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[Diagnosis and therapy of cutaneous and mucocutaneous Leishmaniasis in Germany].
J Dtsch Dermatol Ges. 2011 Nov; 9 Suppl 8:1-51.JD

Abstract

The incidence of cutaneous and mucocutaneous Leishmaniasis (CL/MCL) is increasing globally, also in Germany, although the cases are imported and still low in number. The current evidence for the different therapies has many limitations due to lack of sufficient studies on the different Leishmania species with differing virulence. So far there is no international gold standard for the optimal management. The aim of the German joint working group on Leishmaniasis, formed by the societies of Tropical Medicine (DTG), Chemotherapy (PEG) and Dermatology (DDG), was to establish a guideline for the diagnosis and treatment of CL and MCL in Germany, based on evidence (Medline search yielded 400 articles) and, where lacking, on consensus of the experts. As the clinical features do not necessarily reflect the involved Leishmania species and, as different parasite species and even geographically distinct strains of the same species may require different treatments or varying dosages or durations of therapy, the guidelines suggest for Germany to identify the underlying parasite prior to treatment. Because of relevant differences in prognosis and ensuing therapy species should be identified in i) New World CL/MCL (NWCL/ MCL) to distinguish between L. mexicana-complex and subgenus Viannia, ii) in suspected infections with L. mexicana-complex to distinguish from L. amazonensis, and iii) in Old World CL (OWCL) to distinguish between L. infantum and L. major, L. tropica, or L. aethiopica. A state-of-the-art diagnostic algorithm is presented. For recommendations on localized and systemic drug treatment and physical procedures, data from the accessible literature were adjusted according to the involved parasite species and a clinical differentiation into uncomplicated or complex lesions. Systemic therapy was strictly recommended for i) complex lesions (e. g. > 3 infected lesions, infections in functionally or cosmetically critical areas such as face or hands, presence of lymphangitis), ii) lesions refractory to therapy, iii) NWCL by the subgenus Viannia or by L. amazonensis, iv) in MCL and v) in recalcitrant, or disseminating or diffuse cutaneous courses. In e. g. infection with L. major it encompasses miltefosine, fluconazole and ketoconazole, while antimony or allopurinol were here considered second choice. Local therapy was considered appropriate for i) uncomplicated lesions of OWCL, ii) L. mexicana-complex and iii) pregnant women. In e. g. infection with L. major it encompasses perilesional antimony, combined with cryotherapy, paromomycin 15 %/in methylbenzethoniumchlorid 12 % and thermotherapy. The group also stated that there is an urgent need for improving the design and the way of publishing of clinical trials in leishmaniasis.

Authors+Show Affiliations

Auswärtiges Amt, Gesundheitsdienst, Regionalarztdienststelle Ostafrika, Nairobi, Kenia.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo 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)

English Abstract
Journal Article
Practice Guideline

Language

ger

PubMed ID

22050890

Citation

Boecken, Gerhard, et al. "[Diagnosis and Therapy of Cutaneous and Mucocutaneous Leishmaniasis in Germany]." Journal Der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG, vol. 9 Suppl 8, 2011, pp. 1-51.
Boecken G, Sunderkötter C, Bogdan C, et al. [Diagnosis and therapy of cutaneous and mucocutaneous Leishmaniasis in Germany]. J Dtsch Dermatol Ges. 2011;9 Suppl 8:1-51.
Boecken, G., Sunderkötter, C., Bogdan, C., Weitzel, T., Fischer, M., Müller, A., Löbermann, M., Anders, G., von Stebut, E., Schunk, M., Burchard, G., Grobusch, M., Bialek, R., Harms-Zwingenberger, G., Fleischer, B., Pietras, M., Faulde, M., & Erkens, K. (2011). [Diagnosis and therapy of cutaneous and mucocutaneous Leishmaniasis in Germany]. Journal Der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG, 9 Suppl 8, 1-51. https://doi.org/10.1111/j.1610-0379.2011.07820.x
Boecken G, et al. [Diagnosis and Therapy of Cutaneous and Mucocutaneous Leishmaniasis in Germany]. J Dtsch Dermatol Ges. 2011;9 Suppl 8:1-51. PubMed PMID: 22050890.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Diagnosis and therapy of cutaneous and mucocutaneous Leishmaniasis in Germany]. AU - Boecken,Gerhard, AU - Sunderkötter,Cord, AU - Bogdan,Christian, AU - Weitzel,Thomas, AU - Fischer,Marcellus, AU - Müller,Andreas, AU - Löbermann,Micha, AU - Anders,Gerlind, AU - von Stebut,Esther, AU - Schunk,Mirjam, AU - Burchard,Gerd, AU - Grobusch,Martin, AU - Bialek,Ralf, AU - Harms-Zwingenberger,Gundel, AU - Fleischer,Bernhard, AU - Pietras,Mathias, AU - Faulde,Michael, AU - Erkens,Kay, AU - ,, AU - ,, AU - ,, PY - 2011/11/5/entrez PY - 2011/12/14/pubmed PY - 2012/3/10/medline SP - 1 EP - 51 JF - Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG JO - J Dtsch Dermatol Ges VL - 9 Suppl 8 N2 - The incidence of cutaneous and mucocutaneous Leishmaniasis (CL/MCL) is increasing globally, also in Germany, although the cases are imported and still low in number. The current evidence for the different therapies has many limitations due to lack of sufficient studies on the different Leishmania species with differing virulence. So far there is no international gold standard for the optimal management. The aim of the German joint working group on Leishmaniasis, formed by the societies of Tropical Medicine (DTG), Chemotherapy (PEG) and Dermatology (DDG), was to establish a guideline for the diagnosis and treatment of CL and MCL in Germany, based on evidence (Medline search yielded 400 articles) and, where lacking, on consensus of the experts. As the clinical features do not necessarily reflect the involved Leishmania species and, as different parasite species and even geographically distinct strains of the same species may require different treatments or varying dosages or durations of therapy, the guidelines suggest for Germany to identify the underlying parasite prior to treatment. Because of relevant differences in prognosis and ensuing therapy species should be identified in i) New World CL/MCL (NWCL/ MCL) to distinguish between L. mexicana-complex and subgenus Viannia, ii) in suspected infections with L. mexicana-complex to distinguish from L. amazonensis, and iii) in Old World CL (OWCL) to distinguish between L. infantum and L. major, L. tropica, or L. aethiopica. A state-of-the-art diagnostic algorithm is presented. For recommendations on localized and systemic drug treatment and physical procedures, data from the accessible literature were adjusted according to the involved parasite species and a clinical differentiation into uncomplicated or complex lesions. Systemic therapy was strictly recommended for i) complex lesions (e. g. > 3 infected lesions, infections in functionally or cosmetically critical areas such as face or hands, presence of lymphangitis), ii) lesions refractory to therapy, iii) NWCL by the subgenus Viannia or by L. amazonensis, iv) in MCL and v) in recalcitrant, or disseminating or diffuse cutaneous courses. In e. g. infection with L. major it encompasses miltefosine, fluconazole and ketoconazole, while antimony or allopurinol were here considered second choice. Local therapy was considered appropriate for i) uncomplicated lesions of OWCL, ii) L. mexicana-complex and iii) pregnant women. In e. g. infection with L. major it encompasses perilesional antimony, combined with cryotherapy, paromomycin 15 %/in methylbenzethoniumchlorid 12 % and thermotherapy. The group also stated that there is an urgent need for improving the design and the way of publishing of clinical trials in leishmaniasis. SN - 1610-0387 UR - https://www.unboundmedicine.com/medline/citation/22050890/[Diagnosis_and_therapy_of_cutaneous_and_mucocutaneous_Leishmaniasis_in_Germany]_ L2 - https://doi.org/10.1111/j.1610-0379.2011.07820.x DB - PRIME DP - Unbound Medicine ER -