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Travelers with cutaneous leishmaniasis cured without systemic therapy.
Clin Infect Dis. 2013 Aug; 57(3):370-80.CI

Abstract

BACKGROUND

Cutaneous leishmaniasis (CL) is a disfiguring but not life-threatening disease. Because antileishmanial drugs are potentially toxic, the World Health Organization (WHO) recommends simple wound care or local therapy as first-line treatment, followed or replaced by systemic therapy if local therapy fails or cannot be performed.

METHODS

To determine the feasibility and impact of the recommended approach, we analyzed the results of a centralized referral treatment program in 135 patients with parasitologically proven CL.

RESULTS

Infections involved 10 Leishmania species and were contracted in 29 different countries. Eighty-four of 135 patients (62%) were initially treated without systemic therapy. Of 109 patients with evaluable charts, 23 of 25 (92%) treated with simple wound care and 37 of 47 (79%) treated with local antileishmanial therapy were cured by days 42-60. In 37 patients with large or complex lesions, or preexisting morbidities, or who had not been cured with local therapy, the cure rate with systemic antileishmanial agents was 60%. Systemic adverse events were observed in 15 patients, all receiving systemic therapy.

CONCLUSIONS

In this population of CL patients displaying variable degrees of complexity and severity, almost two-thirds of patients could be initially managed without systemic therapy. Of these, 60 were cured before day 60. The WHO-recommended stepwise approach favoring initial local therapy therefore resulted in at least 44% of all patients being cured without exposure to the risk of systemic adverse events. Efforts are needed to further simplify local therapy of CL and to improve the management of patients with complex lesions and/or preexisting comorbidities.

Authors+Show Affiliations

Unité d'Immunologie Moléculaire des Parasites, Institut Pasteur de Paris, Paris, France.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 available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23633111

Citation

Morizot, G, et al. "Travelers With Cutaneous Leishmaniasis Cured Without Systemic Therapy." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 57, no. 3, 2013, pp. 370-80.
Morizot G, Kendjo E, Mouri O, et al. Travelers with cutaneous leishmaniasis cured without systemic therapy. Clin Infect Dis. 2013;57(3):370-80.
Morizot, G., Kendjo, E., Mouri, O., Thellier, M., Pérignon, A., Foulet, F., Cordoliani, F., Bourrat, E., Laffitte, E., Alcaraz, I., Bodak, N., Ravel, C., Vray, M., Grogl, M., Mazier, D., Caumes, E., Lachaud, L., & Buffet, P. A. (2013). Travelers with cutaneous leishmaniasis cured without systemic therapy. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 57(3), 370-80. https://doi.org/10.1093/cid/cit269
Morizot G, et al. Travelers With Cutaneous Leishmaniasis Cured Without Systemic Therapy. Clin Infect Dis. 2013;57(3):370-80. PubMed PMID: 23633111.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Travelers with cutaneous leishmaniasis cured without systemic therapy. AU - Morizot,G, AU - Kendjo,E, AU - Mouri,O, AU - Thellier,M, AU - Pérignon,A, AU - Foulet,F, AU - Cordoliani,F, AU - Bourrat,E, AU - Laffitte,E, AU - Alcaraz,I, AU - Bodak,N, AU - Ravel,C, AU - Vray,M, AU - Grogl,M, AU - Mazier,D, AU - Caumes,E, AU - Lachaud,L, AU - Buffet,P A, AU - ,, Y1 - 2013/04/30/ PY - 2013/5/2/entrez PY - 2013/5/2/pubmed PY - 2014/1/22/medline KW - cutaneous leishmaniasis KW - intralesional antimony KW - liposomal amphotericin B KW - miltefosine KW - systemic antimony SP - 370 EP - 80 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin Infect Dis VL - 57 IS - 3 N2 - BACKGROUND: Cutaneous leishmaniasis (CL) is a disfiguring but not life-threatening disease. Because antileishmanial drugs are potentially toxic, the World Health Organization (WHO) recommends simple wound care or local therapy as first-line treatment, followed or replaced by systemic therapy if local therapy fails or cannot be performed. METHODS: To determine the feasibility and impact of the recommended approach, we analyzed the results of a centralized referral treatment program in 135 patients with parasitologically proven CL. RESULTS: Infections involved 10 Leishmania species and were contracted in 29 different countries. Eighty-four of 135 patients (62%) were initially treated without systemic therapy. Of 109 patients with evaluable charts, 23 of 25 (92%) treated with simple wound care and 37 of 47 (79%) treated with local antileishmanial therapy were cured by days 42-60. In 37 patients with large or complex lesions, or preexisting morbidities, or who had not been cured with local therapy, the cure rate with systemic antileishmanial agents was 60%. Systemic adverse events were observed in 15 patients, all receiving systemic therapy. CONCLUSIONS: In this population of CL patients displaying variable degrees of complexity and severity, almost two-thirds of patients could be initially managed without systemic therapy. Of these, 60 were cured before day 60. The WHO-recommended stepwise approach favoring initial local therapy therefore resulted in at least 44% of all patients being cured without exposure to the risk of systemic adverse events. Efforts are needed to further simplify local therapy of CL and to improve the management of patients with complex lesions and/or preexisting comorbidities. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/23633111/Travelers_with_cutaneous_leishmaniasis_cured_without_systemic_therapy_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/cit269 DB - PRIME DP - Unbound Medicine ER -