Comparative Assessment of Topical Glucantime® Injection Plus Cryotherapy and Cryotherapy Alone for Treatment of Anthroponotic Cutaneous Leishmaniasis

Abstract

Background: Cutaneous leishmaniasis is a worldwide health problem due to the complications in the transmission cycle, treatment failure, and post-healing problems. Objectives: Infected humans are the parasite reservoirs in the transmission cycle of anthroponotic cutaneous leishmaniasis (ACL); thus, the lack of efficient treatment increases the risk of the disease outbreak. The gold standard treatment for CL is mainly the topical or systematic use of antimonial compounds. Much research has been done on the development of topical therapy alone or in combination with cryotherapy. Therefore, this study was conducted to comparatively evaluate the current treatment protocol, cryotherapy, versus combined cryotherapy (Cryo) and intralesional Glucantime® (IG). Methods: This quasi-experimental study was performed on 476 patients with cutaneous leishmaniasis lesions referred to the health centers of a CL endemic area in southern Iran (Bam County, Kerman Province) during 2013 - 2019. A total of 200 cases with 301 lesions received Cryo using liquid nitrogen once every two weeks, and 276 cases with 406 lesions received weekly IG combined with Cryo, once every two weeks. The lesion size was recorded before and after the treatment. At seven and 12 weeks after the treatment, the lesion healing rate was monitored. Healing was defined as complete re-epithelialization. The obtained data were assessed using logistic regression to calculate the relative risk and therapeutic effects. Results: Out of 476 CL patients with 709 lesions, 200 cases with 221 lesions received Cryo, and 276 patients with 292 lesions received Cryo plus IG. At the seventh week after the treatment, complete healing was observed in 100 out of 221 cases (50%) in the group that received biweekly Cryo only and 225 out of 276 cases (81.5%) in the group that received biweekly Cryo plus weekly IG (P = 0.001). Conclusions: This study found that the use of cryotherapy plus intralesional Glucantime® increases the chance of healing for patients by 4.4 times compared to the use of cryotherapy alone.