CSCH Overall patient characteristics.

BackgroundVisceral Leishmaniasis (VL) is a neglected tropical disease (NTD) with the highest regional burden in East Africa. Relapse and Post Kala-azar Dermal Leishmaniasis (PKDL) contribute to the spread of VL in endemic areas, making their surveillance imperative for control and elimination. Little is known about long-term patient outcomes in Kenya through follow-up after VL treatment, despite its requirement for control and elimination by the World Health Organization (WHO) and the Kenya Ministry of Health (KMOH).Methodology/Principal findings36 follow-up patients in Tiaty East and West, sub-counties, Kenya, and records from 248 patients at the regional Chemolingot Sub-county Hospital (CSCH) were analyzed separately using Fisher’s Exact Tests, two-sample t-tests, and Welch’s t-tests in R (Version 4.3.0). The study found a prevalence rate of 88.89% (n = 32) final cure, 5.56% (n = 2) relapse, and 5.56% (n = 2) PKDL in follow-up patients and 92.74% (n = 230) initial cure, 6.86% (n = 17) relapse, and 0.80% (n = 2) PKDL in overall CSCH patients. The mean lengths of time at which follow-up patients relapsed and developed PKDL were 4.5 and 17 months, respectively. Young age (p = 0.04, 95% CI 0.63–24.31), shorter length of time from initial treatment to follow-up (p = 0.002, 95% CI 1.03-∞), lower Hb level at primary treatment (p = 0.0002, 95% CI 1.23–3.24), and living in Tiaty East sub-county (p = 0.04, 95% CI 0.00–1.43) were significantly associated (pConclusions/SignificanceMore research should be done on PKDL in Kenya with active follow-up to understand its true burden. These results on prevalence and risk factors for PKDL and relapse in Kenya should inform knowledge of patient outcomes and interventions in the region.

研究背景
内脏利什曼病（Visceral Leishmaniasis, VL）是一类被忽视的热带病（neglected tropical disease, NTD），东非地区为全球疾病负担最高的区域。复发与黑热病后皮肤利什曼病（Post Kala-azar Dermal Leishmaniasis, PKDL）会推动流行区内脏利什曼病的传播，因此对二者开展监测对于疾病防控与消除工作至关重要。尽管世界卫生组织（World Health Organization, WHO）与肯尼亚卫生部（Kenya Ministry of Health, KMOH）均要求通过治疗后随访来实现该病的防控与消除，但目前学界对肯尼亚内脏利什曼病患者接受规范治疗后的长期预后情况仍知之甚少。

研究方法与主要结果
本研究分别针对肯尼亚蒂亚蒂东与蒂亚蒂西两个分区的36名随访患者，以及区域级切莫林戈特分区医院（Chemolingot Sub-county Hospital, CSCH）的248份患者病历展开分析，分析工具为R语言（版本4.3.0）中的费希尔精确检验、两样本t检验与韦尔奇t检验。
研究结果显示：随访患者队列中，最终治愈比例为88.89%（n=32）、复发比例为5.56%（n=2）、黑热病后皮肤利什曼病比例为5.56%（n=2）；切莫林戈特分区医院全体患者队列中，初始治愈比例为92.74%（n=230）、复发比例为6.86%（n=17）、黑热病后皮肤利什曼病比例为0.80%（n=2）。随访患者出现复发与黑热病后皮肤利什曼病的平均发病间隔时间分别为4.5个月与17个月。分析结果表明，低龄（p=0.04, 95%CI 0.63–24.31）、从初始治疗至随访的间隔时长更短（p=0.002, 95%CI 1.03-∞）、初始治疗时血红蛋白水平更低（p=0.0002, 95%CI 1.23–3.24）以及居住于蒂亚蒂东分区（p=0.04, 95%CI 0.00–1.43）与不良预后存在显著相关性（p

研究结论与意义
本研究提示，肯尼亚地区需针对黑热病后皮肤利什曼病开展主动随访相关研究，以明确其真实疾病负担。本次关于肯尼亚黑热病后皮肤利什曼病与复发的患病比例及危险因素的研究结果，可为该地区的患者预后认知与干预措施制定提供科学参考依据。