Clinico-Epidemiological Profile of Adolescent and Adult Patients with Tegumentary Leishmaniasis from the Colombian Southwest 2004–2014: Considerations for Local Therapies

Abstract

Background Systemic treatments for Cutaneous Leishmaniasis (CL) have many limitations. Local therapies are an alternative option for this disease. Available Pan-American Health Organization (PAHO) and World Health Organization (WHO) treatment guidelines were designed based on expert opinion considering clinical criteria for local treatment which influences feasibility of implementation of these treatment modalities. In this study, we evaluated the clinico-epidemiological profile and the eligibility for the use of local therapies with current guidelines of patients with CL at the Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM) from 2004 to 2014.Methods A descriptive study was conducted based on clinical records of adolescents (≥12 years) and adults (≥18 years) with confirmed parasitological diagnosis of tegumentary leishmaniasis. Incomplete or unconfirmed records were excluded. We applied WHO criteria (≤3 lesions, longest diameter <5 cm, no disfiguring/incapacitating potential, no immunosuppression) and PAHO (single lesion, diameter ≤3 cm, any location except head and joints, absence of immunosuppression) to assess eligibility for local treatment.ResultsAmong 3,691 records, a total of 1,834 met inclusion criteria. Fourteen percent of records were from adolescent patients and 86% were adults, all from southwestern Colombia. Regarding the clinical presentation of patients, most (57.3%) had a single lesion and 86.2% had ≤ 3 lesions with a median = 2 cm (IQR 1–2). Lesions presented predominantly on upper limbs (40.9%), followed by lower limbs (23.2%). According to PAHO and WHO criteria, 18% (12.3% adult vs. 19.3%, P = 0.007) and 44.4% (adolescents 42% vs. adults 43%, P = 0.45), respectively, were eligible for local therapies.Conclusion Local therapies have feasible use in this population with mild and uncomplicated clinical presentation; however, its applicability is limited to current management criteria. Individualized risk–-benefit assessment may increase eligibility.Disclosures All authors: No reported disclosures.