Cutaneous Leishmaniasis Patients Research Articles

Comparison of urine and serum IgG detection ELISA for tegumentary leishmaniasis diagnosis and prognosis

Laboratorial diagnosis of tegumentary leishmaniasis (TL) is hampered by variable sensitivity and/or specificity of the tests, which are still hampered by blood́ invasive collection. In this context, in the present study, we develop a serum- and urine-based ELISA to TL diagnoses. A recombinant protein (rLiHyA), which was previously showed to be antigenic for the disease, as well as a B-cell epitope produced as synthetic peptide and a Leishmania antigenic extract (SLA), were used as antigens. A total of paired 205 urine and serum samples were used, which were comprised by samples from cutaneous (n = 30) and mucosal (n = 30) leishmaniasis patients, as well as from healthy individuals living in endemic region of disease (n = 45), of patients with Chagas disease (n = 30), leprosy (n = 35), malaria (n = 15) or HIV-infected (n = 20). Results showed that serum-based ELISA presented sensitivity of 24.0 %, 100 % and 41.0 %, when SLA, rLiHyA and synthetic peptide were used as antigens, and specificity of 98.4 %, 98.4 % and 98.4 %, respectively. The area under the curve (AUC) was calculated and results were 0.74, 1.0, and 0.71, respectively, when SLA, rLiHyA and synthetic peptide were used as antigens. Performing an urine-based ELISA, sensitivity was 28.0 %, 100 % and 75.0 %, respectively, when SLA, rLiHyA, and synthetic peptide were used, while specificity values were of 98.4 %, 98.4 % and 98.4 %, respectively. In addition, the AUC values were 0.82, 1.0, and 0.94, respectively. A significant drop in specific antibodies levels in both patientś serum and urine samples was found six months after treatment, suggesting a prognostic role of rLiHyA for TL. In conclusion, preliminary data suggest the potential of use patient urine to TL diagnoses.

Assessing the health-related quality of life of cutaneous Leishmaniasis patients in Draa-Tafilalet, southeastern Morocco

Cutaneous leishmaniasis is a significant public health concern globally. This study aims to evaluate the impact of cutaneous leishmaniasis on the quality of life of patients in the Draa-Tafilalet region of Morocco. In this cross-sectional study, data were collected from 87 patients between December 2022 and July 2023 using the Skindex-16 questionnaire. The results revealed that cutaneous leishmaniasis has a mild to moderate impact on health-related quality of life, with 26.4 % of participants reporting a low impact and 73.6 % reporting a moderate impact. A significant gender difference was observed in Skindex-16 scores, with moderate impact being more prevalent among females (60.90 % vs. 30.10 %, p = 0.002). Furthermore, facial lesions were associated with a statistically significant reduction in quality of life, particularly in the emotional (p < 0.001) and functioning (p = 0.01) domains. These findings highlight the need for targeted management strategies that address the substantial impact of cutaneous leishmaniasis on patients' quality of life. Future studies with larger sample sizes and extended follow-up periods are warranted to further elucidate the effects of cutaneous leishmaniasis on patients' well-being.

Prevalence of Bacterial Infections among Cutaneous Leishmaniasis Patients

Prevalence of Bacterial Infections among Cutaneous Leishmaniasis Patients

Effect Of Pentavalent Antimony Compounds On The İnflammatory, Hematological and Biochemical Parameters İn Patients With Cutaneous Leishmaniasis

Objective This study aimed to evaluate how systemic antimony treatment in cutaneous leishmaniasis (CL) patients affects biochemical, hematological, and inflammatory parameters in child and adult patient groups. Methods A total of 50 patients (29 adults, 21 children) who received systemic meglumine antimonate (MA) treatment in the skin and venereal diseases clinic between September 2022 and January 2024 and were diagnosed with CL by microscopic examination were included in the study. The medical records of the patients were examined retrospectively. Before and after treatment, neutrophil count, leukocyte count, lymphocyte count, hemoglobin concentration, platelet count, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), mean platelet volume (MPV), amylase, lipase, alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood urea nitrogen and serum creatinine levels were recorded. Results In the children group, lymphocyte and platelet values decreased statistically significantly; and lipase value increased statistically significantly after treatment. In the adult group; hemoglobin, neutrophil, lymphocyte and leukocyte values decreased statistically significantly; ALT, AST, amylase, lipase, NLR and PLR values increased statistically significantly after treatment. Conclusion Based on the data in our study, it was stated that systemic meglumine antimonate treatment may lead to an increase in pancreatic enzymes and transaminases and bone marrow suppression. We also think that patients in the adult age group should be followed more closely regarding pancreatic enzymes and kidney function tests than the pediatric age group.

Association of Intestinal Helminthiasis with Disseminated Leishmaniasis, Brazil.

Disseminated leishmaniasis is an emerging clinical form of Leishmania braziliensis infection. Evidence shows that co-infection by L. braziliensis and intestinal helminths does not affect clinical manifestations or response to therapy in cutaneous leishmaniasis patients. We evaluated whether co-infection was associated with those aspects in disseminated leishmaniasis patients in Brazil.

Clinical pattern and treatment outcome of cutaneous leishmaniasis patients in Somali region, eastern Ethiopia

Clinical pattern and treatment outcome of cutaneous leishmaniasis patients in Somali region, eastern Ethiopia

Efficacy of a Combined Herbal Product Containing Indigofera argentea, Pistacia atlantica and Salvia hispanica in Zoonotic Cutaneous Leishmaniasis Patients Treated along Glucantime ®.

Leishmaniasis is highly prevalent worldwide, and while conventional medicine offers numerous treatment methods for cutaneous leishmaniasis, Iranian traditional medicine suggests various remedies. We aimed to evaluate the efficacy of an herbal combination containing Indigofera argentea leaves, Pistacia atlantica resin, and Salvia hispanica seeds in patients with zoonotic cutaneous leishmaniasis. This study was conducted at the Leishmaniasis Department of Chabahar Health Center in southeastern Iran in 2021. It was a double-blinded randomized clinical trial involving 68 patients enrolled after clinical diagnosis, examination of smear samples using Giemsa staining, and PCR confirmation. The volunteers were randomly divided into intervention and control groups. Both groups received 'Glucantime ® as the primary medication weekly until complete healing or up to 12 weeks. Glucantime ® was administered intralesionally at a dosage of 0.1 cc on the wound's margin, with repeat injections at 1 cm intervals along the wound edge when necessary. In addition to the main drug, the intervention group received the herbal product topically twice daily until wound healing or for up to 4 weeks, while the control group received a placebo in the same manner. 82.35% of patients in the intervention group and 20.58% in the control group achieved complete healing within four weeks. There was a significant difference between the two groups (P < 0.001). The herbal product demonstrated effectiveness in treating patients with zoonotic cutaneous leishmaniasis.

Many faces of cutaneous leishmaniasis.

Our objective in this study is to determine the atypical clinical presentations of cutaneous leishmaniasis (CL) patients diagnosed in Şanlıurfa province. This retrospective study included 213 patients with atypical clinical presentations among 1751 patients diagnosed with CL between October 2019 and August 2022 in Şanlıurfa Oriental Boil Diagnosis and Treatment Center located in an endemic region for CL. We found the prevalence of atypical CL to be 12.1%. The most common atypical lesions were lupoid 21 (9.8%), erysipeloid 16 (7.5%), impetiginous 16 (7.5%), recidivan 15 (7%), eczematous 15 (7%), ecthyma-like 13 (6.1%), pyoderma gangrenous-like 12 (5.6%), and sporotrichoid 12 (5.6%). Other lesions with atypical clinical presentations: chalazion-like, verrucous, dental sinus-like, psoriasiform, zosteriform, lymphoma-like, juvenile xanthogranuloma-like, volcano-like, paronychial, basal cell carcinoma-like, squamous cell carcinoma-like, herpes labialis-like, keratoacanthoma-like, chancriform, annular, lichenoid, mastocitoma-like, keloidal, epidermoid cyst-like, kaposi sarcoma-like, scar leishmaniasis, granulomatous cheilitis-like, mycetoma-like, molluscum contagiosum-like, discoid lupus erythematosus-like, and dermatofibroma-like. In addition to the atypical clinical presentations previously reported, we also defined dermatofibroma-like, Kaposi sarcoma-like, dental sinus-like, juvenile xanthogranuloma-like, mastocytoma-like, and epidermoid cyst-like. It should be kept in mind that CL can clinically mimic many infectious, inflammatory, and neoplastic diseases, which should be considered in the differential diagnosis of long-term non-healing lesions, especially in endemic areas. Key message What is already known on this subject: CL is known as the great imitator disease in dermatology. What this study adds: In addition to the atypical clinical presentations previously reported, we also defined dermatofibroma-like, Kaposi sarcoma-like, dental sinus-like, juvenile xanthogranuloma-like, mastocytoma-like, and epidermoid cyst-like. How this study might affect research, practice, or policy: CL can clinically mimic many infectious, inflammatory and neoplastic diseases, which should be considered in the differential diagnosis of long-term non-healing lesions, especially in endemic areas.

Natural resistance to meglumine antimoniate is associated with treatment failure in cutaneous leishmaniasis caused by Leishmania (Viannia) panamensis.

The multifactorial basis of therapeutic response can obscure the relation between antimicrobial drug susceptibility and clinical outcome. To discern the relationship between parasite susceptibility to meglumine antimoniate (SbV) and therapeutic outcome of cutaneous leishmaniasis, risk factors for treatment failure were considered in evaluating this relationship in ninety-one cutaneous leishmaniasis patients and corresponding clinical strains of Leishmania (Viannia) panamensis. Parasite susceptibility to 32 μg SbV/mL (plasma Cmax) was evaluated in primary human macrophages, PBMCs, and U937 macrophages. Early parasitological response to treatment was determined in lesions of a subgroup of patients, and pathogenicity of Sb-resistant and sensitive clinical strains was compared in BALB/c mice. Parasite survival in cell models and patient lesions was determined by qRT-PCR of Leishmania 7SLRNA transcript. Parasite loads in BALB/c mice were quantified by limiting dilution analysis. The disparate Sb-susceptibility of parasite subpopulations distinguished by isoenzyme profiles (zymodemes) was manifest in all cell models. Notably, Sb-resistance defined by parasite survival, was most effectively discerned in U937 macrophages compared with primary human host cells, significantly higher among strains from patients who failed treatment than cured and, significantly associated with treatment failure. Each unit increase in transformed survival rate corresponded to a 10.6-fold rise in the odds of treatment failure. Furthermore, treatment failure was significantly associated with naturally Sb-resistant zymodeme 2.3 strains, which also produced larger lesions and parasite burdens in BALB/c mice than Sb-sensitive zymodeme 2.2 strains. The confounding effect of host risk factors for treatment failure in discerning this association was evidenced in comparing strains from patients with and without the defined risk factors for treatment failure. These results establish the association of natural resistance to meglumine antimoniate with treatment failure, the importance of host risk factors in evaluating drug susceptibility and treatment outcome, and the clinical and epidemiological relevance of natural Sb-resistance in L. (V.) panamensis subpopulations.

Clinical presentations, parasite genotypes, gene expression and immunological profiles of cutaneous Leishmaniasis patients in lay Gayint, Northwest Ethiopia

Clinical presentations, parasite genotypes, gene expression and immunological profiles of cutaneous Leishmaniasis patients in lay Gayint, Northwest Ethiopia

The State of Practicing Traditional Methods and Their Effects on Individuals With Cutaneous Leishmaniasis in Turkey

Background: The aim of this study was to investigate the state of traditional methods used by individuals with cutaneous leishmaniasis (CL) disease and the effects of traditional methods on their health. Materials and Methods: This was a descriptive study. The sample for this study consisted of 232 cutaneous leishmaniasis patients. The research was conducted in the Oriental Sore Treatment Center between January 01, 2020, and March 01, 2021.The research data were collected with a survey. The descriptive statistics were eval-uated with the chi-square test and phi (Φ) and Cramer’s V parameters. A p-value of less than .05 was considered statistically significant. Results: It was observed that 96 people participating in the survey who received treatment with the diagnosis of CL were children and 136 people were adults. It was determined that one of the family members of each patient had previous CL with a rate of 44.9% and that 8.1% of the patients themselves had CL before. While the traditional method is not used in pediatric patients with CL, it was determined that 44.1% of adult patients used the traditional method for securing their disease. Patients using traditional methods mostly (48.3%) bought ready-made ointments from herbalists and applied them to the wounds. 66.7% of the patients suffered from the traditional method they applied. While 10.8% of patients aged 45 years and younger, 74.6% of patients over 45 years of age used traditional methods (p&amp;lt;0.05), and it was observed that there was a negative moderate relationship between age and traditional method usage (Φ =-0,64). While 89.5% of illiterate patients used tra-ditional methods, 13.6% of patients with secondary school or higher education were detected to use traditional methods (p&amp;lt;0,05, V=0,57). Patients with facial wounds preferred to use traditional methods more (p&amp;lt;0,05, V=0,25). Conclusions: This study showed that cutaneous leishmaniasis is still an important public health problem in Şanlıurfa Province in Turkey, and that traditional methods have negative effects on adult patients. Key Words: Cutaneous Leishmaniasis, Şark Çıbanı, Traditional Method, Health, Effect

Genetic diversity in Leishmania infantum and Leishmania tropica isolates from human and canine hosts in northern Morocco

This study investigated nine provinces in northern Morocco and collected 275 skin scraping, 22 bone marrow aspirates, and 89 fine needle aspirations from suspected cutaneous leishmaniasis (CL) and visceral leishmaniasis (VL) patients and potentially infected dogs. Molecular analysis using ITS1 RFLP PCR and RT-PCR revealed a higher prevalence of L. infantum (66.18 %; χ2 = 28.804; df = 1; P-value = 8.01e−08) than L. tropica in skin scraping, with L. infantum being the sole causative agent for both VL and canine leishmaniasis. L. infantum was predominantly found in most provinces, while L. tropica was relatively more dominant in Taza Province. Discriminant Analysis of Principal Components (DAPC) revealed distinct clustering between L. tropica and the other three species. However, no small subset of SNPs could clearly differentiate between Infantum_CL, Infantum_VL, and CanL, as they likely share a significant genetic background. The high rate of L. infantum could be attributed to the abundance of sand fly species transmitting VL. In Taza Province, Phlebotomus sergenti, responsible for anthroponotic CL, is the most abundant species. DNA sequencing demonstrated sequence heterogeneity in L. infantum (variants 1-9) and L. tropica (variants 1-7). Phylogenetic analysis showed a distinct separation between L. tropica and L. infantum strains, with an overlap among L. infantum strains isolated from cutaneous, visceral, and canine cases, and dogs serving as the central population for L. infantum.

Demographic Incidence of Cutaneous Leishmaniasis in Patients of Wasit Province, Iraq

Background: Leishmaniasis is a chronic disease caused by flagellate protozoa of the genus Leishmania, which remains uncontrolled and neglected transmissible disease in many countries including Iraq. Aim: Estimating the incidence rate and association of cutaneous leishmaniasis (CL) to different demographic risk factors including season, geographic area, gender, age, and distribution of lesions on different body’s regions. Materials and methods: Totally, 224 individuals who diagnosed as patients with CL were attended to the governmental hospitals in Wasit province (Iraq) during the year of 2023, and subjected for this questionnaire to collect the required data. Results: The findings of demographic risk factors were showed a significant variation (P&lt;0.05) in their values. Concerning season, significant highest levels of CL (P&lt;0.0357) was recorded in February 29.91% and January 24.11%, while the lowest values were seen in December (0%), September (1.97%), June (2.23%), April (3.13%), August (3.57%), July (4.02%), October (4.91%), and November (6.25%) in comparison to March (14.73%). Significantly (P&lt;0.0185), the higher rate for incidence of leishmaniasis was seen in AlAziziyah (46.43%); whereas, the lower rates were observed in An Numaniyah (2.68%), Al-Hai (5.8%) and Al-Suwaira (759%) in comparison with Kut (37.5%) district. For gender of study patients, males were showed a significant increase (P&lt;0.0442) in incidence rate of leishmaniasis (58.93%) when compared to females (41.07%). Regarding age, significant increases (P&lt;0.0422) in incidence rate of leishmaniasis was reported in patients aged ≤ 20 years (57.14%) and lowest in patients aged ≥ 40 years (31.25%); while in patients of 21-39 years old, it was 11.61%. Distribution of lesions on the body of study patients showed that the incidence of disease was increased significantly (P&lt;0.0278) in legs and abdomen (38.39%) and arms (32.59%); and reduced significantly in all the body (0.45%), back (0.45%), chest (0.89% (2/224)), abdomen (1.34%), and neck (3.13%) when compared to face (22.77%). According to type of lesion, the dry lesions (97.32%) were increased significantly (P&lt;0.0122) when compared to wet lesions (2.68%). Conclusion: This might represent the first recent retrospective study for analysis of documented cases of CL in Wasit province (Iraq). This study concludes that the CL disease is sex, age, seasonal and geographical dependent and it is with continuously increasing in Iraq. To further contain CL incidence and morbidity, there is a need for more intensified preventive research programs into improved vector control, vaccines, and diagnostics.

Involving patients in drug development for Neglected Tropical Diseases (NTDs): A qualitative study exploring and incorporating preferences of patients with cutaneous leishmaniasis into Target Product Profile development.

Target Product Profiles (TPPs) are instrumental to help optimise the design and development of therapeutics, vaccines, and diagnostics - these products, in order to achieve the intended impact, should be aligned with users' preferences and needs. However, patients are rarely involved as key stakeholders in building a TPP. Thirty-three cutaneous leishmaniasis (CL) patients from Brazil, Colombia, and Austria, infected with New-World Leishmania species, were recruited using a maximum variation approach along geographic, sociodemographic and clinical criteria. Semi-structured interviews were conducted in the respective patient's mother tongue. Transcripts, translated into English, were analysed using a framework approach. We matched disease experiences, preferences, and expectations of CL patients to a TPP developed by DNDi (Drug for Neglected Diseases initiative) for CL treatment. Patients' preferences regarding treatments ranged from specific efficacy and safety endpoints to direct and significant indirect costs. Respondents expressed views about trade-offs between efficacy and experienced discomfort/adverse events caused by treatment. Reasons for non-compliance, such as adverse events or geographical and availability barriers, were discussed. Considerations related to accessibility and affordability were relevant from the patients' perspective. NTDs affect disadvantaged populations, often with little access to health systems. Engaging patients in designing adapted therapies could significantly contribute to the suitability of an intervention to a specific context and to compliance, by tailoring the product to the end-users' needs. This exploratory study identified preferences in a broad international patient spectrum. It provides methodological guidance on how patients can be meaningfully involved as stakeholders in the construction of a TPP of therapeutics for NTDs. CL is used as an exemplar, but the approach can be adapted for other NTDs.

Cytokines signatures and susceptibility to cutaneous leishmaniasis in patients from Sistan and Baluchestan province of Iran

BackgroundCutaneous leishmaniasis (CL) is a complex, multifactorial disease that results from environmental factors such as parasite polymorphism, phlebotomine vectors, and host genetic factors. Some studies have identified specific genetic factors that may be associated with cutaneous leishmaniasis. The objective of this research was to resolve the association of 8 cytokine polymorphisms, including TNF-α −308 A/G (rs 1800629), TNF-α −238 A/G (rs 361525), TGF-β1 −509 T/C (rs 1800469), TGF-β1+ 915 G/C (rs 1800471), IFN-γ −874 T/A (rs 2430561), IFN-γ −179 G/A (rs 2069709), IL-10 −819 C/T (rs 1800871), and IL-10 −592 A/C (rs 1800872) with susceptibility to CL. MethodsA total of 152 patients with designated CL and 100 healthy controls were selected from those referred to Sistan and Baluchestan hospitals. CL was diagnosed by microscopic examination of Giemsa-stained samples and culture. Leishmania species were identified using ITS2 gene PCR amplification with universal primers. Genetic polymorphism was determined by the ARMS PCR method on extracted genomic DNA of individuals. Eight SNPs cytokines were genotyped. ResultsMost of the Genotypic and allelic frequency comparisons between patients with CL and healthy subjects showed no difference, except 3. Individual SNP analysis showed highest association of TGF-β1 −509 (rs1800469) –CC genotype (P = 0.03, OR = 7.05, 95 % CI = 3.3–15) with 5.7-fold increase, IFN-γ −874 (rs 2430561) -AA genotype (P = 0.04, OR = 4.72, 95 % CI = 1.6–14) with 4.2-fold increase, and IL10 −819 (rs1800871) –CC genotype (P = 0.05, OR = 3.63, 95 % CI = 2.5–5.3) with 1.9-fold increase, with CL. Odds ratios (ORs) and 95 % confidence intervals (CIs) were evaluated to assess the association power. ConclusionOur results conclude that rs1800469 (TGF-β1), rs2430561 (INF-γ), and rs1800872 (IL10) polymorphisms are associated with CL in southeastern Iranian people.

Isolation and characterisation of Leishmania (Leishmania) infantum from cutaneous leishmaniasis patients in northeast Brazil.

In Brazil, Leishmania (Leishmania) infantum is a widely distributed protozoan parasite. The human leishmaniasis caused by this species is often associated with visceral form. Tegumentary leishmaniasis (TL) cases due to L. (L.) infantum in the country are considered rare but may be underestimated. Although probably uncommon, these cases represent a new challenge to the prevention and control of leishmaniasis. Here, we describe two distinct cases of TL with atypical clinical presentations caused by L. (L.) infantum. Parasites were isolated from cutaneous lesions of the two patients and typed as L. (L.) infantum after sequencing of the ribosomal DNA internal transcribed spacer. The dermotropic L. (L.) infantum isolates were compared in terms of growth culture patterns, metacyclogenesis and in vitro infectivity in macrophages. This study addresses the emergence of L. (L.) infantum as a causative agent of cutaneous disease in a visceral leishmaniasis hotspot located in northeast Brazil. The data presented provides novel information about the presence of dermotropic L. (L.) infantum in the country and demonstrates the infectivity potential of theses isolates.

The role of Tumour Necrosis Factor Alpha (TNF-ALPHA) serum level and genetic polymorphisms with cutaneous leishmania infections

Objective: To assess the role of tumour necrosis factor alpha level and genotyping in susceptibility to leishmaniasis.Method: The case-control study was conducted from March to July 2021 at Baqubah Teaching Hospital, Diyala, Iraq,and comprised patients of cutaneous leishmaniasis in group A and healthy controls in group B. The serum level andsingle nucleotide polymorphisms of tumour necrosis factor-alpha rs41297589 and rs1800629 were compared betweenthe groups. Data was analysed using SPSS 28.Results: Of the 150 subjects, there were 75(50%) in group A; 39(52%) males and 36(48%) females with mean age23.91±13.14 years. The remaining 75(50%) subjects were in group B; 38(50.7%) males and 37(49.3%) females withmean age 22.84±4.35 years. Tumour necrosis factor-alpha level in group A was 55.81±39.64 compared to 7.51±3.61in group B (p&lt;0.05). Single nucleotide polymorphism rs41297589 showed that TT genotype and T allele weresignificantly increased in group A compared to group B (p&lt;0.05), while rs1800629 showed that GA genotype and Aallele were significantly increased in group A compared to group B (p&lt;0.05). The serum level of tumour necrosis factoralphain group A was increased in TT genotype compared to other genotypes at rs41297589, and in GA genotypecompared to other genotypes at rs1800629 (p&lt;0.05).Conclusions: There was a significant association between tumour necrosis factor-alpha serum level and geneticpolymorphisms rs41297589 and rs1800629 among cutaneous leishmaniasis patients.Keywords: Polymorphism, Nucleotide, Alleles, Psychodidae, Leishmania, Parasites, Cutaneous, Nucleotides.

MHealth Monitoring of Treatment of Cutaneous Leishmaniasis Patients: A Community-Based Implementation Study.

Cutaneous leishmaniasis (CL) remains a global health problem. Compelled by the protracted healing process, initial and final outcomes of treatment are determined at 90 and 180 days, respectively, after initiation of treatment. Loss to follow-up during these intervals is substantial. Consequently, the effectiveness of treatment is largely unknown. We conducted an effectiveness-implementation hybrid design study of a community-based mobile health (mHealth) strategy to monitor adherence to anti-leishmanial treatment, adverse drug reactions, and therapeutic response compared with standard of care in two rural communities of Colombia. Three implementation outcomes were evaluated: usability and acceptability by qualitative methods and fidelity using quantitative methods. Fifty-seven patients were prospectively included in the mHealth intervention and 48 in the standard-of-care group. In addition, 24 community health leaders (CHLs), health workers, and patients participated in qualitative evaluations. The intervention significantly increased the proportion of patients having follow-up of therapeutic outcomes 90 and 180 days after initiating treatment from 4.2% (standard of care) to 82.5% (intervention), P < 0.001. The proportion of patients having records of treatment adherence, adverse drug reactions, and therapeutic response also increased significantly (P < 0.001). Fidelity to the intervention (recording of treatment adherence, adverse drug reactions, lesion photographs, and evaluation of therapeutic response) was 70-100%. The app was highly accepted by CHLs, health workers, and patients, who perceived that the app improved case identification and follow-up and met a public health need. Although usability was high, low connectivity affected real-time transmission of data. This community-based mHealth strategy facilitated access to health care for CL in rural areas and knowledge of treatment effectiveness.

Systematic Review of Treatment Failure and Clinical Relapses in Leishmaniasis from a Multifactorial Perspective: Clinical Aspects, Factors Associated with the Parasite and Host.

Leishmaniasis is a disease caused by protozoa of the genus Leishmania. Treatment options are limited, and there are frequent cases of treatment failure and clinical relapse. To understand these phenomena better, a systematic review was conducted, considering studies published between 1990 and 2021 in Portuguese, English, and Spanish. The review included 64 articles divided into three categories. Case reports (26 articles) focused on treatment failure and clinical relapse in cutaneous leishmaniasis patients (47.6%), primarily affecting males (74%) and children (67%), regardless of the clinical manifestation. Experimental studies on the parasite (19 articles), particularly with L. major (25%), indicated that alterations in DNA and genic expression (44.82%) played a significant role in treatment failure and clinical relapse. Population data on the human host (19 articles) identified immunological characteristics as the most associated factor (36%) with treatment failure and clinical relapse. Each clinical manifestation of the disease presented specificities in these phenomena, suggesting a multifactorial nature. Additionally, the parasites were found to adapt to the drugs used in treatment. In summary, the systematic review revealed that treatment failure and clinical relapse in leishmaniasis are complex processes influenced by various factors, including host immunology and parasite adaptation.

Serum Zinc Level and Efficacy of Zinc Therapy in Cutaneous Leishmaniasis: a Systematic Review and Meta-analysis.

Cutaneous leishmaniasis is a parasitic skin disease prevalent in many parts of the world. Zinc has been investigated for its potential role in the immune response against Leishmania parasites. This study aimed to systematically review the literature and conduct meta-analyses to evaluate the serum zinc level and efficacy of zinc therapy in cutaneous leishmaniasis. A comprehensive search of electronic databases was performed to find studies reporting serum zinc levels and the efficacy of zinc therapy in cutaneous leishmaniasis. Meta-analyses were conducted using RevMan software (version 5.4), calculating the mean difference for serum zinc levels and risk ratio for the efficacy of zinc therapy. A total of 11 studies with 1009 participants were evaluated. Five of these studies, comprising 637 participants, examined serum zinc levels; the remaining six, involving 372 individuals, examined the effectiveness of zinc therapy in treating cutaneous leishmaniasis. The results showed that the serum zinc level was significantly lower in cutaneous leishmaniasis patients compared to controls (MD: - 26.65; 95% CI: [- 42.74, - 10.57]; p = 0.001). However, zinc therapy did not demonstrate a significant clinical improvement compared to standard treatment (RR: 0.96; 95% CI: [0.74, 1.23], p = 0.73).