Diyarbakır ilindeki layşmanyalı hastaların demografik özellikleri ve coğrafik dağılımı
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Tarih
2015
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info:eu-repo/semantics/closedAccess
Özet
Deri layşmanyazisi Leishmania türü protozoonların neden olduğu bir infeksiyondur. Hastalığın bulaşması infekte Phlebotomus türü sineklerin ısırması ile oluşur. Hastalık Dünya genelinde yaygın olup, Dünya Sağlık Örgütü verilerine göre Dünya’da 350 milyon kişi risk altındadır. Hastalık infekte Phlebotom’un ısırığı ile bulaşır, ısırık yerinde 2-8 hafta sonra bir papül oluşur. Bu papül haftalar içinde büyüyerek merkezinde krutla kaplı ülsere nodüle dönüşür. Lezyon tedavi edilmezse genellikle 1-2 yıl içinde kendiliğinden skarla iyileşir. Hastaların %5-10’unda hastalık 2 yıl içinde iyileşmez ve kronik forma dönüşür. Hastalık bulaşma riskleri endemik bölgede yaşamak, endemik bölgeye seyahat etmek, uygunsuz atık toplama sistemleri, çevrede Phlebotom yaşam koşulları açısından uygun ortam oluşturacak gübre yığınları ve ahırların bulunmasıdır. Ayrıca tedavi edilmeyen infekte bireyler kaynak olarak kalıp, o bölgede daha sonra yeni olguların oluşmasına neden olur. Bu nedenle hastalık kontrolü için, hasta bireylerin tespiti ve tedavisi gereklidir. Bu çalışmanın amacı deri layşmanyazisi hastalarının demografik ve klinik özelliklerini incelemek ve coğrafi dağılımını göstermektir. Hastalık Güney Amerika, Güney Avrupa, Afrika ve Asya’da endemiktir. Komşu ülkelerimiz olan Irak, Suriye ve İran’da da endemiktir. Ülkemizde Güneydoğu Anadolu bölgesi ve Çukurova’da 1950’lerden beri endemikken, yakın zaman Aydın, Antalya, Hatay ve Mersin gibi ülkenin daha batı illerinde de yeni olgular bildirilmiştir. Sağlık Bakanlığı verileri incelendiğinde Diyarbakır ilinde 2002 yılına kadar hiç olgu bildirimi yapılmamışken, 2002 yılında Dicle Üniversitesi Tıp Fakültesi kayıtlarında 14 hastaya rastlanmıştır. Bir Ocak 2011 ile 1 Ocak 2013 yılları arasında Dicle Üniversitesi Tıp Fakültesi Deri ve Zührevi Hastalıkları polikliniğine başvuran deri layşmanyazisli 131 hasta retrospektif olarak incelendi. Hastaların yaş ortalaması 22,4±20,4’tü. Hastaların %64,9’u 0-19 yaş aralığındaydı. Hastaların 71’i kadın, 60’ı erkekti (Kadın:Erkek oranı 1.18:1). Hastalık başlangıcı ve polikliniğe başvuru arasında geçen süre 1-132 ay arasında değişirken, ortalama 10,1±16,5 ay olarak saptandı. Hastaların %51,1’i öğrenci, %29,9’u ev hanımı, %2,3’ü işçi, %5,3’ü çiftçi, %0,8’i (1 hasta) uzun yol şoförü ve %0,8’i (1 hasta) serbest meslek sahibiydi. Hastaların %16,8’i (22 hasta) çalışmıyordu. Hastaların %81,3’ü (107 hasta) akut, %18,3’ü (24 hasta) kronik formdaydı. Akut formdaki hastaların % 22,4’ünü (24 hasta) yaş tip ve %77,5’ini (83 hasta) kuru tip oluşturmaktaydı. Kronik form hastaların %91,6’sını (22 hasta) rezidivan ve %8,3’ünü (2 hasta) kronik lupoid tip oluşturmaktaydı. Çalışmaya dahil edilen 131 hastada toplam 246 lezyon tespit edildi. Lezyonların %56’sı (138 lezyon) sadece yüz yerleşimliydi. Hastalardaki lezyon sayısı 1 ile 7 arasında değişmekteydi. Hastaların ortalama lezyon sayısı 1,8±1,5’ti. Hasaların lezyon çapları 0,5 ile 9 cm arasındaydı. Hastaların tamamında yaymalarda amastigotlar görülerek tanı konuldu. Hastaların %79,4’üne (104 hasta) tedavi verilirken, %20,6’sına (27 hasta) tedavi verilmedi. Hastalık veya hastalığın tedavisi nedeniyle ölüm vakası olmadı.
Cutaneous Leishmaniasis is a skin infection caused by protozoan parasites of the genus Leishmania. The disease is transmitted through the bites of infected Phlebotomus flies. The disease is endemic to many parts of the World, and according to the data of the WHO, 350 million people are under risk. The disease is transmitted by the bite of infected Phlebotomus, and a papule occurs in the bite site 2-8 weeks later. This papule enlarges over time and turns into an ulcerated nodule. The lesion no treated heals generally, leaving scar within 1-2 years. In 5-10% of patients, however, the disease does not heal and becomes chronic. The risks of the disease transmission are to live in an endemic area, to travel to endemic area, lack of adequate waste management systems, as well as existence of manure piles and barns that may form an environment for favourable living conditions for Phlebotom. In addition, untreated infected individuals may also be a reservoir, leading to occurrence of new cases in that site. Therefore, for the control of the disease, it is of utmost importance to determine individuals with disease and treat them. The aim of this study is to investigate demographic and clinic features of the patients with cutaneous leishmaniasis and demonstrate their geographical distribution. The disease is endemic in Southern America, Southern Europe, Africa and Asia. Our neighbouring countries, such as Iraq, Syria and Iran are also endemic. As far as our country is concerned, while Southeastern Anatolia and Cukurova regions have been endemic since the 1950s, new cases have also been reported from the western parts of the country such as Aydın, Antalya, Hatay and Mersin. When the data of Health Ministry were investigated, no case was reported in Diyarbakır by 2002; however, 14 cases were identified in the records of Medical Faculty, Dicle University, in 2002. A total of 131 patients with cutaneous leishmaniasis, applying to the outpatient clinic of skin and veneral diseases, Medical faculty, Dicle University, between 1 January 2011 and 1 January 2013, were investigated retrospectively. The mean age of the patients was 22,4±20,4 years. Of the patients, 64,9% were between 0-19 years of age. Of them, 71 were female and 60 were male (Female/male ratio; 1.18:1). While the duration between the onset of the disease and approved to the outpatient clinic ranged from 1 to 132 months, the mean duration was 10,1±16,5 months. Of the patients, 51,1% were student, 29,9% house-wife, 2,3% worker, 5,3% farmer, 0,8% (1 patient) was lorry driver and 0,8% (1 patient) self-employed. However, 16,8% (22 patients) of the patients were unemployed. Of the patients, 81,3 (107) were in acute, 18,3% (24) were in chronic form. Of the patients in acute form, 22,4% (24) had wet type, whereas 77,5% (83) had dry type. Of the chronic form patients, 91,6% formed residive type, 8,3% chronic lupoid type. In 131 patients included into the study, 246 lesions were detected. Of the lesions, 56% (138) were located only on the face. The number of lesions in patients varied from 1 to 7. The mean number of the lesions was 1,8±1,5. The lesion diameters were between 0,5 and 9 cm. In all the patients, the diagnosis was made by seeing amastigotes through smear. While 79,4% (104) of the patients were given treatment, 20,6% (27) were not. No death case occurred due to the disease or the treatment of the disease.
Cutaneous Leishmaniasis is a skin infection caused by protozoan parasites of the genus Leishmania. The disease is transmitted through the bites of infected Phlebotomus flies. The disease is endemic to many parts of the World, and according to the data of the WHO, 350 million people are under risk. The disease is transmitted by the bite of infected Phlebotomus, and a papule occurs in the bite site 2-8 weeks later. This papule enlarges over time and turns into an ulcerated nodule. The lesion no treated heals generally, leaving scar within 1-2 years. In 5-10% of patients, however, the disease does not heal and becomes chronic. The risks of the disease transmission are to live in an endemic area, to travel to endemic area, lack of adequate waste management systems, as well as existence of manure piles and barns that may form an environment for favourable living conditions for Phlebotom. In addition, untreated infected individuals may also be a reservoir, leading to occurrence of new cases in that site. Therefore, for the control of the disease, it is of utmost importance to determine individuals with disease and treat them. The aim of this study is to investigate demographic and clinic features of the patients with cutaneous leishmaniasis and demonstrate their geographical distribution. The disease is endemic in Southern America, Southern Europe, Africa and Asia. Our neighbouring countries, such as Iraq, Syria and Iran are also endemic. As far as our country is concerned, while Southeastern Anatolia and Cukurova regions have been endemic since the 1950s, new cases have also been reported from the western parts of the country such as Aydın, Antalya, Hatay and Mersin. When the data of Health Ministry were investigated, no case was reported in Diyarbakır by 2002; however, 14 cases were identified in the records of Medical Faculty, Dicle University, in 2002. A total of 131 patients with cutaneous leishmaniasis, applying to the outpatient clinic of skin and veneral diseases, Medical faculty, Dicle University, between 1 January 2011 and 1 January 2013, were investigated retrospectively. The mean age of the patients was 22,4±20,4 years. Of the patients, 64,9% were between 0-19 years of age. Of them, 71 were female and 60 were male (Female/male ratio; 1.18:1). While the duration between the onset of the disease and approved to the outpatient clinic ranged from 1 to 132 months, the mean duration was 10,1±16,5 months. Of the patients, 51,1% were student, 29,9% house-wife, 2,3% worker, 5,3% farmer, 0,8% (1 patient) was lorry driver and 0,8% (1 patient) self-employed. However, 16,8% (22 patients) of the patients were unemployed. Of the patients, 81,3 (107) were in acute, 18,3% (24) were in chronic form. Of the patients in acute form, 22,4% (24) had wet type, whereas 77,5% (83) had dry type. Of the chronic form patients, 91,6% formed residive type, 8,3% chronic lupoid type. In 131 patients included into the study, 246 lesions were detected. Of the lesions, 56% (138) were located only on the face. The number of lesions in patients varied from 1 to 7. The mean number of the lesions was 1,8±1,5. The lesion diameters were between 0,5 and 9 cm. In all the patients, the diagnosis was made by seeing amastigotes through smear. While 79,4% (104) of the patients were given treatment, 20,6% (27) were not. No death case occurred due to the disease or the treatment of the disease.
Açıklama
Anahtar Kelimeler
Demografi, Demography, Deri, Skin, Deri hastalıkları, Skin diseases, Diyarbakır, Leishmania, Phlebotomus, Protozoa
