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Leishmania tropica in northern Israel: a clinical overview of an emerging focus.
J Am Acad Dermatol. 2005 Nov; 53(5):810-5.JA

Abstract

BACKGROUND

In Israel, most cutaneous leishmaniasis (CL) is caused by Leishmania major. Recently a new focus of CL caused by Leishmania tropica has been described in Tiberias and the surrounding area of northern Israel.

OBJECTIVE

The aim of this study was to evaluate clinical (size, number, location, and type of lesion) and laboratory (culture and polymerase chain reaction [PCR] analysis) parameters at diagnosis, response to treatment, and outcome of patients with CL due to L tropica.

METHODS

Between September 2002 and March 2004, patients with direct smear-confirmed CL were evaluated; clinical records were reviewed and a telephone survey was performed.

RESULTS

Forty nine patients, 34 (69%) male and 15 (31%) female, were studied. Mean age was 31.1 years (median 26 years, range 1-70); 76% of patients live in Tiberias and the surrounding area. The mean number of lesions was 2.6 (median 2, range 1-10). Lesions were commonly located on the face (61%) and upper limbs (57%). PCR analysis was performed in 27 patients and was positive for L tropica in 26. Fifty percent of patients studied received multiple therapeutic regimens because of incomplete response or treatment failure. Topical paromomycin was used in 44 patients (90%), with a complete response reported in only 17 (39%); of the 9 patients treated with intralesional sodium stibogluconate, a complete response was reported in 6 (67%); of the 5 patients treated with intravenous sodium stibogluconate, 4 (80%) were cured.

LIMITATIONS

The relatively small number of patients studied combined with the fact that some were assessed retrospectively limit our conclusions. In addition, 50% of the patients studied received multiple therapeutic regimens because of failure of, or incomplete responses to, their initial therapy, thereby making comparisons difficult.

CONCLUSIONS

The cure rate in those completing a course of antimony therapy, either 10 or more days of intravenous therapy or therapy administered intralesionally, was 75% (95% confidence interval [CI], 50.5-99.5%) as compared with 45% (95% CI, 28.9-60.5%) among those completing at least 10 days of topical paromomycin. To date, no standardized, simple, safe, and highly effective regimen for treating L tropica exists. Large, controlled clinical trials to evaluate current treatment regimens as well as new medications for CL, and especially CL attributed to L tropica, are urgently needed.

Authors+Show Affiliations

Department of Dermatology, Emek Medical Center, Afula, Israel. adir-sh@zahav.net.ilNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16243129

Citation

Shani-Adir, Ayelet, et al. "Leishmania Tropica in Northern Israel: a Clinical Overview of an Emerging Focus." Journal of the American Academy of Dermatology, vol. 53, no. 5, 2005, pp. 810-5.
Shani-Adir A, Kamil S, Rozenman D, et al. Leishmania tropica in northern Israel: a clinical overview of an emerging focus. J Am Acad Dermatol. 2005;53(5):810-5.
Shani-Adir, A., Kamil, S., Rozenman, D., Schwartz, E., Ramon, M., Zalman, L., Nasereddin, A., Jaffe, C. L., & Ephros, M. (2005). Leishmania tropica in northern Israel: a clinical overview of an emerging focus. Journal of the American Academy of Dermatology, 53(5), 810-5.
Shani-Adir A, et al. Leishmania Tropica in Northern Israel: a Clinical Overview of an Emerging Focus. J Am Acad Dermatol. 2005;53(5):810-5. PubMed PMID: 16243129.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Leishmania tropica in northern Israel: a clinical overview of an emerging focus. AU - Shani-Adir,Ayelet, AU - Kamil,Stephanie, AU - Rozenman,Dganit, AU - Schwartz,Eli, AU - Ramon,Michal, AU - Zalman,Lucia, AU - Nasereddin,Abed, AU - Jaffe,Charles L, AU - Ephros,Moshe, Y1 - 2005/09/15/ PY - 2005/03/08/received PY - 2005/07/06/revised PY - 2005/07/09/accepted PY - 2005/10/26/pubmed PY - 2006/5/24/medline PY - 2005/10/26/entrez SP - 810 EP - 5 JF - Journal of the American Academy of Dermatology JO - J Am Acad Dermatol VL - 53 IS - 5 N2 - BACKGROUND: In Israel, most cutaneous leishmaniasis (CL) is caused by Leishmania major. Recently a new focus of CL caused by Leishmania tropica has been described in Tiberias and the surrounding area of northern Israel. OBJECTIVE: The aim of this study was to evaluate clinical (size, number, location, and type of lesion) and laboratory (culture and polymerase chain reaction [PCR] analysis) parameters at diagnosis, response to treatment, and outcome of patients with CL due to L tropica. METHODS: Between September 2002 and March 2004, patients with direct smear-confirmed CL were evaluated; clinical records were reviewed and a telephone survey was performed. RESULTS: Forty nine patients, 34 (69%) male and 15 (31%) female, were studied. Mean age was 31.1 years (median 26 years, range 1-70); 76% of patients live in Tiberias and the surrounding area. The mean number of lesions was 2.6 (median 2, range 1-10). Lesions were commonly located on the face (61%) and upper limbs (57%). PCR analysis was performed in 27 patients and was positive for L tropica in 26. Fifty percent of patients studied received multiple therapeutic regimens because of incomplete response or treatment failure. Topical paromomycin was used in 44 patients (90%), with a complete response reported in only 17 (39%); of the 9 patients treated with intralesional sodium stibogluconate, a complete response was reported in 6 (67%); of the 5 patients treated with intravenous sodium stibogluconate, 4 (80%) were cured. LIMITATIONS: The relatively small number of patients studied combined with the fact that some were assessed retrospectively limit our conclusions. In addition, 50% of the patients studied received multiple therapeutic regimens because of failure of, or incomplete responses to, their initial therapy, thereby making comparisons difficult. CONCLUSIONS: The cure rate in those completing a course of antimony therapy, either 10 or more days of intravenous therapy or therapy administered intralesionally, was 75% (95% confidence interval [CI], 50.5-99.5%) as compared with 45% (95% CI, 28.9-60.5%) among those completing at least 10 days of topical paromomycin. To date, no standardized, simple, safe, and highly effective regimen for treating L tropica exists. Large, controlled clinical trials to evaluate current treatment regimens as well as new medications for CL, and especially CL attributed to L tropica, are urgently needed. SN - 1097-6787 UR - https://www.unboundmedicine.com/medline/citation/16243129/Leishmania_tropica_in_northern_Israel:_a_clinical_overview_of_an_emerging_focus_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0190-9622(05)02302-9 DB - PRIME DP - Unbound Medicine ER -