目的分析1990—2021年全球内脏利什曼病(visceral leishmaniasis,VL)疾病负担变化,并预测2022—2035年VL疾病负担变化趋势,为全球VL防控提供科学依据。方法基于2021年全球疾病负担研究(Global Burden of Disease Study 2021)数据库,获...目的分析1990—2021年全球内脏利什曼病(visceral leishmaniasis,VL)疾病负担变化,并预测2022—2035年VL疾病负担变化趋势,为全球VL防控提供科学依据。方法基于2021年全球疾病负担研究(Global Burden of Disease Study 2021)数据库,获取全球VL年龄标化发病率、患病率、死亡率和伤残调整寿命年(disability-adjusted life years,DALYs)率及其95%不确定性区间(uncertainty interval,UI),采用平均年度变化百分比(average annual percent change,AAPC)及其95%可信区间(confidence interval,CI)描述1990—2021年全球VL疾病负担变化趋势,并按性别、年龄组、国家、地理区域和社会人口学指数(socio-demographic index,SDI)分层后进行分析。采用贝叶斯年龄-时期-队列(Bayesian age-period-cohort,BAPC)模型预测2022—2035年全球VL疾病负担及其变化趋势,采用平滑样条模型分析VL年龄标化发病率、患病率、死亡率、DALYs率与SDI间的相关性。结果1990—2021年全球VL年龄标化发病率[AAPC=-0.25%,95%CI:(-0.25%,-0.24%)]、患病率[AAPC=-0.06%,95%CI:(-0.06%,-0.06%)]、死亡率[AAPC=-0.25%,95%CI:(-0.25%,-0.24%)]和DALYs率[AAPC=-2.38%,95%CI:(-2.44%,-2.33%)]均呈下降趋势。2021年全球不同地理区域中,热带拉丁美洲地区VL年龄标化发病率[2.55/10万,95%UI:(1.49/10万,4.07/10万)]、患病率[0.64/10万,95%UI:(0.37/10万,1.02/10万)]、死亡率[0.51/10万,95%UI:(0,1.80/10万)]、DALYs率[33.81/10万,95%UI:(0.06/10万,124.09/10万)]均最高;全球男性VL年龄标化发病率[0.57/10万,95%UI:(0.45/10万,0.72/10万)]和患病率[0.14/10万,95%UI:(0.11/10万,0.18/10万)]均高于女性[0.27/10万,95%UI:(0.21/10万,0.33/10万);0.06/10万,95%UI:(0.05/10万,0.08/10万)];各年龄组中,5岁以下儿童VL死亡率[0.24/10万,95%UI:(0.08/10万,0.66/10万)]最高。1990—2021年,全球VL年龄标化发病率(r=-0.483,P<0.001)、患病率(r=-0.483,P<0.001)、死亡率(r=-0.511,P<0.001)和DALYs率(r=-0.514,P<0.001)与SDI水平呈显著负相关。经BAPC模型预测,2022—2035年全球VL疾病负担呈下降趋势,2035年VL年龄标化发病率、患病率、死亡率、DALYs率将分别下降至0.11/10万、0.03/10万、0.02/10万、1.44/10万。结论1990—2021年全球VL疾病负担总体呈下降趋势,但中亚和西部撒哈拉以南非洲地区呈上升趋势;男性VL年龄标化发病率及患病率、5岁以下儿童VL年龄标化死亡率相对较高。预测2022—2035年全球VL疾病负担将持续下降。展开更多
Objective:To characterize the pediatric population with cutaneous leishmaniasis treated at a research center and to determine the therapeutic response and safety of the treatment.Methods:A cross-sectional study was de...Objective:To characterize the pediatric population with cutaneous leishmaniasis treated at a research center and to determine the therapeutic response and safety of the treatment.Methods:A cross-sectional study was designed,in which data related to sociodemographic information,history of leishmaniasis,clinical characteristics,treatment,therapeutic response and adverse events were collected from the review of the clinical records.Results:The analysis was conducted in 156 pediatric patients with median age of 10.5(6-14)years.Regarding clinical and therapeutic characteristics,the lesions in these patients were mostly single ulcers,primarily located on the upper and lower extremities.A total of 114 patients were managed at Programa de Estudio y Control de Enfermedades Tropicales(PECET),and 26 of them received more than one treatment.Upon administration of the first therapeutic option,intralesional meglumine antimoniate had a cure rate of 43.18%(19/44 patients),followed by systemic meglumine antimoniate with a cure rate of 40%(8/20)and topical investigational medication with a cure rate of 25%(5/20).The most frequent adverse events were:arthralgia and myalgia for systemic meglumine antimoniate;nausea and vomiting for miltefosine;and local pain,edema,erythema and rash for topical treatment.Conclusions:Although more prospective studies are needed to generate evidence-based recommendations and management protocols,miltefosine appears to be a favorable,safe and well-tolerated therapeutic option for the pediatric population.Despite the high percentage of loss to follow-up,the success achieved in pediatric patients with local treatments suggests that local therapies could also be considered for managing this condition in this population.展开更多
文摘Objective:To characterize the pediatric population with cutaneous leishmaniasis treated at a research center and to determine the therapeutic response and safety of the treatment.Methods:A cross-sectional study was designed,in which data related to sociodemographic information,history of leishmaniasis,clinical characteristics,treatment,therapeutic response and adverse events were collected from the review of the clinical records.Results:The analysis was conducted in 156 pediatric patients with median age of 10.5(6-14)years.Regarding clinical and therapeutic characteristics,the lesions in these patients were mostly single ulcers,primarily located on the upper and lower extremities.A total of 114 patients were managed at Programa de Estudio y Control de Enfermedades Tropicales(PECET),and 26 of them received more than one treatment.Upon administration of the first therapeutic option,intralesional meglumine antimoniate had a cure rate of 43.18%(19/44 patients),followed by systemic meglumine antimoniate with a cure rate of 40%(8/20)and topical investigational medication with a cure rate of 25%(5/20).The most frequent adverse events were:arthralgia and myalgia for systemic meglumine antimoniate;nausea and vomiting for miltefosine;and local pain,edema,erythema and rash for topical treatment.Conclusions:Although more prospective studies are needed to generate evidence-based recommendations and management protocols,miltefosine appears to be a favorable,safe and well-tolerated therapeutic option for the pediatric population.Despite the high percentage of loss to follow-up,the success achieved in pediatric patients with local treatments suggests that local therapies could also be considered for managing this condition in this population.
