Post-Kala-azar Dermal Leishmaniasis in Nepal A Retrospective Cohort Study (2000–2010) 英文参考文献.docVIP

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Post-Kala-azar Dermal Leishmaniasis in Nepal A Retrospective Cohort Study (2000–2010) 英文参考文献.doc

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Post-Kala-azar Dermal Leishmaniasis in Nepal A Retrospective Cohort Study (2000–2010) 英文参考文献

Post-Kala-azarDermalLeishmaniasisinNepal:A RetrospectiveCohortStudy(2000–2010) SurendraUranw1,2,BartOstyn2*,ArpanaRijal3,SaruDevkota1,BasudhaKhanal4,JorisMenten2, MarleenBoelaert2,SumanRijal1 1DepartmentofInternalMedicine,B.P.KoiralaInstituteofHealthSciences,Ghopa,Dharan,Nepal,2DepartmentofPublicHealth,InstituteofTropicalMedicine,Antwerp, Belgium,3DepartmentofDermatology,B.P.Koirala Institute ofHealth Sciences, Ghopa,Dharan,Nepal, 4DepartmentofMicrobiology, B.P. KoiralaInstitute ofHealth Sciences,Ghopa,Dharan,Nepal Abstract Introduction:Post-kala-azardermalleishmaniasis(PKDL)isacutaneouscomplicationappearingaftertreatmentofvisceral leishmaniasis,andPKDLpatientsareconsideredinfectioustosandfliesandmaythereforeplayaroleinthetransmissionof VL.WeestimatedtheriskandriskfactorsofPKDLinpatientswithpastVLtreatmentinsouth-easternNepal. Methods:BetweenFebruaryandMay2010wetracedallpatientswhohadreceivedVLtreatmentduring2000–2009infive high-endemic districts and screened them for PKDL-like skin lesions. Suspected cases were referred to a tertiary care hospitalforconfirmationbyparasitology(slitskinsmear(SSS))and/orhistopathology.WecalculatedtheriskofPKDLusing Kaplan-Meiersurvivalcurvesandexactlogisticregressionforriskfactors. Results: Out of 680 past-treated VL patients, 37(5.4%) presented active skin lesions suspect of PKDL during the survey. Thirty-threeofthemunderwentdermatologicalassessment,and16(2.4%)wereascertainedasprobable(2)orconfirmed (14)PKDL.Survivalanalysisshoweda1.4%riskofPKDLwithin2yearsofVLtreatment.All16hadbeenpreviouslytreated with sodium stibogluconate (SSG) for their VL. In 5, treatment had not been completed (#21 injections). Skin lesions developedafteramediantimeintervalof23months[interquartilerange(IQR)16–40].WefoundahigherPKDLrate(29.4%) inthoseinadequatelytreatedcomparedtothosewhoreceivedafullSSGcourse(2.0%).Inthelogisticregressionmodel, unsupervised treatment [odds ratio (OR)=8.58, 95% CI 1.21–374.77], and inadequate SSG treatment for VL in the pa