Management Of Cutaneous Leishmaniasis Research Articles

Pediatric Cutaneous Leishmaniasis in a Private Clinic of Abidjan, Ivory Coast: A Case Report

Introduction: Cutaneous Leishmaniasis (CL) is a zoonotic disease with global distribution, especially in underdeveloped countries. This parasitic disease is caused by the bite of an infected sandfly. Case Report: We report here the first case of cutaneous leishmaniasis discovered incidentally in an 11-year-old child in a private clinic. He is a primarian boy who had a wound located on his left leg. On questioning, we ascertained that the wound was not the first one and had been present for about 2 months. The cutaneous lesion was painless but itchy. The location, the crateriform appearance, and the chronic nature of the wound led us to suspect a case of cutaneous leishmaniasis. Methods: Microscopic examination of cutaneous exsudation’s smears of lesions revealed amastigote forms of leishmania, confirming our diagnostic hypothesis. The child was placed under Imidazole-based treatment associate cloxacilline. The child also received local gentamycin-based dressings. Results: The child was cured after one month. The diagnostic issues of cutaneous leishmaniasis constitute a great challenge for practitioners in endemic zone. Also, a systematic differential diagnostic should be required in the face of chronic wounds. Conclusion: The integration of the screening and management of cutaneous leishmaniasis against Buruli ulcer are eagerly waited as a future work.

Epidemiological Features of Cutaneous Leishmaniasis in Zliten (North West of Libya)

Cutaneous Leishmaniasis is endemic in north-west of Libya for long time and it’s spread to other new foci continues to involve new areas like Taurgha, Sirt and recently, Zliten. Most of the patients in north-west of Libya were infected with zoonotic Cutaneous Leishmaniasis, which caused by leishmania major, although some cases of anthroponotic cutaneous leishmaniasis caused by leishmania tropica were also reported. Zliten is a coastal city in the north west of Libya; with more than 289000 people; and now is known to be a new focus since 2016 when the sudden increase of the number of patients with Cutaneous Leishmaniasis had occurred.
 Aims: This study was performed to observe epidemiological changes about incidence, age of patients, geographical distribution in Zliten city over a period of last 2 year (2017 and 2018(.
 Study Design: Cross-sectional study as retrospective study over time of two years, involving all patients, who were presented or referred, to get management of Cutaneous Leishmaniasis, in three accredited outpatient departments for cutaneous leishmania (in Zliten). The data were collected and analyzed in Zliten Teching Hospital.
 Place and Duration of Study: Outpatient Department of Dermatology and Venereology of Zliten Teaching Hospital between 1st January 2017 and 31st December 2018.
 Methodology: The study included all patients (different gender and from all age groups) with Cutaneous Leishmaniasis, who sought medical advice in dermatology reference clinics in Zliten, over the period of 2 years (2017 and 2018). The main collected data were age, sex, number of lesions, and affected sites in the body, residency of the patients, year and month of presentation. The analysis of data was made with the use of Statistical Package for the Social Sciences (SPSS 25).
 Results: Eight hundred thirty nine patients were included in this study. The majority of patients came from Zliten and these represented 95.6%, while the most of them came from Majer (south eastern part of Zliten City with more than 25000 people living in it) and represented 45.5% of total patients with CL included in this study, followed by Al-juma (south western part of Zliten with around 52000 people), represented (28%) of total patients with CL.
 Males were found to be more affected, with male to female ratio, 2.4:1. The most affected age group were these less than forty with peak incidence at age group (20 yrs to 30 yrs). The registered patients in 2017 were 397, this number had increased slightly to be 440 in the following year (2018).
 The distribution of patients had shown seasonal variations, with steep increase in the number of cases in December, November and January.
 Conclusion: Cutaneous Leishmaniasis is remained to be a major health problem in Zliten, affecting a large number of population every year and need further study to determine molecular identification of parasites, and more efforts are needed to control the vector and reservoir.

Efficacy of photodynamic therapy in the treatment of cutaneous leishmaniasis

Introduction: A limited number of case reports have studies the efficacy of Photodynamic Therapy (PDT) in management of Cutaneous Leishmaniasis (CL). Topical PDT is an innovative mode of therapy that works on principle of selective uptake of photosensitizing agent by CL lesions. Current study was conducted to determine efficacy of topical photodynamic therapy of CL. Study Design: Descriptive cross sectional study. Setting: Dermatology outdoor clinic PIMS Islamabad. Period: July 2015 to Jan 2016. Materials & Methods: Total 75 patients (>12 years) of either gender with biopsy proven CL lesions were included after ethical approval. Pregnant or lactating women, those with sensitivity to light or photo sensitizer were excluded. The selected cases were administered once a week sessions of topical 5-ALA PDT therapy. This therapy was continued till 4 weeks and efficacy was observed at 6th week; efficacy labeled as yes if there was no erythema with resolution of papules, plaques or nodules, surrounded by normal healthy skin clinically and the histo-pathological smears revealing absence of amastigotes, otherwise labeled as non-effective. Results: Mean age was 24.37+7.43 years. There were 44(58.67%) females and 31(41.33%) males. Mean duration of disease was 40.29+11.73 days and mean size of lesion was 19.69+9.88 mm. Effective PDT outcome was seen in 67(89.33%) patients at 6th week of therapy. Conclusion: This study concluded that topical photodynamic therapy is an effective method for treatment of Cutaneous Leishmaniasis.

Comparison of Intralesional Meglumine Antimonite along with oral Itraconazole to Intralesional Meglumine Antimonite in the treatment of Cutaneous Leishmaniasis.

Background & Objective:Cutaneous leishmaniasis (CL) is endemic in developing countries like Pakistan. Pentavalent antimonials are still drug of choice, despite being toxic and intolerable for patients. Second line treatments have been extensively studied but the results of their efficacy are conflicting. This, to our knowledge, will be the first study in this regard. Our objective was to determine if combination of oral itraconazole with intralesional (IL) meglumine antimoniate (MA) reduces the duration of treatment for cutaneous leishmaniasis, as compared to intralesional MA alone.Methods:A randomized controlled trial (single blinded) was carried out from August 2017 till December 2017 on 69 patients who fulfilled inclusion criteria. They were assigned to Group-A or B by lottery method. Group-A patients received IL MA once a week while Group-B received oral itraconazole 200mg, once daily, for six weeks along with similar regimen of IL MA as Group-A. The patients were assessed every three weeks by the blinded assessor till clinical cure was achieved. A follow up visit, two months after clinical cure was done to look for relapse of the disease.Results:Thirty patients in Group-A and 35 patients in Group-B completed the study. At 3, 6, 9 and 12 weeks the patients were assessed for: no, partial or complete response and results of the two groups were compared for statistical significance. The p-values of 0.20, 0.57 and 0.11 at 3, 6 and 9 weeks, respectively, depict that there was no significant difference at any step of assessment between the two groups in terms of healing. The p values of each t test was>0.05 refuting the hypothesis.Conclusion:Combination of oral itraconazole with intralesional MA offered no benefit over intralesional MA alone in the management of cutaneous leishmaniasis in terms of duration of therapy.

Comportamiento epidemiológico, distribución geográfica y manejo clínico inicial de la leishmaniasis cutánea en Boyacá. 2008-2015

Introduction: Leishmaniasis is a reemerging disease that causes more sequelae and disability than any other of its kind in areas where geographical conditions favor the presence of the vector.Objective: To describe the behavior, geographical distribution and initial clinical management of cutaneous leishmaniasis in the department of Boyacá between 2008 and 2015.Materials and methods: Observational, retrospective study on a sample of patients diagnosed with cutaneous leishmaniasis in the department of Boyacá, Colombia, registered in the mandatory epidemiological notification sheets of the Colombian public health surveillance system from 2008 to 2015.Results: 63.6% of patients were men with occupations related to forestry activities and from rural areas. 81% of the reported cases were located in western Boyacá, along the Magdalena River basin, one of the main tributaries of Colombia. Inadequate initial clinical management was observed in 25% of the study sample, which is a risk factor for resistance to pentavalent antimonials.Conclusion: It is necessary to implement follow-up strategies for patients with cutaneous leishmaniasis in order to verify the cure criteria for the disease and propose strategies for its prevention in the identified populations that are at greater risk.

Comprehensive economic evaluation of thermotherapy for the treatment of cutaneous leishmaniasis in Colombia

BackgroundCutaneous leishmaniasis causes a high disease burden in Colombia, and available treatments present systemic toxicity, low patient compliance, contraindications, and high costs. The purpose of this study was to estimate the cost-effectiveness of thermotherapy versus Glucantime in patients with cutaneous leishmaniasis in Colombia.MethodsCost-effectiveness study from an institutional perspective in 8133 incident cases. Data on therapeutic efficacy and safety were included, calculating standard costs; the outcomes were disability adjusted life years (DALYs) and the number of patients cured. The information sources were the Colombian Public Health Surveillance System, disease burden studies, and one meta-analysis of controlled clinical trials. Incremental cost-effectiveness was determined, and uncertainty was evaluated with tornado diagrams and Monte Carlo simulations.ResultsThermotherapy would generate costs of US$ 501,621; the handling of adverse effects, US$ 29,224; and therapeutic failures, US$ 300,053. For Glucantime, these costs would be US$ 2,731,276, US$ 58,254, and US$ 406,298, respectively. With thermotherapy, the cost would be US$ 2062 per DALY averted and US$ 69 per patient cured; with Glucantime, the cost would be US$ 4241 per DALY averted and US$ 85 per patient cured. In Monte Carlo simulations, thermotherapy was the dominant strategy for DALYs averted in 67.9% of cases and highly cost-effective for patients cured in 72%.ConclusionIn Colombia, thermotherapy can be included as a cost-effective strategy for the management of cutaneous leishmaniasis. Its incorporation into clinical practice guidelines could represent savings of approximately US$ 10,488 per DALY averted and costs of US$ 116 per additional patient cured, compared to the use of Glucantime. These findings show the relevance of the incorporation of this treatment in our country and others with similar parasitological, clinical, and epidemiological patterns.

Clinical aspects and management of cutaneous leishmaniasis in rheumatoid patients treated with TNF-α antagonists

Patients under immunosuppressive therapy with tumor necrosis factor alpha (TNF-α) antagonists are vulnerable to various opportunistic infections including leishmaniasis. We present a case series of 8 travellers developing cutaneous leishmaniasis whilst on TNF-α antagonist treatment and review the literature on aspects of cutaneous leishmaniasis developing in patients treated with TNF-α antagonists. We make interim recommendations regarding the drug therapy used to maintain remission in travellers with rheumatoid disease travelling to leishmania prone areas. Despite having a medical condition requiring continued rheumatological review the interval to diagnosis appears not to be reduced compared to that described in non-rheumatoid patients. Rheumatologists and family doctors should be aware of the need for post-travel surveillance for leishmaniasis in rheumatoid patients on TNF-alpha antagonist treatment.

Clinical findings and management of imported cutaneous leishmaniasis: Report of 14 cases from Austria

The management of cutaneous leishmaniasis in non-endemic countries is challenging due to the wide variety of clinical manifestations and little information available on treatment modalities for travellers. Retrospective analysis and follow-up investigation in patients with imported cutaneous leishmaniasis managed at the General Hospital Vienna from 2004 to 2010. In total, 14 patients with cutaneous leishmaniasis were analyzed. The time to diagnosis ranged between weeks and several months and up to four consultations were necessary before diagnosis was accomplished. Histological investigations performed in all patients were diagnostic for CL in 8 (57%) patients. PCR analyses were performed in 12 patients and were positive in 10 (83%) patients. All six patients with negative histological results for CL tested positive in the PCR analysis. Treatment regimens applied included systemic therapy with liposomal amphotericin B, miltefosine, or fluconazole, and local therapy with cryotherapy, paromomycin ointment, photodynamic therapy, surgery, and various combinations. The present analysis strongly suggests that awareness of CL among physicians and travellers remains low and highlights the need to harmonize diagnostic and treatment guidelines for cutaneous and mucosal leishmaniasis in European travellers. Diagnostic outcome can be improved by combining histology and PCR in patients with suspected cutaneous leishmaniasis.

Management of cutaneous leishmaniasis.

There is an urgent need for a safe, effective, easily administered and cheap treatment for cutaneous leishmaniasis. Unfortunately it remains elusive. There have been a number of contributions during the last year, but none will change present day management. The diagnosis of cutaneous leishmaniasis is established on the basis of a typical lesion, a history of exposure and demonstration of the parasite. Molecular methods, usually based on kinetoplast DNA, are being developed and used increasingly to diagnose and type the infecting organism. Pentavalent antimonials remain the mainstay of treatment.

The management of cutaneous leishmaniasis from Belize.

We report 20 patients who contracted cutaneous leishmaniasis in Central and South America, 18 of them in Belize. The diagnosis was confirmed by the polymerase chain reaction (PCR) in 79% of those tested; the corresponding figure for histology was 62%, touch smear 46%, and culture 11%. Results of PCR can be falsely positive, so treatment should not be based on PCR alone. Of the 20 cases 18 were healed 6 weeks after intravenous sodium stibogluconate 20 mg/kg per day for 20 days. We present a management protocol.

Treatment of cutaneous leishmaniasis with 20% paromomycin ointment

Cutaneous leishmaniasis is an infectious disease caused by flagellate protozoa of the genus Leishmania. In Mediterranean countries, the most common causative agents are Leishmania (L.) major, L. infantum and L. tropica. In Croatia, cutaneous leishmaniasis is a rare disease, the last case being reported in 1988. Our patient was a 5-year-old boy with a left cheek skin lesion in the form of papule with central exulceration, hyperkeratotic crust and erythema of a 6-month duration. The diagnosis of cutaneous leishmaniasis was based on history data (stay in the southernmost region of Croatia and multiple mosquito bites), light microscopic histology (dense infiltrates of large histiocytes with extracellular bodies), and positive Montenegro (leishmanin) test. A new therapy with aminosidine (paromomycin), an aminoglycoside antibiotic, in the form of ointment at a concentration of 20%, was for the first time used in Croatia. Four-week therapy resulted in complete regression of the skin lesions with residual hyperpigmentation. During therapy, no local or systemic side effects were observed. Thus, topical therapy with paromomycin could be considered an efficient therapeutic alternative in the management of cutaneous leishmaniasis.

Dermal leishmaniasis and rifampicin.

In an uncontrolled study, the effectiveness of rifampicin was assessed in cutaneous leishmaniasis. Twelve of 15 patients (80%) showed good response. The treatment ranged from 2 to 12 weeks. Tolerance of the drug was excellent and apart from red discolouration of the urine, no other side effects were encountered. Rifampicin appears to have a place in the management of cutaneous leishmaniasis.