济里斯坦地区总部医院Miranshah与Gomal医学院病理学系DeraIsmailKhan合作进行,开伯尔·普赫图赫瓦。针抽吸物用于显微Giemsa染色的载玻片。采用SPSS进行数据分析。
    在5406例临床疑似病例中,2603(48.2%)通过显微镜检查为阳性。在这2603名患者中,1474(57%)为男性,1129(43%)为女性。大部分病变在脸上,其次是上肢和下肢。5-10岁年龄组的比例最高,为1167(45%)。单个病变影响了96.6%的患者,2.7%有双重病变,0.7%有三重病变。从4月到8月,出现了大量的皮肤利什曼病,而最低的数字是11月至12月。
    这项研究提供了有关巴基斯坦北瓦济里斯坦地区皮肤利什曼病存在的广泛信息,以及受这种疾病影响的人的详细人口特征。
    UNASSIGNED: Cutaneous leishmaniasis is an emerging tropical disease that remains a serious public health issue in Pakistan, particularly in North Waziristan. The current research was carried out to investigate the presence of cutaneous leishmaniasis in this region.
    UNASSIGNED: This prospective observational study was conducted from October 2018 to December 2020 at District Head Quarter Hospital Miranshah in North Waziristan with the collaboration of the Pathology Department of Gomal Medical College Dera Ismail Khan, Khyber Pakhtunkhwa. Needle aspirates were used for the microscopic Giemsa-stained slides. SPSS was used for data analysis.
    UNASSIGNED: Of the 5406 clinically-suspected cases, 2603(48.2%) were positive by microscopic examination. Of these 2603 patients, 1474 (57%) were male and 1129 (43%) were female. Most of the lesions were on the face, followed by upper and lower limbs. The 5-10-year age group had the highest percentage of 1167 (45%). A single lesion affected 96.6% of the patients, while 2.7% had double lesions and 0.7% had triple lesions. A high number of cutaneous leishmaniasis were seen from April to August, while the lowest number was seen November to December.
    UNASSIGNED: This study provides extensive information in relation to the existence of cutaneous leishmaniasis in the North Waziristan district of Pakistan, as well as the detailed demographic features of those affected by the disease.
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