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Lindner AK, Moreno-Del Castillo MC, Wintel M, Equihua Martinez G, Richter J, Kurth F, Pfäfflin F, Zoller T, Gertler M, Georgi S, Nürnberg M, Hülso C, Bernhard J, Kotsias SK, Seigerschmidt A, van Loon W, Mockenhaupt F, Kampmann B, Harms G. American Cutaneous Leishmaniasis: Imported cases in Berlin 2000-2023. PLoS Negl Trop Dis 2024; 18:e0012323. [PMID: 39008517 DOI: 10.1371/journal.pntd.0012323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 06/26/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND American Cutaneous Leishmaniasis (ACL) shows variable response to therapy, but data on species-specific treatment efficacy is scarce. We describe the clinical characteristics and outcome of patients with ACL imported to a tertiary centre in Germany and determine whether species-specific therapy according to the 2014 "LeishMan" group recommendations is associated with cure. METHODS A retrospective chart review was conducted at the Charité Institute of International Health in Berlin. We analysed data on PCR-confirmed ACL cases collected between 2000 and 2023. Systemic therapy included liposomal amphotericin B, miltefosine, pentavalent antimony, ketoconazole or itraconazole. Localized therapy included perilesional pentavalent antimony or paromomycin ointment. Cure was defined as re-epithelialization of ulcers or disappearance of papular-nodular lesions after 3 months of treatment. Logistic regression models were used to quantify the effect of species-specific systemic therapy on the outcome. RESULTS 75 cases were analysed. Most patients were male (62%), median age was 35 years, no patient had a history of immunosuppression. The most common reason for travel was tourism (60%), the most common destination was Costa Rica (28%), the median duration of illness was 8 weeks, and most patients presented with ulcers (87%). Lesions were complex in 43%. The most common Leishmania (L.) species was L. braziliensis (28%), followed by L. panamensis (21%). 51/73 (70%) patients were cured after initial therapy and 17/21 (81%) after secondary therapy. Cure after systemic therapy was more frequent when species-specific treatment recommendations were followed (33/45; 73%), compared to when not followed, (6/17; 35%, P = 0.008). This association was independent of age, sex, previous therapy, complex lesions, and Leishmania species (adjusted OR, 5.06; 95% CI, 1.22-24.16). CONCLUSIONS ACL is a rare, imported disease in Germany. Complex lesions were common, challenging successful therapy. This study highlights the importance of identifying the parasite species and suggests that a species-specific approach to treatment leads to better outcomes.
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Affiliation(s)
- Andreas K Lindner
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of International Health, Charité Center for Global Health, Berlin, Germany
| | - Maria Cristina Moreno-Del Castillo
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of International Health, Charité Center for Global Health, Berlin, Germany
| | - Mia Wintel
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of International Health, Charité Center for Global Health, Berlin, Germany
| | - Gabriela Equihua Martinez
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of International Health, Charité Center for Global Health, Berlin, Germany
| | - Joachim Richter
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of International Health, Charité Center for Global Health, Berlin, Germany
| | - Florian Kurth
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases, Respiratory and Critical Care Medicine, Berlin, Germany
| | - Frieder Pfäfflin
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases, Respiratory and Critical Care Medicine, Berlin, Germany
| | - Thomas Zoller
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases, Respiratory and Critical Care Medicine, Berlin, Germany
| | - Maximilian Gertler
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of International Health, Charité Center for Global Health, Berlin, Germany
| | - Susanne Georgi
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of International Health, Charité Center for Global Health, Berlin, Germany
| | - Michael Nürnberg
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of International Health, Charité Center for Global Health, Berlin, Germany
| | - Claudia Hülso
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of International Health, Charité Center for Global Health, Berlin, Germany
| | - Julian Bernhard
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of International Health, Charité Center for Global Health, Berlin, Germany
| | - Sarah Konopelska Kotsias
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of International Health, Charité Center for Global Health, Berlin, Germany
| | - Antonio Seigerschmidt
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of International Health, Charité Center for Global Health, Berlin, Germany
| | - Welmoed van Loon
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of International Health, Charité Center for Global Health, Berlin, Germany
| | - Frank Mockenhaupt
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of International Health, Charité Center for Global Health, Berlin, Germany
| | - Beate Kampmann
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of International Health, Charité Center for Global Health, Berlin, Germany
| | - Gundel Harms
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of International Health, Charité Center for Global Health, Berlin, Germany
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De los Santos MB, Loyola S, Perez-Velez ES, Santos RDP, Ramírez IM, Valdivia HO. Sampling is decisive to determination of Leishmania (Viannia) species. PLoS Negl Trop Dis 2024; 18:e0012113. [PMID: 38662642 PMCID: PMC11045131 DOI: 10.1371/journal.pntd.0012113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/28/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Accuracy of molecular tools for the identification of parasites that cause human cutaneous leishmaniasis (CL) could largely depend on the sampling method. Non-invasive or less-invasive sampling methods such as filter paper imprints and cotton swabs are preferred over punch biopsies and lancet scrapings for detection methods of Leishmania based on polymerase chain reaction (PCR) because they are painless, simple, and inexpensive, and of benefit to military and civilian patients to ensure timely treatment. However, different types of samples can generate false negatives and there is a clear need to demonstrate which sample is more proper for molecular assays. METHODOLOGY Here, we compared the sensitivity of molecular identification of different Leishmania (Viannia) species from Peru, using three types of sampling: punch biopsy, filter paper imprint and lancet scraping. Different composite reference standards and latent class models allowed to evaluate the accuracy of the molecular tools. Additionally, a quantitative PCR assessed variations in the results and parasite load in each type of sample. PRINCIPAL FINDINGS Different composite reference standards and latent class models determined higher sensitivity when lancet scrapings were used for sampling in the identification and determination of Leishmania (Viannia) species through PCR-based assays. This was consistent for genus identification through kinetoplastid DNA-PCR and for the determination of species using FRET probes-based Nested Real-Time PCR. Lack of species identification in some samples correlated with the low intensity of the PCR electrophoretic band, which reflects the low parasite load in samples. CONCLUSIONS The type of clinical sample can directly influence the detection and identification of Leishmania (Viannia) species. Here, we demonstrated that lancet scraping samples consistently allowed the identification of more leishmaniasis cases compared to filter paper imprints or biopsies. This procedure is inexpensive, painless, and easy to implement at the point of care and avoids the need for anesthesia, surgery, and hospitalization and therefore could be used in resource limited settings for both military and civilian populations.
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Affiliation(s)
- Maxy B. De los Santos
- Department of Parasitology, U.S. Naval Medical Research Unit SOUTH (NAMRU SOUTH), Bellavista, Lima, Peru
| | - Steev Loyola
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Erika S. Perez-Velez
- Departamento Académico de Medicina Humana, Universidad Andina del Cusco, Cusco, Peru
| | | | - Ivonne Melissa Ramírez
- Facultad de Ciencias Biológicas, Universidad Nacional Mayor de San Marcos, Cercado de Lima, Lima, Peru
| | - Hugo O. Valdivia
- Department of Parasitology, U.S. Naval Medical Research Unit SOUTH (NAMRU SOUTH), Bellavista, Lima, Peru
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Alves LL, Freire ML, Troian IL, de Morais-Teixeira E, Cota G. Local amphotericin B therapy for Cutaneous Leishmaniasis: A systematic review. PLoS Negl Trop Dis 2024; 18:e0012127. [PMID: 38626196 PMCID: PMC11051593 DOI: 10.1371/journal.pntd.0012127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 04/26/2024] [Accepted: 04/01/2024] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND Cutaneous leishmaniasis (CL) is characterized by potentially disfiguring skin ulcers carrying significant social stigma. To mitigate systemic drug exposure and reduce the toxicity from available treatments, studies addressing new local therapeutic strategies using available medications are coming up. This review systematically compiles preclinical and clinical data on the efficacy of amphotericin B (AmB) administered locally for cutaneous leishmaniasis. METHODOLOGY Structured searches were conducted in major databases. Clinical studies reporting cure rates and preclinical studies presenting any efficacy outcome were included. Exclusion criteria comprised nonoriginal studies, in vitro investigations, studies with fewer than 10 treated patients, and those evaluating AmB in combination with other antileishmanial drug components. PRINCIPAL FINDINGS A total of 21 studies were identified, encompassing 16 preclinical and five clinical studies. Preclinical assessments generally involved the topical use of commercial AmB formulations, often in conjunction with carriers or controlled release systems. However, the variation in the treatment schedules hindered direct comparisons. In clinical studies, topical AmB achieved a pooled cure rate of 45.6% [CI: 27.5-64.8%; I2 = 79.7; p = 0.002), while intralesional (IL) administration resulted in a 69.8% cure rate [CI: 52.3-82.9%; I2 = 63.9; p = 0.06). In the direct comparison available, no significant difference was noted between AmB-IL and meglumine antimoniate-IL administration (OR:1.7; CI:0.34-9.15, I2 = 79.1; p = 0.00), however a very low certainty of evidence was verified. CONCLUSIONS Different AmB formulations and administration routes have been explored in preclinical and clinical studies. Developing therapeutic technologies is evident. Current findings might be interpreted as a favorable proof of concept for the local AmB administration which makes this intervention eligible to be explored in future well-designed studies towards less toxic treatments for leishmaniasis.
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Affiliation(s)
- Líndicy Leidicy Alves
- Clinical Research and Public Policy Group on Infectious and Parasitic Diseases–René Rachou Institute—Fundação Oswaldo Cruz–FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil
| | - Mariana Lourenço Freire
- Clinical Research and Public Policy Group on Infectious and Parasitic Diseases–René Rachou Institute—Fundação Oswaldo Cruz–FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil
| | - Isadora Lana Troian
- Clinical Research and Public Policy Group on Infectious and Parasitic Diseases–René Rachou Institute—Fundação Oswaldo Cruz–FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil
| | - Eliane de Morais-Teixeira
- Clinical Research and Public Policy Group on Infectious and Parasitic Diseases–René Rachou Institute—Fundação Oswaldo Cruz–FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil
| | - Gláucia Cota
- Clinical Research and Public Policy Group on Infectious and Parasitic Diseases–René Rachou Institute—Fundação Oswaldo Cruz–FIOCRUZ, Belo Horizonte, Minas Gerais, Brazil
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Khazal RM, Flaih MH, Kadhim MK, Hussein KR. Genetic Diversity of Leishmania major Isolated from Different Dermal Lesions Using ITS2 Region. Acta Parasitol 2024; 69:831-838. [PMID: 38436865 DOI: 10.1007/s11686-024-00817-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 01/24/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND AND OBJECTIVE Cutaneous leishmaniasis (CL) is still considered to be an uncontrolled endemic disease that spreads in many countries. The current study aimed to determine intra-species relationships of L. major using ITS2 sequencing. METHODS The study was conducted from the beginning of March to the end of November 2022. All medical information regarding CL was collected from patients of Thi-Qar province who attended the Dermatology Department of Al-Hussein Teaching Hospital in Nasiriyah city. Seventy-three samples were selected for the molecular identification after confirming microscopy with Giemsa stain. In this study, the primers were designed using NCBI GenBank sequence database and Primer 3 plus primer design online software. RESULTS The results recorded 21 (28.77%) positive samples of L. major using the internal transcribed spacer 2 region (ITS2) in ribosomal RNA gene. The local L. major IQN.1-IQN.10 were submitted to NCBI GenBank database with accession numbers OM069357.1-OM069366.1, respectively. The phylogenetic analysis revealed that local isolates of L. major showed a close relationship with NCBI-BLAST L. major Iran isolate (KU680848.1). CONCLUSION ITS2-PCR is suitable for identifying Leishmania spp. and determining genetic diversity. A phylogenetic data analysis may provide an idea on the genetic homogeneity of local isolates and knowing the genetic origin of the dermal lesion. However, the local isolates showed genetic proximity to the KU680848.1 isolate. This signifies the possibility of infection prevalence from Iranian areas. In general, genetic variation of L. major isolates may give several clinical manifestations of the cutaneous lesion. Therefore, determination of the heterogeneity is important for detecting the infection origin, epidemiology, therapy, and control strategies.
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Affiliation(s)
- Ruaa M Khazal
- Department of Medical Laboratory Techniques, Nasiriyah Technical Institute, Southern Technical University, Nasiriyah, 64001, Iraq
| | - Mohammed H Flaih
- Department of Nursing Techniques, Nasiriyah Technical Institute, Southern Technical University, Nasiriyah, 64001, Iraq.
| | - Manar K Kadhim
- Education Directorate of Thi-Qar, Ministry of Education, Nasiriyah, 64001, Iraq
| | - Khwam R Hussein
- Department of Nursing Techniques, Nasiriyah Technical Institute, Southern Technical University, Nasiriyah, 64001, Iraq
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Pennini SN, de Oliveira Guerra JA, Rebello PFB, Abtibol-Bernardino MR, de Castro LL, da Silva Balieiro AA, de Oliveira Ferreira C, Noronha AB, Dos Santos da Silva CG, Leturiondo AL, Vital de Jesus D, de Araújo Santos FJ, Chrusciak-Talhari A, Guerra MDGVB, Talhari S. Treatment of cutaneous leishmaniasis with a sequential scheme of pentamidine and tamoxifen in an area with a predominance of Leishmania (Viannia) guyanensis: A randomised, non-inferiority clinical trial. Trop Med Int Health 2023; 28:871-880. [PMID: 37936525 DOI: 10.1111/tmi.13943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
OBJECTIVE To determine whether a combination of a single intramuscular (IM) dose of pentamidine (7 mg/kg) followed by oral tamoxifen 40 mg/day for 20 days is non-inferior to three IM doses of pentamidine 7 mg/kg in the treatment of cutaneous leishmaniasis with a margin of 15%. METHODS Phase II, randomised, controlled, open-label, non-inferiority clinical trial. Primary outcome was the complete healing of the lesions 6 months after starting treatment. Secondary outcomes were healing 3 months after starting treatment and determining the presence and severity of adverse effects (AE). RESULTS The research was concluded with 49 patients; Leishmania (Viannia) guyanensis was the most frequent species isolated. In the primary outcome, 18 (72%) (95% CI: 52.4%-85.7%) of the 25 patients allocated to the intervention group and 24 (100%) (95% CI: 86.2%-100%) of the control group (p = 0.015) met the established criteria of cure. There was no AE with tamoxifen. CONCLUSION Although a 72% cure rate presented by the combination of tamoxifen and pentamidine was lower than in the control group that achieved a 100% cure, it is still a safe and is a clinically relevant result. It indicates that the therapeutic scheme evaluated may be a promising option for populations in remote areas, however it should be further studied, in order to include a larger number of patients.
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Affiliation(s)
- Silmara Navarro Pennini
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas / Fundação de Medicina Topical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Fundação Hospitalar de Dermatologia Tropical e Venereologia Alfredo da Matta, Manaus, Brazil
| | - Jorge Augusto de Oliveira Guerra
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas / Fundação de Medicina Topical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | | | - Marília Rosa Abtibol-Bernardino
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas / Fundação de Medicina Topical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Faculdade de Medicina, Universidade Federal do Amazonas, Manaus, Brazil
| | | | | | - Cynthia de Oliveira Ferreira
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas / Fundação de Medicina Topical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Fundação Hospitalar de Dermatologia Tropical e Venereologia Alfredo da Matta, Manaus, Brazil
| | - Ariani Batista Noronha
- Fundação Hospitalar de Dermatologia Tropical e Venereologia Alfredo da Matta, Manaus, Brazil
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz - FIOCRUZ-Amazônia, Manaus, Brazil
| | | | - André Luiz Leturiondo
- Fundação Hospitalar de Dermatologia Tropical e Venereologia Alfredo da Matta, Manaus, Brazil
| | - Denison Vital de Jesus
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas / Fundação de Medicina Topical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | | | - Anette Chrusciak-Talhari
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas / Fundação de Medicina Topical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Maria Das Graças Vale Barbosa Guerra
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas / Fundação de Medicina Topical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Fundação Hospitalar de Dermatologia Tropical e Venereologia Alfredo da Matta, Manaus, Brazil
- Faculdade de Medicina, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Sinésio Talhari
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas / Fundação de Medicina Topical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Fundação Hospitalar de Dermatologia Tropical e Venereologia Alfredo da Matta, Manaus, Brazil
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Vandeputte M, van Henten S, van Griensven J, Bottieau E. Which trial do we need? A collaborative platform trial for cutaneous leishmaniasis amongst international travellers. Clin Microbiol Infect 2023; 29:1237-1240. [PMID: 37230249 DOI: 10.1016/j.cmi.2023.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/15/2023] [Accepted: 05/18/2023] [Indexed: 05/27/2023]
Affiliation(s)
- Martin Vandeputte
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; Infection Medicine, University of Edinburgh, Edinburgh, UK.
| | - Saskia van Henten
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Johan van Griensven
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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Lyra MR, Oliveira LFA, Schubach AO, Sampaio RNR, Rodrigues BC, Hueb M, Cota G, Silva RE, Francesconi F, Pompilio MA, França AO, Amato VS, Souza RM, Oliveira RVC, Valete CM, Pimentel MIF. A Randomized, Controlled, Noninferiority, Multicenter Trial of Systemic vs Intralesional Treatment With Meglumine Antimoniate for Cutaneous Leishmaniasis in Brazil. Clin Infect Dis 2023; 77:574-582. [PMID: 37100061 DOI: 10.1093/cid/ciad253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 01/30/2023] [Accepted: 04/24/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Meglumine antimoniate (MA) remains the main treatment for cutaneous leishmaniasis (CL). Uncontrolled studies suggest that intralesional MA (IL-MA) may be noninferior and safer than systemic MA (S-MA). METHODS Multicenter, randomized, controlled, open-label, phase 3 clinical trial to evaluate the efficacy and toxicity of IL-MA in 3 infiltrations at 14-day intervals compared with S-MA (10-20 mg Sb5+/kg/day, 20 days) for CL, with noninferiority margin of 20%. Primary and secondary outcomes were definitive cure at day 180 and epithelialization rate at day 90 of treatment, respectively. A 2-year follow-up was performed to assess relapses and emergence of mucosal lesions. Adverse events (AEs) were monitored according to the Division of AIDS AE grading system. RESULTS We evaluated 135 patients. The cure rates (95% confidence interval) for IL-MA and S-MA treatment were, respectively, 82.8% (70.5-91.4) and 67.8% (53.3-78.3) per protocol (PP) and 70.6% (58.3-81.0) and 59.7% (47.0-71.5) per intention to treat (ITT). The epithelialization rates of the IL-MA and S-MA treatment were, respectively, 79.3% (66.6-88 + 8) and 71.2% (57.9-82.2) PP and 69.1% (55.2-78.5) and 64.2% (50.0-74.2) ITT. AEs in the IL-MA and S-MA groups were, respectively, clinical, 45.6% and 80.6%; laboratory, 26.5% and 73.1%; and electrocardiogram, 8.8% and 25.4%. Ten participants in the S-MA group and 1 in the IL-MA group were discontinued due to severe or persistent AEs. CONCLUSIONS IL-MA provides a similar cure rate and results in less toxicity compared with S-MA and may be used as first-line therapy for CL patients. CLINICAL TRIALS REGISTRATION REBEC: RBR-6mk5n4.
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Affiliation(s)
- Marcelo R Lyra
- Laboratory of Clinical Research and Surveillance in Leishmaniasis, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Liliane F A Oliveira
- Laboratory of Clinical Research and Surveillance in Leishmaniasis, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Armando O Schubach
- Laboratory of Clinical Research and Surveillance in Leishmaniasis, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Raimunda N R Sampaio
- Dermatology Service of Internal Medicine, Faculty of Medicine of the University of Brasília, Brasília, DF, Brazil
| | - Bruna C Rodrigues
- Dermatology Service of Internal Medicine, Faculty of Medicine of the University of Brasília, Brasília, DF, Brazil
| | - Marcia Hueb
- Internal Medicine Department, Julio Muller University Hospital, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
| | - Gláucia Cota
- Clinical Research and Public Policies in Infectious Diseases, René Rachou Institute, Fiocruz Minas, Belo Horizonte, MG, Brazil
| | - Rosiana E Silva
- Clinical Research and Public Policies in Infectious Diseases, René Rachou Institute, Fiocruz Minas, Belo Horizonte, MG, Brazil
| | - Fabio Francesconi
- Dermatology Department, Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, AM, Brazil
- Dermatology Department, Federal University of Amazonas, Manaus, AM, Brazil
| | - Maurício A Pompilio
- Faculty of Medicine of the Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Adriana O França
- Faculty of Medicine of the Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Valdir S Amato
- Laboratory of Parasitology, Institute of Tropical Medicine, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Regina M Souza
- Laboratory of Parasitology, Institute of Tropical Medicine, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Raquel V C Oliveira
- Laboratory of Clinical Epidemiology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Cláudia M Valete
- Laboratory of Clinical Research and Surveillance in Leishmaniasis, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Department of Otorhinolaryngology and Ophthalmology, Faculty of Medicine of Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maria I F Pimentel
- Laboratory of Clinical Research and Surveillance in Leishmaniasis, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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van Henten S, Bialfew F, Hassen S, Tilahun F, van Griensven J, Abdela SG. Treatment of Cutaneous Leishmaniasis with Sodium Stibogluconate and Allopurinol in a Routine Setting in Ethiopia: Clinical and Patient-Reported Outcomes and Operational Challenges. Trop Med Infect Dis 2023; 8:414. [PMID: 37624352 PMCID: PMC10459856 DOI: 10.3390/tropicalmed8080414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 08/26/2023] Open
Abstract
Cutaneous leishmaniasis (CL) is common in Ethiopia, but the national guideline does not offer specific treatment recommendations. Consequently, different treatment regimens are used in the country, without quality evidence. In Boru Meda Hospital, sodium stibogluconate (SSG) is routinely used in combination with allopurinol for systemic CL treatment, although evidence on its effectiveness is limited. An observational cohort study was carried out to document clinical treatment outcomes in patients receiving SSG/allopurinol at the end of each 28-day treatment cycle and after 180 days. Patient-reported outcomes were assessed by asking patients to rate lesion severity, and by the dermatological life quality index. A total of 104 patients were included. After one treatment cycle, only four patients were clinically cured, although patient-reported outcomes significantly improved. The majority (88) of patients were appointed for a second treatment cycle, of whom only 37 (42%) attended. Among the 36 patients who came for final outcome assessment, 50% were cured. Follow-up and treatment were severely affected by conflict; drug stock-outs and insufficient ward capacity for treatment were additional challenges. The treatment outcomes of SSG/allopurinol were relatively poor, and most patients required more than one cycle of treatment. Shortages of drugs and beds indicate the existing gaps in providing CL treatment in Ethiopia.
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Affiliation(s)
| | | | - Seid Hassen
- Boru Meda Hospital, Dessie P.O. Box 70, Ethiopia
| | | | | | - Seid Getahun Abdela
- Department of Internal Medicine, Wollo University, Dessie P.O. Box 1145, Ethiopia;
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Castillo M, Alexander N, Rubiano L, Rojas C, Navarro A, Rincon D, Bernal LV, Lerma YO, Saravia NG, Aronoff-Spencer E. Randomized trial evaluating an mHealth intervention for the early community-based detection and follow-up of cutaneous leishmaniasis in rural Colombia. PLoS Negl Trop Dis 2023; 17:e0011180. [PMID: 36972285 PMCID: PMC10079216 DOI: 10.1371/journal.pntd.0011180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/06/2023] [Accepted: 02/19/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND In Latin America, cutaneous leishmaniasis primarily affects dispersed rural communities, that have limited access to the public health system and medical attention. Mobile health (mHealth) strategies have shown potential to improve clinical management and epidemiological surveillance of neglected tropical diseases, particularly those of the skin. METHODS The Guaral +ST app for Android was designed to monitor cutaneous leishmaniasis treatment and assess therapeutic response. We carried out a randomized trial in the coastal municipality of Tumaco in southwestern Colombia, with parallel arms comparing a) follow-up aided by the app to b) standard institution-based follow-up. Treatment was prescribed according to national guidelines. Follow-up of therapeutic response was scheduled at the end of treatment and at 7, 13 and 26 weeks after the start of treatment. The primary endpoint was the proportion of participants who were monitored at or around week 26, allowing outcome and effectiveness of treatment to be determined. RESULTS Follow-up of treatment and outcome assessment was achieved in significantly more patients in the intervention arm than the controls, Of the 75 participants in the two randomized arms, 74 had information on whether or not treatment was followed and outcome determined at or around week 26. Among these, 26/49 (53.1%) were evaluated in the intervention arm, and none (0/25, 0%) in the control arm (difference = 53.1%, 95% confidence interval 39.1-67.0%, p<0.001). Of the 26 participants evaluated at or around week 26 in the intervention arm, 22 (84.6%) had cured. There were no serious adverse events, nor events of severe intensity among patients monitored by CHW using the app. CONCLUSION This study provides proof of concept for mHealth to monitor treatment of CL in remote and complex settings, deliver improved care and to provide information to the health system on the effectiveness of treatment as it is delivered to affected populations. CLINICAL TRIAL REGISTRATION ISRCTN54865992.
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Affiliation(s)
- Mabel Castillo
- Centro Internacional de Entrenamiento e Investigaciones Médicas, CIDEIM, Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | - Neal Alexander
- Centro Internacional de Entrenamiento e Investigaciones Médicas, CIDEIM, Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | - Luisa Rubiano
- Centro Internacional de Entrenamiento e Investigaciones Médicas, CIDEIM, Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | - Carlos Rojas
- Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia
| | | | | | | | - Yenifer Orobio Lerma
- Centro Internacional de Entrenamiento e Investigaciones Médicas, CIDEIM, Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | - Nancy Gore Saravia
- Centro Internacional de Entrenamiento e Investigaciones Médicas, CIDEIM, Cali, Colombia
- Universidad Icesi, Cali, Colombia
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Castro MDM, Rode J, Machado PRL, Llanos-Cuentas A, Hueb M, Cota G, Rojas IV, Orobio Y, Oviedo Sarmiento O, Rojas E, Quintero J, Pimentel MIF, Soto J, Suprien C, Alvarez F, Ramos AP, Arantes RBDS, da Silva RE, Arenas CM, Vélez ID, Lyra MR, Saravia NG, Arana B, Alexander N. Cutaneous leishmaniasis treatment and therapeutic outcomes in special populations: A collaborative retrospective study. PLoS Negl Trop Dis 2023; 17:e0011029. [PMID: 36689465 PMCID: PMC9894540 DOI: 10.1371/journal.pntd.0011029] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 02/02/2023] [Accepted: 12/16/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Treatment guidance for children and older adult patients affected by cutaneous leishmaniasis (CL) is unclear due to limited representation of these groups in clinical trials. METHODS We conducted a collaborative retrospective study to describe the effectiveness and safety of antileishmanial treatments in children ≤ 10 and adults ≥ 60 years of age, treated between 2014 and 2018 in ten CL referral centers in Latin America. RESULTS 2,037 clinical records were assessed for eligibility. Of them, the main reason for non-inclusion was lack of data on treatment follow-up and therapeutic response (182/242, 75% of children and 179/468, 38% of adults). Data on 1,325 eligible CL patients (736 children and 589 older adults) were analyzed. In both age groups, disease presentation was mild, with a median number of lesions of one (IQR: 1-2) and median lesion diameter of less than 3 cm. Less than 50% of the patients had data for two or more follow-up visits post-treatment (being only 28% in pediatric patients). Systemic antimonials were the most common monotherapy regimen in both age groups (590/736, 80.2% of children and 308/589, 52.3% of older adults) with overall cure rates of 54.6% (95% CI: 50.5-58.6%) and 68.2% (95% CI: 62.6-73.4%), respectively. Other treatments used include miltefosine, amphotericin B, intralesional antimonials, and pentamidine. Adverse reactions related to the main treatment were experienced in 11.9% (86/722) of children versus 38.4% (206/537) of older adults. Most adverse reactions were of mild intensity. CONCLUSION Our findings support the need for greater availability and use of alternatives to systemic antimonials, particularly local therapies, and development of strategies to improve patient follow-up across the region, with special attention to pediatric populations.
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Affiliation(s)
- Maria del Mar Castro
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | - Joelle Rode
- Drugs for Neglected Diseases initiative (DNDi), Rio de Janeiro, Brazil
| | - Paulo R. L. Machado
- Servico de Imunologia, Hospital Universitário Prof. Edgar Santos, Universidade Federal da Bahia, Salvador, Brazil
| | - Alejandro Llanos-Cuentas
- Unidad de Leishmaniasis y Malaria, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, and Hospital Cayetano Heredia, Lima, Perú
| | - Marcia Hueb
- Universidade Federal de Mato Grosso, Hospital Universitário Júlio Müller (HUJM), Cuiabá, Mato Grosso, Brazil
| | - Gláucia Cota
- Instituto René Rachou, Fundação Oswaldo Cruz, Fiocruz, Belo Horizonte, Minas Gerais, Brazil
| | | | - Yenifer Orobio
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | - Oscar Oviedo Sarmiento
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | - Ernesto Rojas
- Centro Universitario de Medicina Tropical–Universidad Mayor de San Simón (CUMT), Cochabamba, Bolivia
| | - Juliana Quintero
- PECET—Programa de Estudio y Control de Enfermedades Tropicales, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | | | - Jaime Soto
- FUNDERMA (Fundación Nacional de Dermatología), Santa Cruz de la Sierra, Bolivia
| | - Carvel Suprien
- Servico de Imunologia, Hospital Universitário Prof. Edgar Santos, Universidade Federal da Bahia, Salvador, Brazil
| | - Fiorela Alvarez
- Unidad de Leishmaniasis y Malaria, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, and Hospital Cayetano Heredia, Lima, Perú
| | - Ana Pilar Ramos
- Unidad de Leishmaniasis y Malaria, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, and Hospital Cayetano Heredia, Lima, Perú
| | | | | | | | - Ivan Darío Vélez
- PECET—Programa de Estudio y Control de Enfermedades Tropicales, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - Marcelo Rosandiski Lyra
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Nancy Gore Saravia
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | - Byron Arana
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
| | - Neal Alexander
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia
- Universidad Icesi, Cali, Colombia
- * E-mail:
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Del Castillo AM, Castro MDM, Cossio A, García Luna JA, Rincón D, Castillo RM, Prieto MD, Rebellón-Sánchez DE, Navarro A, Alexander N. Sensitivity and Specificity of the Remote Evaluation of Therapeutic Response in Cutaneous Leishmaniasis Using Photographs from a Mobile Application. Am J Trop Med Hyg 2022; 107:tpmd220164. [PMID: 35895332 PMCID: PMC9490675 DOI: 10.4269/ajtmh.22-0164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/23/2022] [Indexed: 11/07/2022] Open
Abstract
Cutaneous leishmaniasis (CL) primarily affects people in remote settings with limited access to health services. mHealth tools offer an opportunity to overcome knowledge gaps about clinical response to treatment. We evaluated the validity of the Guaral+ST mobile application for the remote assessment of therapeutic response in patients with CL, through photographs of lesions captured with the app by community health volunteers. Patients with confirmed CL were followed at weeks 13 and 26 after completion of treatment to assess therapeutic response in two clinical settings in southwest Colombia. Direct evaluation of lesions performed by an experienced physician was considered the reference standard. Photographs of lesions taken by CHV or nurse assistants with the mobile app, were independently evaluated by three physicians to define clinical response. A summary measure of clinical outcome defined by the three physicians was considered the index test. Sensitivity, specificity, and positive and negative predictive values were estimated. Interrater reliability (kappa) was calculated. Among 53 participants with CL who had at least one follow-up visit, the sensitivity of therapeutic response evaluation through photographs taken with the Guaral+ST app, compared with direct evaluation by an expert physician, had high validity with sensitivity of 100% (95% confidence interval: 80.5-100%) and specificity of 97.2% (95% confidence interval: 85.5-99.9%). The chance-adjusted agreement (κ) was > 0.8, which is conventionally characterized as almost perfect. The high accuracy of the remote evaluation of photographs for the assessment of therapeutic response supports the use of mHealth tools for improving access to treatment follow-up for CL.
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Affiliation(s)
| | - Maria del Mar Castro
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | - Alexandra Cossio
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | - Jonny Alejandro García Luna
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | - Domiciano Rincón
- Universidad Icesi, Cali, Colombia
- Grupo i2t, Universidad Icesi, Cali, Colombia
| | - Ruth Mabel Castillo
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | - Miguel Darío Prieto
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia
| | | | - Andrés Navarro
- Universidad Icesi, Cali, Colombia
- Grupo i2t, Universidad Icesi, Cali, Colombia
| | - Neal Alexander
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia
- Universidad Icesi, Cali, Colombia
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Treatment outcome of imported cutaneous leishmaniasis among travellers and migrants infected with Leishmania major and Leishmania tropica: a retrospective study in European centres 2013 to 2019. Int J Infect Dis 2022; 122:375-381. [PMID: 35728749 DOI: 10.1016/j.ijid.2022.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Cutaneous leishmaniasis (CL) in Asia, Northern and Sub-Saharan Africa is mainly caused by Leishmania major and Leishmania tropica. We describe and evaluate the treatment outcome of CL among travellers and migrants in Europe. METHODS A retrospective study of parasitological confirmed CL cases caused by L. major and L. tropica during 2013-2019 in Europe. Data were collected from medical records and databases within the LeishMan network. RESULTS Out of 206 included cases of CL, seventy-five were identified as L. major and 131 as L. tropica. Eighty percent of the patients with L. tropica infection were migrants, whereas 53 % of patients with L. major infection had been visiting friends and relatives. Among patients with L. tropica, 48 %, were younger than 15. Pentavalent antimony cured 73 % (L. major) and 78 % (L. tropica). Intralesional administration had a cure rate, 86 % and systemic, 67%, on L. tropica. Liposomal amphotericin B had a cure rate of 44-63 %. CONCLUSION L. major infections were mostly found in individuals visiting friends and relatives, whereas L. tropica were mainly identified in migrants. No patients with L. major relapsed. Pentavalent antimony, liposomal amphotericin B and cryotherapy had cure rates in accordance with previous studies.
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Lemieux A, Lagacé F, Billick K, Ndao M, Yansouni CP, Semret M, Libman MD, Barkati S. Cutaneous leishmaniasis in travellers and migrants: a 10-year case series in a Canadian reference centre for tropical diseases. CMAJ Open 2022; 10:E546-E553. [PMID: 35728837 PMCID: PMC9343123 DOI: 10.9778/cmajo.20210238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Cutaneous leishmaniasis is increasingly encountered in returned travellers and migrants to nonendemic countries. We sought to describe the clinical characteristics and treatment outcomes of cases of cutaneous leishmaniasis diagnosed at our reference centre over a 10-year period. METHODS This case series included all laboratory-confirmed cases of cutaneous leishmaniasis in travellers and migrants for whom complete clinical data were available, diagnosed between January 2008 and October 2018 at the J.D. MacLean Centre for Tropical Diseases in Montréal. We examined the number of cases each year. We used descriptive statistics to summarize variables (e.g., demographic characteristics, travel history, clinical presentation, diagnostic methods, treatments, adverse events) extracted from the patients' electronic medical records. The primary outcome for evaluating clinical response to treatment was defined as the complete re-epithelialization of the wound surface at 1 year. RESULTS We identified 48 patients who received diagnoses of cutaneous leishmaniasis in the 10-year study period, including 33 exposed in the Americas and 15 exposed in other regions (median age 43.5 [range 1-75] yr); 28 [58%] males). The annual number of cases increased from 9 in 2008/09 to 16 in 2017/18. The median time from onset to diagnosis was 89 (IQR 58-134) days. Liposomal amphotericin B was the most commonly used initial treatment (20 [53%] patients). Thirty-five patients completed their follow-up, and 11 had successful response to 1 course of liposomal amphotericin B. Adverse events (including acute kidney injury, increased pancreatic enzymes and fatigue) were reported in 6 (30%) patients. Clinical cure was achieved within 1 year for 32 (91%) of the 35 patients who completed follow-up. INTERPRETATION This study showed an increase in the number of cases of cutaneous leishmaniasis seen in our centre over the study period, likely because of increased travel and migration. This diagnosis should be considered in travellers and migrants with a chronic cutaneous lesion.
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Affiliation(s)
- Alexandre Lemieux
- Department of Medicine (Lemieux), Division of Dermatology, Centre Hospitalier de l'Université de Montréal; Department of Medicine (Lagacé, Billick), Division of Dermatology, McGill University Health Centre; J.D. MacLean Centre for Tropical Diseases at McGill University (Billick, Ndao, Yansouni, Semret, Libman, Barkati); National Reference Centre for Parasitology (Ndao), Research Institute of the McGill University Health Centre; Department of Medicine (Yansouni, Semret, Libman, Barkati), Division of Infectious Diseases, McGill University Health Centre, Montréal, Que
| | - François Lagacé
- Department of Medicine (Lemieux), Division of Dermatology, Centre Hospitalier de l'Université de Montréal; Department of Medicine (Lagacé, Billick), Division of Dermatology, McGill University Health Centre; J.D. MacLean Centre for Tropical Diseases at McGill University (Billick, Ndao, Yansouni, Semret, Libman, Barkati); National Reference Centre for Parasitology (Ndao), Research Institute of the McGill University Health Centre; Department of Medicine (Yansouni, Semret, Libman, Barkati), Division of Infectious Diseases, McGill University Health Centre, Montréal, Que
| | - Kendall Billick
- Department of Medicine (Lemieux), Division of Dermatology, Centre Hospitalier de l'Université de Montréal; Department of Medicine (Lagacé, Billick), Division of Dermatology, McGill University Health Centre; J.D. MacLean Centre for Tropical Diseases at McGill University (Billick, Ndao, Yansouni, Semret, Libman, Barkati); National Reference Centre for Parasitology (Ndao), Research Institute of the McGill University Health Centre; Department of Medicine (Yansouni, Semret, Libman, Barkati), Division of Infectious Diseases, McGill University Health Centre, Montréal, Que
| | - Momar Ndao
- Department of Medicine (Lemieux), Division of Dermatology, Centre Hospitalier de l'Université de Montréal; Department of Medicine (Lagacé, Billick), Division of Dermatology, McGill University Health Centre; J.D. MacLean Centre for Tropical Diseases at McGill University (Billick, Ndao, Yansouni, Semret, Libman, Barkati); National Reference Centre for Parasitology (Ndao), Research Institute of the McGill University Health Centre; Department of Medicine (Yansouni, Semret, Libman, Barkati), Division of Infectious Diseases, McGill University Health Centre, Montréal, Que
| | - Cédric P Yansouni
- Department of Medicine (Lemieux), Division of Dermatology, Centre Hospitalier de l'Université de Montréal; Department of Medicine (Lagacé, Billick), Division of Dermatology, McGill University Health Centre; J.D. MacLean Centre for Tropical Diseases at McGill University (Billick, Ndao, Yansouni, Semret, Libman, Barkati); National Reference Centre for Parasitology (Ndao), Research Institute of the McGill University Health Centre; Department of Medicine (Yansouni, Semret, Libman, Barkati), Division of Infectious Diseases, McGill University Health Centre, Montréal, Que
| | - Makeda Semret
- Department of Medicine (Lemieux), Division of Dermatology, Centre Hospitalier de l'Université de Montréal; Department of Medicine (Lagacé, Billick), Division of Dermatology, McGill University Health Centre; J.D. MacLean Centre for Tropical Diseases at McGill University (Billick, Ndao, Yansouni, Semret, Libman, Barkati); National Reference Centre for Parasitology (Ndao), Research Institute of the McGill University Health Centre; Department of Medicine (Yansouni, Semret, Libman, Barkati), Division of Infectious Diseases, McGill University Health Centre, Montréal, Que
| | - Michael D Libman
- Department of Medicine (Lemieux), Division of Dermatology, Centre Hospitalier de l'Université de Montréal; Department of Medicine (Lagacé, Billick), Division of Dermatology, McGill University Health Centre; J.D. MacLean Centre for Tropical Diseases at McGill University (Billick, Ndao, Yansouni, Semret, Libman, Barkati); National Reference Centre for Parasitology (Ndao), Research Institute of the McGill University Health Centre; Department of Medicine (Yansouni, Semret, Libman, Barkati), Division of Infectious Diseases, McGill University Health Centre, Montréal, Que
| | - Sapha Barkati
- Department of Medicine (Lemieux), Division of Dermatology, Centre Hospitalier de l'Université de Montréal; Department of Medicine (Lagacé, Billick), Division of Dermatology, McGill University Health Centre; J.D. MacLean Centre for Tropical Diseases at McGill University (Billick, Ndao, Yansouni, Semret, Libman, Barkati); National Reference Centre for Parasitology (Ndao), Research Institute of the McGill University Health Centre; Department of Medicine (Yansouni, Semret, Libman, Barkati), Division of Infectious Diseases, McGill University Health Centre, Montréal, Que.
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Valencia BM, Lau R, Kariyawasam R, Jara M, Ramos AP, Chantry M, Lana JT, Boggild AK, Llanos-Cuentas A. Leishmania RNA virus-1 is similarly detected among metastatic and non-metastatic phenotypes in a prospective cohort of American Tegumentary Leishmaniasis. PLoS Negl Trop Dis 2022; 16:e0010162. [PMID: 35089930 PMCID: PMC8827429 DOI: 10.1371/journal.pntd.0010162] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/09/2022] [Accepted: 01/11/2022] [Indexed: 12/19/2022] Open
Abstract
American Tegumentary Leishmaniasis (ATL) is an endemic and neglected disease of South America. Here, mucosal leishmaniasis (ML) disproportionately affects up to 20% of subjects with current or previous localised cutaneous leishmaniasis (LCL). Preclinical and clinical reports have implicated the Leishmania RNA virus-1 (LRV1) as a possible determinant of progression to ML and other severe manifestations such as extensive cutaneous and mucosal disease and treatment failure and relapse. However, these associations were not consistently found in other observational studies and are exclusively based on cross-sectional designs. In the present study, 56 subjects with confirmed ATL were assessed and followed out for 24-months post-treatment. Lesion biopsy specimens were processed for molecular detection and quantification of Leishmania parasites, species identification, and LRV1 detection. Among individuals presenting LRV1 positive lesions, 40% harboured metastatic phenotypes; comparatively 58.1% of patients with LRV1 negative lesions harboured metastatic phenotypes (p = 0.299). We found treatment failure (p = 0.575) and frequency of severe metastatic phenotypes (p = 0.667) to be similarly independent of the LRV1. Parasite loads did not differ according to the LRV1 status (p = 0.330), nor did Leishmanin skin induration size (p = 0.907) or histopathologic patterns (p = 0.780). This study did not find clinical, parasitological, or immunological evidence supporting the hypothesis that LRV1 is a significant determinant of the pathobiology of ATL. The Leishmania RNA virus-1 (LRV1) has been implicated as a possible modulator agent in the pathogenesis of leishmaniasis. In-vivo and in-vitro studies have depicted specific mechanisms of how LRV1 could lead to metastasis. Clinical studies and epidemiological evidence have both supported and rejected the hypothesis that LRV1 is a relevant determinant of progression, treatment failure and clinical severity of American Tegumentary Leishmaniasis (ATL). This lack of consistency between preclinical and clinical reports requires further longitudinal studies to clarify the role of LRV1 in ATL. Due to the complex nature of ATL, as other frequent human diseases, these studies should tackle multiple determinants of pathogenicity, including LRV1 status, parasite features, immune status, and prevalent comorbidities affecting individuals in endemic settings. Also, critical methodological aspects allowing for the reliable identification and quantification of LRV1 should be guaranteed.
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Affiliation(s)
- Braulio Mark Valencia
- Kirby Institute, The University of New South Wales (UNSW Sydney), Sydney, Australia
- * E-mail:
| | - Rachel Lau
- Public Health Ontario Laboratory, Toronto, Canada
| | | | - Marlene Jara
- Institute of Tropical Medicine of Antwerp, Antwerp, Belgium
| | - Ana Pilar Ramos
- Instituto de Medicina Tropical “Alexander von Humboldt”, Universidad Peruana Cayetano Heredia, Lima, Peru
- Hospital Nacional Cayetano Heredia, Lima, Peru
| | | | - Justin T. Lana
- Nicholas School of the Environment, Duke University, Durham, North Carolina, United States of America
| | - Andrea K. Boggild
- Institute of Medical Science, University of Toronto, Toronto, Canada
- Tropical Disease Unit, Toronto General Hospital, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Alejandro Llanos-Cuentas
- Instituto de Medicina Tropical “Alexander von Humboldt”, Universidad Peruana Cayetano Heredia, Lima, Peru
- Hospital Nacional Cayetano Heredia, Lima, Peru
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Clinical diversity and treatment results in Tegumentary Leishmaniasis: A European clinical report in 459 patients. PLoS Negl Trop Dis 2021; 15:e0009863. [PMID: 34644288 PMCID: PMC8544871 DOI: 10.1371/journal.pntd.0009863] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/25/2021] [Accepted: 09/28/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Cutaneous leishmaniasis (CL) is frequent in travellers and can involve oro-nasal mucosae. Clinical presentation impacts therapeutic management. METHODOLOGY Demographic and clinical data from 459 travellers infected in 47 different countries were collected by members of the European LeishMan consortium. The infecting Leishmania species was identified in 198 patients. PRINCIPAL FINDINGS Compared to Old World CL, New World CL was more frequently ulcerative (75% vs 47%), larger (3 vs 2cm), less frequently facial (17% vs 38%) and less frequently associated with mucosal involvement (2.7% vs 5.3%). Patients with mucosal lesions were older (58 vs 30 years) and more frequently immunocompromised (37% vs 3.5%) compared to patients with only skin lesions. Young adults infected in Latin America with L. braziliensis or L. guyanensis complex typically had an ulcer of the lower limbs with mucosal involvement in 5.8% of cases. Typically, infections with L. major and L. tropica acquired in Africa or the Middle East were not associated with mucosal lesions, while infections with L. infantum, acquired in Southern Europe resulted in slowly evolving facial lesions with mucosal involvement in 22% of cases. Local or systemic treatments were used in patients with different clinical presentations but resulted in similarly high cure rates (89% vs 86%). CONCLUSION/SIGNIFICANCE CL acquired in L. infantum-endemic European and Mediterranean areas displays unexpected high rates of mucosal involvement comparable to those of CL acquired in Latin America, especially in immunocompromised patients. When used as per recommendations, local therapy is associated with high cure rates.
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Merson L, Bourner J, Jalloh S, Erber A, Salam AP, Flahault A, Olliaro PL. Clinical characterization of Lassa fever: A systematic review of clinical reports and research to inform clinical trial design. PLoS Negl Trop Dis 2021; 15:e0009788. [PMID: 34547033 PMCID: PMC8486098 DOI: 10.1371/journal.pntd.0009788] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 10/01/2021] [Accepted: 09/03/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Research is urgently needed to reduce the morbidity and mortality of Lassa fever (LF), including clinical trials to test new therapies and to verify the efficacy and safety of the only current treatment recommendation, ribavirin, which has a weak clinical evidence base. To help establish a basis for the development of an adaptable, standardised clinical trial methodology, we conducted a systematic review to identify the clinical characteristics and outcomes of LF and describe how LF has historically been defined and assessed in the scientific literature. METHODOLOGY Primary clinical studies and reports of patients with suspected and confirmed diagnosis of LF published in the peer-reviewed literature before 15 April 2021 were included. Publications were selected following a two-stage screening of abstracts, then full-texts, by two independent reviewers at each stage. Data were extracted, verified, and summarised using descriptive statistics. RESULTS 147 publications were included, primarily case reports (36%), case series (28%), and cohort studies (20%); only 2 quasi-randomised studies (1%) were found. Data are mostly from Nigeria (52% of individuals, 41% of publications) and Sierra Leone (42% of individuals, 31% of publications). The results corroborate the World Health Organisation characterisation of LF presentation. However, a broader spectrum of presenting symptoms is evident, such as gastrointestinal illness and other nervous system and musculoskeletal disorders that are not commonly included as indicators of LF. The overall case fatality ratio was 30% in laboratory-confirmed cases (1896/6373 reported in 109 publications). CONCLUSION Systematic review is an important tool in the clinical characterisation of diseases with limited publications. The results herein provide a more complete understanding of the spectrum of disease which is relevant to clinical trial design. This review demonstrates the need for coordination across the LF research community to generate harmonised research methods that can contribute to building a strong evidence base for new treatments and foster confidence in their integration into clinical care.
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Affiliation(s)
- Laura Merson
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Josephine Bourner
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Astrid Erber
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Alex Paddy Salam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Antoine Flahault
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Piero L. Olliaro
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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17
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Barkati S, Libman MD. Cutaneous leishmaniasis and the vicious cycle of neglect. J Travel Med 2021; 28:6302448. [PMID: 34142151 DOI: 10.1093/jtm/taab093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 06/14/2021] [Indexed: 11/13/2022]
Abstract
Cutaneous leishmaniasis remains a widespread poorly controlled disease, also seriously affecting travellers and migrants. Resources for diagnosis and management are lacking in endemic areas, timely recognition of cases is problematic everywhere, and we lack evidence to support guidelines for treatments, which are incompletely effective and often toxic, despite scores of publications.
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Affiliation(s)
- Sapha Barkati
- J.D. MacLean Centre for Tropical Diseases, McGill University, Montreal, Quebec, Canada.,Research Institute, McGill University Health Centre, Montreal, Quebec, Canada.,Department of Medicine, Division of Infectious Diseases, McGill University Health Centre, Montreal, Quebec, Canada
| | - Michael D Libman
- J.D. MacLean Centre for Tropical Diseases, McGill University, Montreal, Quebec, Canada.,Research Institute, McGill University Health Centre, Montreal, Quebec, Canada.,Department of Medicine, Division of Infectious Diseases, McGill University Health Centre, Montreal, Quebec, Canada
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18
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Gómez MA, Navas A, Prieto MD, Giraldo-Parra L, Cossio A, Alexander N, Gore Saravia N. Immuno-pharmacokinetics of Meglumine Antimoniate in Patients With Cutaneous Leishmaniasis Caused by Leishmania (Viannia). Clin Infect Dis 2021; 72:e484-e492. [PMID: 32818964 PMCID: PMC8130027 DOI: 10.1093/cid/ciaa1206] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Control of cutaneous leishmaniasis (CL) relies on chemotherapy, yet gaps in our understanding of the determinants of therapeutic outcome impede optimization of antileishmanial drug regimens. Pharmacodynamic (PD) parameters of antimicrobials are based on the relationship between drug concentrations/exposure and microbial kill. However, viable Leishmania persist in a high proportion of individuals despite clinical resolution, indicating that determinants other than parasite clearance are involved in drug efficacy. METHODS In this study, the profiles of expression of neutrophils, monocytes, Th1 and Th17 gene signatures were characterized in peripheral blood mononuclear cells (PBMCs) during treatment with meglumine antimoniate (MA) and clinical cure of human CL caused by Leishmania (Viannia). We explored relationships of immune gene expression with plasma and intracellular antimony (Sb) concentrations. RESULTS Our findings show a rapid and orchestrated modulation of gene expression networks upon exposure to MA. We report nonlinear pharmacokinetic/pharmacodynamic (PK/PD) relationships of Sb and gene expression dynamics in PBMCs , concurring with a time lag in the detection of intracellular drug concentrations and with PK evidence of intracellular Sb accumulation. CONCLUSIONS Our results quantitatively portray the immune dynamics of therapeutic healing, and provide the knowledge base for optimization of antimonial drug treatments, guiding the selection and/or design of targeted drug delivery systems and strategies for targeted immunomodulation.
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Affiliation(s)
- María Adelaida Gómez
- Centro Internacional de Entrenamiento e Investigaciones Médicas-CIDEIM, Cali, Colombia
- Universidad Icesi, Cali, Colombia
- Correspondence: M. Adelaida Gómez, CIDEIM, Calle 18 # 122-135, Universidad Icesi, Edificio O, Cali, Colombia ()
| | - Adriana Navas
- Centro Internacional de Entrenamiento e Investigaciones Médicas-CIDEIM, Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | - Miguel Dario Prieto
- Centro Internacional de Entrenamiento e Investigaciones Médicas-CIDEIM, Cali, Colombia
| | - Lina Giraldo-Parra
- Centro Internacional de Entrenamiento e Investigaciones Médicas-CIDEIM, Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | - Alexandra Cossio
- Centro Internacional de Entrenamiento e Investigaciones Médicas-CIDEIM, Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | - Neal Alexander
- Centro Internacional de Entrenamiento e Investigaciones Médicas-CIDEIM, Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | - Nancy Gore Saravia
- Centro Internacional de Entrenamiento e Investigaciones Médicas-CIDEIM, Cali, Colombia
- Universidad Icesi, Cali, Colombia
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Naeem F, Nathan K, Chivinski J, Ekmekjian T, Libman M, Barkati S. Intravenous liposomal amphotericin B efficacy and safety for cutaneous and mucosal leishmaniasis: a systematic review and meta-analysis protocol. BMJ Open 2021; 11:e045707. [PMID: 34135039 PMCID: PMC8211079 DOI: 10.1136/bmjopen-2020-045707] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 06/02/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Treatment of cutaneous and mucosal leishmaniasis (CL and ML, respectively) must be individualised as there is no universal therapeutic approach. Intravenous liposomal amphotericin B (L-AmB) is an accessible and relatively safe treatment that has been increasingly used for the treatment of CL and ML. While several descriptive studies have been published on the efficacy and safety of L-AmB, there are no interventional studies. Moreover, the findings from published studies have not yet been integrated and synthesised. Therefore, we aim to evaluate and consolidate the descriptive evidence on the efficacy and the safety of Intravenous L-AmB treatment for CL and ML in both the New and Old World. METHODS AND ANALYSES A systematic review of all relevant study types with no restriction on date or language of publication will be conducted. Online databases including MEDLINE, The Cochrane Library, EMBASE, EBSCO, Scopus, Ovid and WHO databases were searched on 3 April 2020. The search included all study types that assess Intravenous L-AmB treatment for CL and ML in humans. The Population, Intervention, Comparison, Outcome and Study Design strategy and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines will be used to determine which studies will be selected for final inclusion. The quality of included case series and case reports will be assessed using modified quality assessment tools. A narrative synthesis of the findings will be provided and the primary outcome and secondary outcome of interest, response rate and adverse events rate, respectively, and the 95% CI will be ascertained. Estimates from individual studies will be pooled using random-effects model. ETHICS AND DISSEMINATION This systematic review does not require formal ethical approval since no primary data will be collected. Findings will be disseminated through a peer-reviewed publication and relevant conferences. PROSPERO REGISTRATION NUMBER CRD42020173440.
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Affiliation(s)
- Faheel Naeem
- Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Keren Nathan
- Pediatrics, McGill University Health Centre, Montreal, Québec, Canada
| | - Jeffrey Chivinski
- Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - Taline Ekmekjian
- Medical Libraries, McGill University Health Centre, Montreal, Québec, Canada
| | - Michael Libman
- Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
- Medicine, McGill University Health Centre, Montreal, Québec, Canada
| | - Sapha Barkati
- Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
- Medicine, McGill University Health Centre, Montreal, Québec, Canada
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van Henten S, Tesfaye AB, Abdela SG, Tilahun F, Fikre H, Buyze J, Kassa M, Cnops L, Pareyn M, Mohammed R, Vogt F, Diro E, van Griensven J. Miltefosine for the treatment of cutaneous leishmaniasis-A pilot study from Ethiopia. PLoS Negl Trop Dis 2021; 15:e0009460. [PMID: 34048461 PMCID: PMC8191986 DOI: 10.1371/journal.pntd.0009460] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 06/10/2021] [Accepted: 05/09/2021] [Indexed: 11/19/2022] Open
Abstract
Background Cutaneous leishmaniasis (CL) in Ethiopia, caused by Leishmania aethiopica, is often severe and hard to treat compared to CL caused by other species elsewhere. Miltefosine is the only oral anti-leishmanial drug, with a favorable side-effect profile compared to routinely available sodium stibogluconate (SSG), but evidence about its use for L. aethiopica is lacking. Methodology and principal findings In an observational cohort study, treatment outcomes, safety and adherence among CL patients who required systemic treatment and received miltefosine for 28 days in Boru Meda Hospital and University of Gondar Hospital were studied. Patient cure was defined as 100% flattening for non-ulcerated lesions and 100% flattening and 100% re-epithelization for ulcerated lesions. Outcomes were documented for day 28, 90 and 180, both per site, and pooled, adjusting for site as a fixed effect with effect coding. Among 94 included patients (32 in Gondar, 62 in Boru Meda), median lesion duration was 12 months, median size six cm, and mucosal involvement (46.8%) and diffuse (30.9%) lesions were common. Adherence to miltefosine was good, and side-effects were tolerable. Initial outcomes at day 28 were promising, with 68.8% and 94.0% of patients having good improvement or cure in Gondar and Boru Meda respectively. In Boru Meda, outcomes were good with 72.7% and 72.9% cure at day 90 and day 180 respectively. In Gondar, results were less promising, with only 12.5% and 26.7% cure at day 90 and day 180, although confidence intervals were wide. In pooled estimates, 48.7% of patients reached cure at day 180, and 32.3% relapsed. Outcomes were better in Boru Meda Hospital, for smaller lesions and for mucosal lesions. Conclusions/Significance Based on miltefosine’s good initial response, tolerable side-effects, tablet-form, we propose to include miltefosine for future clinical trials using extended treatment schedules, combination therapy, or targeting specific subgroups. Trial registration ClinicalTrials.gov NCT04004754. Cutaneous leishmaniasis (CL) in Ethiopia is caused by Leishmania aethiopica, resulting in relatively severe lesions, which are hard to treat. Currently, most patients are treated with pentavalent antimonials, although effectiveness seems poor, with many patients requiring repeated treatment cycles before good response is seen. Miltefosine is the only oral drug available for leishmaniasis treatment and has a good safety profile compared to other treatment options. Although evidence on the use of miltefosine for CL in other regions looks promising, reports from Ethiopia are lacking. We systematically recorded outcomes and side-effects for patients with CL lesions that required systemic treatment and who were treated with 28 days of miltefosine in a prospective study in two hospitals in Ethiopia. Side-effects were common but generally mild. Although all patients showed improvement after 28 days, overall, around half of patients were cured after six months, with relapse being common. Therefore, we propose to include miltefosine in future clinical trials, but to adapt the treatment regimen using combination therapy or treatment extension to improve overall outcomes and reduce relapse.
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Affiliation(s)
- Saskia van Henten
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- * E-mail:
| | | | - Seid Getahun Abdela
- Department of Internal Medicine, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | | | - Helina Fikre
- Leishmania Research and Treatment Center, University of Gondar Hospital, Gondar, Ethiopia
| | - Jozefien Buyze
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Mekibib Kassa
- Leishmania Research and Treatment Center, University of Gondar Hospital, Gondar, Ethiopia
| | - Lieselotte Cnops
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Myrthe Pareyn
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Rezika Mohammed
- Leishmania Research and Treatment Center, University of Gondar Hospital, Gondar, Ethiopia
| | - Florian Vogt
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- National Centre for Epidemiology and Population Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Ermias Diro
- Leishmania Research and Treatment Center, University of Gondar Hospital, Gondar, Ethiopia
| | - Johan van Griensven
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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21
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Akuffo R, Sanchez C, Chicharro C, Carrillo E, Attram N, Mosore MT, Yeboah C, Kotey NK, Boakye D, Ruiz-Postigo JA, Moreno J, Wilson M, Sarfo B, Anto F. Detection of cutaneous leishmaniasis in three communities of Oti Region, Ghana. PLoS Negl Trop Dis 2021; 15:e0009416. [PMID: 34029326 PMCID: PMC8177633 DOI: 10.1371/journal.pntd.0009416] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 06/04/2021] [Accepted: 04/27/2021] [Indexed: 11/19/2022] Open
Abstract
Background Cutaneous leishmaniasis (CL) is the most common type of leishmaniasis, a neglected tropical disease caused by parasites of the genus Leishmania. In Ghana, some studies in the Volta region have detected Leishmania parasites among persons with skin ulcers. Methodology/Principal findings Using a cross-sectional study design, the prevalence of CL in three communities of the Oti Region of Ghana was investigated. Demographic and epidemiological data were obtained by a structured interviewer administered questionnaire. A total of 426 (12.4%) out of 3,440 participants screened had at least one skin ulcer. Of 595 skin ulcers sampled and tested by PCR for Leishmania infection, 150 (25.2%) ulcers from 136 individuals tested positive, accounting for an overall CL prevalence of 31.9% among persons with skin ulcers. Individual community CL prevalence of 23.2%, 29.8%, and 36.8% was observed in Ashiabre, Keri, and Sibi Hilltop respectively among persons with skin ulcers. Conclusions/Significance Confirmation of CL in the study area suggests an active cycle of transmission of Leishmania infection. The observation of skin ulcers which tested negative to Leishmania infection suggests a need to test for additional causes of skin ulcers such as Treponema pallidum pertenue and Mycobacterium ulcerans in the study area. Cutaneous leishmaniasis (CL) is a neglected tropical disease caused by parasites of the genus Leishmania and is transmitted by various species of female sandflies. CL usually begins as painless nodules and is usually characterized by skin ulcers which may be single or multiple. Although ulcers due to CL are often self-healing, they may become painful and result in scarring after healing. Typically, CL occurs on exposed parts of the body such as the neck, limbs, and face, which may be easily accessible to sandflies. Although cases of CL had previously been reported in some parts of the Volta region of Ghana, no previous case of CL had been reported in the Oti region. This study was initiated following reports of skin ulcers which were suggestive of CL in some communities of the Oti region. This study confirmed Leishmania infection in 150(25.5%) out of 595 skin ulcer samples obtained from 426 study participants. Given that 445(74,8%) of the skin ulcers tested negative for Leishmania parasite suggests a need for investigation of additional causes of skin ulcers such as yaws and Buruli ulcer in the study area.
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Affiliation(s)
- Richard Akuffo
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
- School of Public Health, University of Ghana, Accra, Ghana
| | - Carmen Sanchez
- WHO Collaborating Center for Leishmaniasis, Instituto de Salud Carlos III, Madrid, Spain
| | - Carmen Chicharro
- WHO Collaborating Center for Leishmaniasis, Instituto de Salud Carlos III, Madrid, Spain
| | - Eugenia Carrillo
- WHO Collaborating Center for Leishmaniasis, Instituto de Salud Carlos III, Madrid, Spain
| | - Naiki Attram
- U.S. Naval Medical Research Unit No. 3, Ghana Detachment, Accra, Ghana
| | | | - Clara Yeboah
- U.S. Naval Medical Research Unit No. 3, Ghana Detachment, Accra, Ghana
| | | | - Daniel Boakye
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Jose-Antonio Ruiz-Postigo
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Javier Moreno
- WHO Collaborating Center for Leishmaniasis, Instituto de Salud Carlos III, Madrid, Spain
| | - Michael Wilson
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Bismark Sarfo
- School of Public Health, University of Ghana, Accra, Ghana
| | - Francis Anto
- School of Public Health, University of Ghana, Accra, Ghana
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Kämink S, Masih B, Ali N, Ullah A, Khan SJ, Ashraf S, Pylypenko T, Grobusch MP, Fernhout J, den Boer M, Ritmeijer K. Effectiveness of miltefosine in cutaneous leishmaniasis caused by Leishmania tropica in Pakistan after antimonial treatment failure or contraindications to first line therapy-A retrospective analysis. PLoS Negl Trop Dis 2021; 15:e0008988. [PMID: 33507944 PMCID: PMC7872246 DOI: 10.1371/journal.pntd.0008988] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 02/09/2021] [Accepted: 11/17/2020] [Indexed: 12/15/2022] Open
Abstract
Background Cutaneous leishmaniasis (CL) is a neglected tropical skin disease, caused by Leishmania protozoa. In Pakistan, where CL caused by L. tropica is highly endemic, therapy with pentavalent antimonials is the standard of care, but has significant toxicity when used in systemic therapy, while are no evidence-based safer alternative treatment options for L. tropica. The efficacy of oral miltefosine has not been studied in CL caused by L. tropica. We evaluated effectiveness and tolerability of miltefosine in patients with previous treatment failure or with contraindications to systemic antimonial treatment. Methods A retrospective review was conducted of a cohort of CL patients who were treated with a 28-day course of miltefosine between December 2017 and August 2019, in urban Quetta, Pakistan, an area endemic for L. tropica. Descriptive analyses were performed, and effectiveness was assessed by initial response after treatment, and final cure at routine follow up visits, six weeks to three months post-treatment. Tolerability was assessed by routinely reported adverse events. Results Of the 76 CL patients in the cohort, 42 (55%) had contraindications to systemic antimonial treatment, and 34 (45%) had failure or relapse after antimonial treatment. Twelve patients defaulted during treatment and 12 patients were lost to follow up. In the remaining 52 patients, final cure rate was 77% (40/52). In those with contraindications to systemic antimonial treatment the final cure rate was 83% (24/29) and in the failure and relapse group 70% (16/23). Twenty-eight patients (40.0%) reported 39 mild to moderate adverse events with the main complaints being nausea (41.0%), general malaise (25.6%), and stomach pain (12.8%). Conclusion Results indicate that miltefosine is an effective second line treatment in CL in areas endemic for L. tropica. Prospective studies with systematic follow up are needed to obtain definitive evidence of effectiveness and tolerability, including identification of risk factors for miltefosine treatment failure. Cutaneous Leishmaniasis (CL) is a neglected tropical skin disease, which globally affects an estimated 0.6 to 1 million people. The skin disease is caused by the protozoa Leishmania and is transmitted by phlebotomine sandflies in Old World CL (OWCL). In Pakistan, CL is highly endemic, especially in the provinces Balochistan and Khyber Pashtunkwa, where L. tropica is the main causative species. In this context, untreated CL often leads to stigmatisation and severe (psycho)social suffering, due to the disfiguring ulcerating wounds and scars. The mainstay treatment is with pentavalent antimonials, and evidence for efficacy of alternative treatments for L. tropica is lacking. Médecins sans Frontières (MSF) has specialised treatment centres in Balochistan (Quetta and Kuchlak), where in December 2017 miltefosine was introduced for patients who did not respond to, or had contraindications for antimonials. In this study, we showed favourable outcomes of miltefosine as second-line treatment for these CL patients.
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Affiliation(s)
- Suzette Kämink
- Médecins Sans Frontières, Quetta, Pakistan
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, location AMC, Amsterdam Public Health, Amsterdam Infection and Immunity, University of Amsterdam, Amsterdam, The Netherlands
- * E-mail:
| | | | - Noor Ali
- Médecins Sans Frontières, Quetta, Pakistan
| | - Aman Ullah
- Médecins Sans Frontières, Quetta, Pakistan
| | | | - Shakil Ashraf
- Mohtarma Shaheed Benazir Bhutto General Hospital,Quetta, Pakistan
| | | | - Martin P. Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, location AMC, Amsterdam Public Health, Amsterdam Infection and Immunity, University of Amsterdam, Amsterdam, The Netherlands
| | - Jena Fernhout
- Médecins Sans Frontières, Amsterdam, the Netherlands
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Ollech A, Solomon M, Horev A, Reiss-Huss S, Ben-Amitai D, Zvulunov A, Friedland R, Atar-Snir V, Molho-Pessach V, Barzilai A, Greenberger S. Cutaneous Leishmaniasis Treated with Miltefosine: A Case Series of 10 Paediatric Patients. Acta Derm Venereol 2020; 100:adv00322. [PMID: 33074340 PMCID: PMC9309834 DOI: 10.2340/00015555-3669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 11/16/2022] Open
Abstract
Cutaneous leishmaniasis poses a therapeutic challenge in the paediatric population. The aim of this study was to assess the efficacy and safety of miltefosine treatment for Old World cutaneous leishmaniasis in paediatric patients. A multicentre retrospective review of 10 children (≤ 18 years of age) with cutaneous leishmaniasis treated with miltefosine in Israel was performed. Mean ± standard deviation age at diagnosis was 9.1 ± 5.0 years. The Leishmania species diagnosed was L. tropica in 8 cases and Leishmania major in 2 cases. Mean ± standard deviation duration of treatment was 44.8 ± 20.6 days, with a mean follow-up period of 12.1 ± 17.1 months. Complete response was noted in 8 (80%) patients. Treatment failure was noted in 2 (20%) cases. Side-effects related to the medication were minimal. In conclusion, oral miltefosine may be an effective and safe treatment for Old World cutaneous leishmaniasis caused by Leishmania tropica or Leishmania major in children. However, further studies are warranted to draw a definite conclusion.
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Affiliation(s)
- Ayelet Ollech
- Department of Dermatology, Rabin Medical Center, Beilinson Hospital Petach Tikva, Petach Tikva 49100, Israel. E-mail:
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Pinart M, Rueda JR, Romero GA, Pinzón-Flórez CE, Osorio-Arango K, Silveira Maia-Elkhoury AN, Reveiz L, Elias VM, Tweed JA. Interventions for American cutaneous and mucocutaneous leishmaniasis. Cochrane Database Syst Rev 2020; 8:CD004834. [PMID: 32853410 PMCID: PMC8094931 DOI: 10.1002/14651858.cd004834.pub3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND On the American continent, cutaneous and mucocutaneous leishmaniasis (CL and MCL) are diseases associated with infection by several species of Leishmania parasites. Pentavalent antimonials remain the first-choice treatment. There are alternative interventions, but reviewing their effectiveness and safety is important as availability is limited. This is an update of a Cochrane Review first published in 2009. OBJECTIVES To assess the effects of interventions for all immuno-competent people who have American cutaneous and mucocutaneous leishmaniasis (ACML). SEARCH METHODS We updated our database searches of the Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase, LILACS and CINAHL to August 2019. We searched five trials registers. SELECTION CRITERIA Randomised controlled trials (RCTs) assessing either single or combination treatments for ACML in immuno-competent people, diagnosed by clinical presentation and Leishmania infection confirmed by smear, culture, histology, or polymerase chain reaction on a biopsy specimen. The comparators were either no treatment, placebo only, or another active compound. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Our key outcomes were the percentage of participants 'cured' at least three months after the end of treatment, adverse effects, and recurrence. We used GRADE to assess evidence certainty for each outcome. MAIN RESULTS We included 75 studies (37 were new), totalling 6533 randomised participants with ATL. The studies were mainly conducted in Central and South America at regional hospitals, local healthcare clinics, and research centres. More male participants were included (mean age: roughly 28.9 years (SD: 7.0)). The most common confirmed species were L. braziliensis, L. panamensis, and L. mexicana. The most assessed interventions and comparators were non-antimonial systemics (particularly oral miltefosine) and antimonials (particularly meglumine antimoniate (MA), which was also a common intervention), respectively. Three studies included moderate-to-severe cases of mucosal leishmaniasis but none included cases with diffuse cutaneous or disseminated CL, considered the severe cutaneous form. Lesions were mainly ulcerative and located in the extremities and limbs. The follow-up (FU) period ranged from 28 days to 7 years. All studies had high or unclear risk of bias in at least one domain (especially performance bias). None of the studies reported the degree of functional or aesthetic impairment, scarring, or quality of life. Compared to placebo, at one-year FU, intramuscular (IM) MA given for 20 days to treat L. braziliensis and L. panamensis infections in ACML may increase the likelihood of complete cure (risk ratio (RR) 4.23, 95% confidence interval (CI) 0.84 to 21.38; 2 RCTs, 157 participants; moderate-certainty evidence), but may also make little to no difference, since the 95% CI includes the possibility of both increased and reduced healing (cure rates), and IMMA probably increases severe adverse effects such as myalgias and arthralgias (RR 1.51, 95% CI 1.17 to 1.96; 1 RCT, 134 participants; moderate-certainty evidence). IMMA may make little to no difference to the recurrence risk, but the 95% CI includes the possibility of both increased and reduced risk (RR 1.79, 95% CI 0.17 to 19.26; 1 RCT, 127 participants; low-certainty evidence). Compared to placebo, at six-month FU, oral miltefosine given for 28 days to treat L. mexicana, L. panamensis and L. braziliensis infections in American cutaneous leishmaniasis (ACL) probably improves the likelihood of complete cure (RR 2.25, 95% CI 1.42 to 3.38), and probably increases nausea rates (RR 3.96, 95% CI 1.49 to 10.48) and vomiting (RR 6.92, 95% CI 2.68 to 17.86) (moderate-certainty evidence). Oral miltefosine may make little to no difference to the recurrence risk (RR 2.97, 95% CI 0.37 to 23.89; low-certainty evidence), but the 95% CI includes the possibility of both increased and reduced risk (all based on 1 RCT, 133 participants). Compared to IMMA, at 6 to 12 months FU, oral miltefosine given for 28 days to treat L. braziliensis, L. panamensis, L. guyanensis and L. amazonensis infections in ACML may make little to no difference to the likelihood of complete cure (RR 1.05, 95% CI 0.90 to 1.23; 7 RCTs, 676 participants; low-certainty evidence). Based on moderate-certainty evidence (3 RCTs, 464 participants), miltefosine probably increases nausea rates (RR 2.45, 95% CI 1.72 to 3.49) and vomiting (RR 4.76, 95% CI 1.82 to 12.46) compared to IMMA. Recurrence risk was not reported. For the rest of the key comparisons, recurrence risk was not reported, and risk of adverse events could not be estimated. Compared to IMMA, at 6 to 12 months FU, oral azithromycin given for 20 to 28 days to treat L. braziliensis infections in ACML probably reduces the likelihood of complete cure (RR 0.51, 95% CI 0.34 to 0.76; 2 RCTs, 93 participants; moderate-certainty evidence). Compared to intravenous MA (IVMA) and placebo, at 12 month FU, adding topical imiquimod to IVMA, given for 20 days to treat L. braziliensis, L. guyanensis and L. peruviana infections in ACL probably makes little to no difference to the likelihood of complete cure (RR 1.30, 95% CI 0.95 to 1.80; 1 RCT, 80 participants; moderate-certainty evidence). Compared to MA, at 6 months FU, one session of local thermotherapy to treat L. panamensis and L. braziliensis infections in ACL reduces the likelihood of complete cure (RR 0.80, 95% CI 0.68 to 0.95; 1 RCT, 292 participants; high-certainty evidence). Compared to IMMA and placebo, at 26 weeks FU, adding oral pentoxifylline to IMMA to treat CL (species not stated) probably makes little to no difference to the likelihood of complete cure (RR 0.86, 95% CI 0.63 to 1.18; 1 RCT, 70 participants; moderate-certainty evidence). AUTHORS' CONCLUSIONS Evidence certainty was mostly moderate or low, due to methodological shortcomings, which precluded conclusive results. Overall, both IMMA and oral miltefosine probably result in an increase in cure rates, and nausea and vomiting are probably more common with miltefosine than with IMMA. Future trials should investigate interventions for mucosal leishmaniasis and evaluate recurrence rates of cutaneous leishmaniasis and its progression to mucosal disease.
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Affiliation(s)
- Mariona Pinart
- Free time independent Cochrane reviewer, Berlin, Germany
| | - José-Ramón Rueda
- Department of Preventive Medicine and Public Health, University of the Basque Country, Leioa, Spain
| | - Gustavo As Romero
- Center for Tropical Medicine, University of Brasilia, Brasilia, Brazil
| | | | - Karime Osorio-Arango
- Dirección de Redes en Salud Pública, Instituto Nacional de Salud, Bogotá, Colombia
| | - Ana Nilce Silveira Maia-Elkhoury
- Communicable Diseases and Environmental Determinants of Health (CDE), Neglected, Tropical and Vector Borne Diseases (VT), Pan American Health Organization/ World Health Organization (PAHO/WHO), Rio de Janeiro, Brazil
| | - Ludovic Reveiz
- Evidence and Intelligence for Action in Health Department, Pan American Health Organization (PAHO), Washington DC, USA
| | - Vanessa M Elias
- Evidence and Intelligence for Action in Health Department, Pan American Health Organization (PAHO), Washington DC, USA
| | - John A Tweed
- c/o Cochrane Skin Group, The University of Nottingham, Nottingham, UK
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Abstract
PURPOSE OF REVIEW Despite modern advances in molecular diagnostic tools and a better understanding of its complex pathophysiology, cutaneous leishmaniasis, a neglected tropical disease, remains a major global health problem. Laboratory methods to inform prognosis and treatment are not widely available, the therapeutic options are limited and have significant adverse effects, and emergence of drug resistance is a further complication. New advances in the understanding of the role of Leishmania RNA virus (LRV) as a prognostic factor, speciation methods and antimicrobial resistance testing and their limitations will be discussed. RECENT FINDINGS LRV, an intracytoplasmic endosymbiont found mostly in Leishmania spp. associated with more severe disease, appears to play a role in modulating the host immune response and has been associated with treatment failure in some Viannia subgenus species. Proper speciation is an important guide to management. However, recent findings have demonstrated significant heterogeneity of results related to differences in genotyping methods. SUMMARY Recognition of the role of LRV in immune modulation and response to treatment along with more accessible tools for its detection to guide management at the bedside should allow a better individualized approach. Improving accessibility and standardization of speciation methods and antimicrobial susceptibility testing should be major goals to improve cutaneous leishmaniasis management in the 21st century.
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Nazar E, Yazdani Charati J, Pazoki H, Saki A, Fakhar M, Boroumand F, Rasooli SA. Modelling the number of dermal lesions in anthroponotic cutaneous leishmaniasis and its associated factors in Herat province, western Afghanistan, during 2012-2013. Transbound Emerg Dis 2020; 67:2692-2701. [PMID: 32403184 DOI: 10.1111/tbed.13623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 11/28/2022]
Abstract
Cutaneous leishmaniasis (CL), caused by Leishmania tropica, is the main causative agent of CL in the Herat province, western Afghanistan. In CL patients, one of the most important indicators for reducing the amount of body damage and the choice of treatment is the number of dermal lesions, but there is no strong evidence in this regard. Therefore, using count regression models, the main objective of this historical cohort study was to identify the distribution of the number of dermal lesions and determine the associated factors among CL patients referring to leishmaniasis reference laboratory in Herat province, from January 2012 to December 2013. In a total of 4,127 clinically suspected CL cases, 50.20% were female and 49.80% male. Based on the results of ZINB model, which is the best model suggested by goodness-of-fit criteria, age variables (IRR = 1.007), duration of lesion (6-12 weeks compared to < 6 weeks with IRR = 1.36 and >12 weeks with IRR = 1.39 compared to <6 weeks), type of lesion(both nodule and ulcer compared to papule with IRR = 2.03), location of lesion (trunk with IRR = 1.90, upper with IRR = 1.66, lower with IRR = 1.61 and mix with IRR = 10.35 compared to head/neck/ears) and type of lesion (ulcer compared to papule with IRR = 0.50, nodule and lupoid, respectively, as IRR = 0.72 and IRR = 0.51 compared to papule) had a significant effect on the mean number of dermal lesions (p < .05). Also, our results showed that among four models used, the ZINB model represented a better performance to determine the associated probable factors about the number of dermal lesions in ACL patients. Moreover, there was a direct association between age and number of dermal lesions; in addition, duration of lesion, type of lesion and location of lesion had a significant effect on the number of dermal lesions. Therefore, a comprehensive planning is necessary for controlling and reducing the number of dermal lesions.
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Affiliation(s)
- Eisa Nazar
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Epidemiology and Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Jamshid Yazdani Charati
- Department of Biostatistics, Health Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hossein Pazoki
- Student Research Committee, Department of Medical Parasitology and Mycology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azadeh Saki
- Department of Epidemiology and Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.,Social Determinants of Health Research Centre, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahdi Fakhar
- Department of Parasitology, School of Medicine, Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Farzaneh Boroumand
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Epidemiology and Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sayed Abobakar Rasooli
- National Health Coordinator (NHC) and Head of Herat WHO Sub-office, Herat Province, Afghanistan
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27
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Kämink S, Abdi A, Kamau C, Ashraf S, Ansari MA, Qureshi NA, Schallig H, Grobusch MP, Fernhout J, Ritmeijer K. Failure of an Innovative Low-Cost, Noninvasive Thermotherapy Device for Treating Cutaneous Leishmaniasis Caused by Leishmania tropica in Pakistan. Am J Trop Med Hyg 2020; 101:1373-1379. [PMID: 31595864 PMCID: PMC6896852 DOI: 10.4269/ajtmh.19-0430] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Cutaneous leishmaniasis (CL), a neglected parasitic skin disease, is endemic in Pakistan, where Leishmania tropica and Leishmania major are the causative protozoan species. Standard treatment with antimonial injections is long, painful, and costly; has toxic side effects; and is not always available in public hospitals. Small pilot studies have previously evaluated a low-cost and noninvasive hand-held exothermic crystallization thermotherapy for cutaneous leishmaniasis (HECT-CL) device. We aimed to further establish the effectiveness, safety, and feasibility of HECT-CL in L. tropica. In a prospective observational study, patients with parasitological confirmation of CL were treated using the HECT-CL heat pack for 3 minutes with an initial temperature of 52–53°C for 7 consecutive days. Dried blood spot samples were taken for species identification by polymerase chain reaction (PCR). Effectiveness was assessed by using medical photographs and measurements of the lesion size at baseline and subsequent follow-up visits, for up to 180 days. We intended to enroll 317 patients. The HECT-CL treatment was easy to apply and well tolerated. Species identification demonstrated the presence of L. tropica. Interim analysis of 56 patients showed a failure rate of 91% at follow-up (median 45 days after treatment, interquartile range 30–60 days). Enrollment of patients was prematurely suspended because of futility. This study showed a high failure rate for HECT-CL thermotherapy in this setting. Leishmania tropica is known to be less sensitive to antileishmanial drugs, more temperature-resistant, and spontaneous healing is slower than that in L. major. More research is needed to identify low-cost, effective, and more patient-friendly treatment for L. tropica.
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Affiliation(s)
- Suzette Kämink
- Department of Infectious Diseases, Amsterdam University Medical Centers, Center of Tropical Medicine and Travel Medicine, University of Amsterdam, Amsterdam, The Netherlands.,Médecins Sans Frontières, Quetta, Pakistan
| | - Ahmed Abdi
- Médecins Sans Frontières, Quetta, Pakistan
| | - Charity Kamau
- Médecins Sans Frontières, Amsterdam, The Netherlands
| | - Shakil Ashraf
- Mohtama Shaheed Benazir Bhutto Hospital, Quetta, Pakistan
| | | | - Naveeda Akhtar Qureshi
- Department of Animal Sciences, Parasitology Laboratory, Quaid-i-Azam University, Islamabad, Pakistan
| | - Henk Schallig
- Department of Medical Microbiology, Parasitology Unit, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Martin P Grobusch
- Department of Infectious Diseases, Amsterdam University Medical Centers, Center of Tropical Medicine and Travel Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - Jena Fernhout
- Médecins Sans Frontières, Amsterdam, The Netherlands
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28
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Erber AC, Arana B, Ben Salah A, Bennis I, Boukthir A, Castro Noriega MDM, Cissé M, Cota GF, Handjani F, López-Carvajal L, Marsh K, Medina DM, Plugge E, Lang T, Olliaro P. Patients' preferences of cutaneous leishmaniasis treatment outcomes: Findings from an international qualitative study. PLoS Negl Trop Dis 2020; 14:e0007996. [PMID: 32092059 PMCID: PMC7058360 DOI: 10.1371/journal.pntd.0007996] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 03/05/2020] [Accepted: 12/15/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Cutaneous leishmaniasis (CL) is a disease that often affects exposed skin areas and may heal leaving lifelong scars. Patients' expectations from treatment are rarely considered in drug development for CL. An initiative aiming to address shortcomings in clinical trial design and conduct for CL treatments involving the researchers' community is on-going. This manuscript presents patient-preferred outcomes for CL and an assessment on how to consider these in the conduct of future trials. METHODOLOGY/PRINCIPAL FINDINGS We report preferred treatment outcomes by 74 patients with confirmed CL in endemic regions of Brazil, Burkina Faso, Colombia, Iran, Morocco, Peru and Tunisia during individual in-depth interviews. Beyond outcomes customarily considered in trials (such as lesion appearance and adverse events), patients talked about a large number of outcomes related to quality of life, such as pain, scar formation, and others affecting their work and daily activities. They also reported fears around getting rid of the parasite, disease recurrence, and possible sequelae. CONCLUSIONS/SIGNIFICANCE The study results provide a rich insight into important outcomes for CL treatments, as well as related topics, from the perspective of a diverse patient population. Among the outcomes identified, we argue that those related to quality of life as well as recurrence should be included to a greater extent for assessment in clinical trials, and discuss the suitability of measurement instruments such as the Dermatology Quality of Life Index (DLQI). Interviews also point out the potential need to address concerns related to parasitological cure or scar formation, such as social stigmatization and disability. In addition, patients should be given information in order to clarify reported misconceptions. This study therefore suggests a methodology for consulting CL patients on outcomes as elements of clinical trial design, and how to incorporate these outcomes in trials. It also discusses how reported outcomes could be addressed in clinical care.
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Affiliation(s)
- Astrid C. Erber
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Byron Arana
- Drugs for Neglected Diseases Initiative (DNDi), Geneva, Switzerland
| | - Afif Ben Salah
- Institut Pasteur de Tunis, Tunis, Tunisia
- Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Issam Bennis
- National School of Public Health, Rabat, Morocco
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - María del Mar Castro Noriega
- Centro Internacional de Entrenamiento de Investigaciones Médicas (CIDEIM), Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | | | | | - Farhad Handjani
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Liliana López-Carvajal
- Programa de Estudio y Control de Enfermedades Tropicales (PECET), Universidad de Antioquia, Medellín, Colombia
| | - Kevin Marsh
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Dalila Martínez Medina
- Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Perú
- Departamento de Enfermedades Infecciosas, Dermatológicas y Tropicales, Hospital Cayetano Heredia, Lima, Perú
| | - Emma Plugge
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- UK Collaborating Centre for the WHO Health in Prisons Programme, Public Health England, Reading, United Kingdom
| | - Trudie Lang
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Piero Olliaro
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Special Programme for Research & Training in Tropical Diseases (WHO/TDR), Geneva, Switzerland
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29
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Brito NC, Machado de Assis TS, Rabello A, Cota G. Intralesional infiltration versus parenteral use of meglumine antimoniate for treatment of cutaneous leishmaniasis: A cost-effectiveness analysis. PLoS Negl Trop Dis 2019; 13:e0007856. [PMID: 31805052 PMCID: PMC6917345 DOI: 10.1371/journal.pntd.0007856] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 12/17/2019] [Accepted: 10/17/2019] [Indexed: 01/11/2023] Open
Abstract
Cutaneous leishmaniasis (LC) is a complex and variable disease in terms of epidemiology, aetiology, pathology and clinical characteristics. The mainstay of treatment is still pentavalent antimony (Sbv) compounds administered systemically, despite their recognized toxicity. The advantages of antimony intralesional (IL) infiltration are the use of lower doses of Sbv and, therefore, less toxic effects. The objective of this study was to estimate the cost-effectiveness ratio of intralesional meglumine antimoniate therapy (IL-MA) compared with endovenous meglumine antimoniate therapy (EV-MA) for the treatment of CL in the context of the Brazilian National Health System (SUS). An analytical decision model (decision tree) was developed using TreeAge Pro 2018 software. Data from the open-label, uncontrolled phase II clinical trial evaluating IL-MA were used as a reference for posology, efficacy, and adverse event rates (AE). The same premises for the intravenous approach (EV-MA) were extracted from systematic literature reviews. Macro and micro calculations of spending were included in the analysis. The IL-MA and EV-MA strategies had a total cost per patient cured of US$330.81 and US$494.16, respectively. The intralesional approach was dominant, meaning it was more economic and effective than was endovenous therapy. The incremental cost-effectiveness ratio showed that IL-MA could result in savings of US$864.37 for each additional patient cured, confirming that the IL-MA strategy is cost effective in the context of the Brazilian public health scenario.
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Affiliation(s)
- Nayara C. Brito
- Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias-Centro de Pesquisas René Rachou-Fundação Oswaldo Cruz, Fiocruz, Belo Horizonte, Minas Gerais, Brazil
| | - Tália S. Machado de Assis
- Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias-Centro de Pesquisas René Rachou-Fundação Oswaldo Cruz, Fiocruz, Belo Horizonte, Minas Gerais, Brazil
| | - Ana Rabello
- Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias-Centro de Pesquisas René Rachou-Fundação Oswaldo Cruz, Fiocruz, Belo Horizonte, Minas Gerais, Brazil
| | - Gláucia Cota
- Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias-Centro de Pesquisas René Rachou-Fundação Oswaldo Cruz, Fiocruz, Belo Horizonte, Minas Gerais, Brazil
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30
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Development and Characterization of a Semi-Solid Dosage Form of Meglumine Antimoniate for Topical Treatment of Cutaneous Leishmaniasis. Pharmaceutics 2019; 11:pharmaceutics11110613. [PMID: 31731660 PMCID: PMC6920791 DOI: 10.3390/pharmaceutics11110613] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/11/2019] [Accepted: 11/13/2019] [Indexed: 12/12/2022] Open
Abstract
Cutaneous leishmaniasis (CL) is treated with painful intralesional injections of meglumine antimoniate (MA). With the aim of developing an alternative topical treatment for CL, a gel-based formulation with 30% MA was prepared and its physicochemical properties, stability and rheological behavior were studied. The following were assessed: drug release on propylene hydrophilic membranes ex vivo human skin permeation, tolerance in healthy volunteers, cytotoxicity in three cell lines and anti-leishmanial activity against Leishmania infantum promastigotes and amastigotes. The MA gel formulation was found to have suitable pH, and good spreadability and stability. Low quantities of pentavalent antimony (SbV) were observed in release and permeation tests, whereas retention was high in both non-damaged and damaged skin (71,043.69 ± 10,641.57 and 10,728 ± 2254.61 µg/g/cm2 of SbV, respectively). The formulation did not have a toxic effect on the cell lines, and presented lower SbV IC50 values against amastigotes (15.76 ± 4.81 µg/mL) in comparison with the MA solution. The high amount of drug retained in the skin and the SbV IC50 values obtained suggest that this semi-solid dosage form has potential as an alternative treatment of CL.
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31
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Prieto MD, Uribe-Restrepo AF, Arcos D, Vargas DA. Case Report: Squamous Cell Carcinoma Referred for Mohs Surgery Found to be Cutaneous Leishmaniasis. Am J Trop Med Hyg 2019; 99:1537-1540. [PMID: 30277199 DOI: 10.4269/ajtmh.18-0243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Chronic skin lesions constitute a clinical diagnostic challenge. We report the case of a patient whose facial lesion was histopathologically compatible with squamous cell carcinoma and hence programmed for Mohs surgery. However, review of the clinical and epidemiological history led to laboratory diagnosis of cutaneous leishmaniasis, treatment with miltefosine, and complete resolution of the lesion.
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Affiliation(s)
- Miguel Darío Prieto
- Leishmaniasis Clinical Research Unit, Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia
| | - Andrés Felipe Uribe-Restrepo
- Public and Comunitary Health Department, Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia.,Leishmaniasis Clinical Research Unit, Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia
| | - Daniela Arcos
- Leishmaniasis Clinical Research Unit, Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia
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Jayasena Kaluarachchi TD, Weerasekera MM, McBain AJ, Ranasinghe S, Wickremasinghe R, Yasawardene S, Jayanetti N, Wickremasinghe R. Diagnosing Cutaneous leishmaniasis using Fluorescence in Situ Hybridization: the Sri Lankan Perspective. Pathog Glob Health 2019; 113:180-190. [PMID: 31429388 DOI: 10.1080/20477724.2019.1650228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Cutaneous leishmaniasis (CL) caused by Leishmania donovani MON-37 is becoming a major public health problem in Sri Lanka, with 100 new cases per month being reported in endemic regions. Diagnosis of CL is challenging for several reasons. Due to relative specificity and rapidity we propose Fluorescence in Situ Hybridization as a diagnostic tool for CL. The objective was to evaluate the potential of Fluorescence in Situ Hybridization as a diagnostic method for Cutaneous leishmaniasis in Sri Lanka. Literature on current laboratory tests used to diagnose Cutaneous leishmaniasis in Sri Lanka and globally was reviewed. Sri Lankan data were reviewed systematically following the PRISMA guidelines. A narrative of the results is presented. There is currently no gold standard diagnostic method for Cutaneous leishmaniasis. Fluorescence in Situ Hybridization has been previously applied to detect dermal pathologies including those involving infectious agents, and its use to detect the Leishmania parasite in human cutaneous lesions reported in small number of studies, generally with limited numbers of subjects. Advantages of FISH has been specificity, cost and ease-of-use compared to the alternatives. Based on the available literature and our current work, FISH has potential for diagnosing CL and should now be evaluated in larger cohorts in endemic regions. FISH for CL diagnosis could find application in countries such as Sri Lanka, where laboratory facilities may be limited in rural areas where the disease burden is highest.
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Affiliation(s)
| | - Manjula Manoji Weerasekera
- Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayewardenepura , Nugegoda , Sri Lanka
| | - Andrew J McBain
- Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayewardenepura , Nugegoda , Sri Lanka.,Division of Pharmacy & Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester , Manchester
| | - Shalindra Ranasinghe
- Department of Parasitology, Faculty of Medical Sciences, University of Sri Jayewardenepura , Colombo , Sri Lanka
| | - Renu Wickremasinghe
- Department of Parasitology, Faculty of Medical Sciences, University of Sri Jayewardenepura , Colombo , Sri Lanka
| | - Surangi Yasawardene
- Department of Anatomy, Faculty of Medical Sciences, University of Sri Jayewardenepura , Colombo , Sri Lanka
| | - Nisal Jayanetti
- Department of Parasitology, Faculty of Medical Sciences, University of Sri Jayewardenepura , Colombo , Sri Lanka
| | - Rajitha Wickremasinghe
- Department of Public Health, Faculty of Medicine, University of Kelaniya , Kelaniya , Sri Lanka
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33
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Vargas DA, Prieto MD, Martínez-Valencia AJ, Cossio A, Burgess KEV, Burchmore RJS, Gómez MA. Pharmacometabolomics of Meglumine Antimoniate in Patients With Cutaneous Leishmaniasis. Front Pharmacol 2019; 10:657. [PMID: 31281253 PMCID: PMC6595045 DOI: 10.3389/fphar.2019.00657] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 05/20/2019] [Indexed: 12/04/2022] Open
Abstract
Control of cutaneous leishmaniasis (CL) in the Americas is dependent on chemotherapy with parenteral pentavalent antimonials. High rates of treatment failure urge the search for predictive and prognostic markers of therapeutic responsiveness. In this study, we aimed to identify biomarkers of therapeutic response during treatment with meglumine antimoniate (MA). We conducted untargeted metabolomic profiling of plasma samples from CL patients (n = 39; 25 who cured and 14 who did not cure), obtained before and at the end of treatment. Exposure to MA induced metabolic perturbations primarily reflecting alteration in long-chain fatty acid β-oxidation and energy production. Allantoin, N-acetylglutamine, taurine, and pyruvate were significantly more abundant in samples from patients who responded to treatment, and were predictive and prognostic of treatment outcome in this patient cohort (AUC > 0.7). In an ex vivo model of infection, allantoin but not taurine enhanced the MA-dependent killing of intracellular Leishmania (Viannia) panamensis. Our results support the participation of metabolites mediating antioxidant and wound healing responses in clinical cure of CL, revealing relationships between metabolism and immune responses in the outcome of antileishmanial treatment.
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Affiliation(s)
- Deninson Alejandro Vargas
- Centro Internacional de Entrenamiento e Investigaciones Médicas, CIDEIM, Cali, Colombia.,Universidad de Valle, Cali, Colombia
| | - Miguel Dario Prieto
- Centro Internacional de Entrenamiento e Investigaciones Médicas, CIDEIM, Cali, Colombia
| | | | - Alexandra Cossio
- Centro Internacional de Entrenamiento e Investigaciones Médicas, CIDEIM, Cali, Colombia.,Universidad ICESI, Cali, Colombia
| | - Karl E V Burgess
- Glasgow Polyomics, Wolfson Wohl Cancer Research Centre, College of Medical Veterinary & Life Sciences, University of Glasgow, Glasgow, United Kingdom.,Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Richard J S Burchmore
- Glasgow Polyomics, Wolfson Wohl Cancer Research Centre, College of Medical Veterinary & Life Sciences, University of Glasgow, Glasgow, United Kingdom.,Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - María Adelaida Gómez
- Centro Internacional de Entrenamiento e Investigaciones Médicas, CIDEIM, Cali, Colombia.,Universidad ICESI, Cali, Colombia
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Route map for the discovery and pre-clinical development of new drugs and treatments for cutaneous leishmaniasis. INTERNATIONAL JOURNAL FOR PARASITOLOGY-DRUGS AND DRUG RESISTANCE 2019; 11:106-117. [PMID: 31320296 PMCID: PMC6904839 DOI: 10.1016/j.ijpddr.2019.06.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 06/16/2019] [Accepted: 06/17/2019] [Indexed: 12/11/2022]
Abstract
Although there have been significant advances in the treatment of visceral leishmaniasis (VL) and several novel compounds are currently in pre-clinical and clinical development for this manifestation of leishmaniasis, there have been limited advances in drug research and development (R & D) for cutaneous leishmaniasis (CL). Here we review the need for new treatments for CL, describe in vitro and in vivo assays, models and approaches taken over the past decade to establish a pathway for the discovery, and pre-clinical development of new drugs for CL. These recent advances include novel mouse models of infection using bioluminescent Leishmania, the introduction of PK/PD approaches to skin infection, and defined pre-clinical candidate profiles.
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de Oliveira Duque MC, Quintão Silva JJ, Soares PAO, Magalhães RS, Horta APA, Paes LRB, Rosandiski Lyra M, Pimentel MIF, de Fátima Antonio L, de Camargo Ferreira e Vasconcellos É, Saheki MN, de Almeida Marzochi MC, Valete-Rosalino CM, de Oliveira Schubach A. Comparison between systemic and intralesional meglumine antimoniate therapy in a primary health care unit. Acta Trop 2019; 193:176-182. [PMID: 30851256 DOI: 10.1016/j.actatropica.2019.03.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 11/27/2022]
Abstract
Cutaneous leishmaniasis (CL) is not a life-threatening condition. However, its treatment can cause serious adverse effects and may sometimes lead to death. Recently, safer local treatments have been included among therapies acceptable to New World CL cases, but the use of intralesional meglumine antimoniate (IL-MA) is recommended to be performed in reference centers, for patients with single cutaneous lesions <3 cm in diameter at any location except the head and periarticular regions; the volume of injected MA should not exceed 5 mL. In this study we compared two groups of patients with CL treated with MA in a primary health care unit in Brazil. Patients were treated with systemic MA (n = 76) or IL-MA (n = 30). In the IL-MA group, 93% of patients had one or more of the following lesion characteristics: two or more lesions, lesions >3 cm in diameter, lesions located in the head or in periarticular regions, or had been administered IL-MA volumes >5 mL. Patients responded well (68.4% and 66.7% for the MA and IL-MA groups, respectively). When a second cycle of treatment was necessary, the responses were 72.4% and 90%, respectively. There were no significant differences between groups. In the IL-MA group, 43% had mild to moderate adverse effects, without needing treatment discontinuation. Results suggest that the treatment of CL lesions with IL-MA is simple, efficient, and safe.
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Cataldo JI, Conceição-Silva F, Antônio LDF, Schubach ADO, Marzochi MCDA, Valete-Rosalino CM, Pimentel MIF, Lyra MR, Oliveira RDVCD, Barros JHDS, Pacheco RDS, Madeira MDF. Favorable responses to treatment with 5 mg Sbv/kg/day meglumine antimoniate in patients with American tegumentary leishmaniasis acquired in different Brazilian regions. Rev Soc Bras Med Trop 2019; 51:769-780. [PMID: 30517530 DOI: 10.1590/0037-8682-0464-2017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 10/08/2018] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Favorable responses in American tegumentary leishmaniasis (ATL) patients to treatment with 5 mg Sbv/kg/day meglumine antimoniate (MA) has been reported in Rio de Janeiro, but little is known regarding the therapeutic response to low doses in patients from other locations. METHODS A retrospective review of medical records was conducted to compare the therapeutic response to 5 mg Sbv/kg/day MA treatment among 36 patients who acquired ATL in Brazilian states other than Rio de Janeiro (OS group) and 72 patients from Rio de Janeiro (RJ group). RESULTS One course of 5 mg Sbv/kg/day MA cured 72.8% of 81 cutaneous (CL) and 66.6% of 27 mucosal (ML) leishmaniasis-infected patients: 70% in the CL/RJ group, 81% in the CL/OS group, 50% in the ML/RJ group, and 80% in the ML/OS group. After up to two additional treatment courses at the same dose, 88.9% and 85.2% of the CL and ML patients were cured, respectively. Adverse events were observed in 40% of patients in the CL/RJ group, 57% of the CL/OS group, 58% of the ML/RJ group, and 80% of the ML/OS group. No significant differences were observed in the cure rates or adverse effects between the RJ and OS groups. No patients required permanent discontinuation of treatment due to adverse events. CONCLUSIONS Patients with ATL acquired in both RJ and OS may respond to low-dose MA. While high-dose MA should remain the standard treatment for ATL, low-dose MA might be preferred when toxicity is a primary concern.
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Affiliation(s)
- Jamyra Iglesias Cataldo
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Rio de Janeiro, RJ, Brasil
| | - Fátima Conceição-Silva
- Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Laboratório de Imunoparasitologia, Rio de Janeiro, RJ, Brasil
| | - Liliane de Fátima Antônio
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Rio de Janeiro, RJ, Brasil
| | - Armando de Oliveira Schubach
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Rio de Janeiro, RJ, Brasil
| | - Mauro Célio de Almeida Marzochi
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Rio de Janeiro, RJ, Brasil
| | - Cláudia Maria Valete-Rosalino
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Rio de Janeiro, RJ, Brasil.,Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Departamento de Otorrinolaringologia e Oftalmologia, Rio de Janeiro, RJ, Brasil
| | - Maria Inês Fernandes Pimentel
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Rio de Janeiro, RJ, Brasil
| | - Marcelo Rosandiski Lyra
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Rio de Janeiro, RJ, Brasil
| | | | - Juliana Helena da Silva Barros
- Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Laboratório de Biologia de Tripanossomatídeos, Rio de Janeiro, RJ, Brasil
| | - Raquel da Silva Pacheco
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Rio de Janeiro, RJ, Brasil
| | - Maria de Fátima Madeira
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Rio de Janeiro, RJ, Brasil
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Uribe-Restrepo AF, Prieto MD, Cossio A, Desai MM, Castro MDM. Eligibility for Local Therapies in Adolescents and Adults with Cutaneous Leishmaniasis from Southwestern Colombia: A Cross-Sectional Study. Am J Trop Med Hyg 2019; 100:306-310. [PMID: 30628567 PMCID: PMC6367628 DOI: 10.4269/ajtmh.18-0643] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 10/31/2018] [Indexed: 12/21/2022] Open
Abstract
Local therapies have been proposed as safe and effective alternatives to systemic drugs in cutaneous leishmaniasis (CL), especially among less severe cases. However, they are not widely available and used in endemic places, including Colombia, which has a high burden of disease. Further complicating the uptake of local therapies is that different treatment guidelines have been established by the World Health Organization (WHO) and Pan American Health Organization (PAHO). Using data from a large referral center in Colombia, we determined the proportion of patients who would be eligible for and potentially benefit from local therapies according to both international guidelines. The sample included 1,891 confirmed cases of CL aged ≥ 12 years, mostly infected with Leishmania Viannia panamensis (91%, n = 601/660), between 2004 and 2014. Overall, 57% of the sample had one lesion, whereas another 31% had two to three lesions. For 74% of patients, all lesions were in an area other than head or neck. The maximum lesion size was ≤ 3 cm for 58% and < 5 cm for 88% of the sample. Based on our data, up to 56% of patients could have been eligible for local therapies according to the WHO criteria. By contrast, only 23% were eligible according to the more restrictive PAHO criteria. Regardless, these data suggest that a substantial proportion of CL patients in Colombia may benefit from local therapies given their relatively mild presentation of disease and low risk of complications. Individualized risk-benefit assessment and guideline adjustments may increase local therapy eligibility and benefit a large number of patients.
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Affiliation(s)
- Andrés Felipe Uribe-Restrepo
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | - Miguel Dario Prieto
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia
| | - Alexandra Cossio
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | | | - María del Mar Castro
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia
- Universidad Icesi, Cali, Colombia
- European Vaccine Initiative, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
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Uribe-Restrepo A, Cossio A, Desai MM, Dávalos D, Castro MDM. Interventions to treat cutaneous leishmaniasis in children: A systematic review. PLoS Negl Trop Dis 2018; 12:e0006986. [PMID: 30550538 PMCID: PMC6310290 DOI: 10.1371/journal.pntd.0006986] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 12/28/2018] [Accepted: 11/12/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Case management in children with cutaneous leishmaniasis (CL) is mainly based on studies performed in adults. We aimed to determine the efficacy and harms of interventions to treat CL in children. METHODS We conducted a systematic review of clinical trials and cohort studies, assessing treatments of CL in children (≤12 years old). We performed structured searches in PubMed, CENTRAL, LILACS, SciELO, Scopus, the International Clinical Trials Registry Platform (ICTRP), clinicaltrials.gov and Google Scholar. No restrictions regarding ethnicity, country, sex or year of publication were applied. Languages were limited to English, Spanish and Portuguese. Two reviewers screened articles, completed the data extraction and assessment of risk of bias. A qualitative summary of the included studies was performed. RESULTS We identified 1092 records, and included 8 manuscripts (6 Randomized Clinical Trials [RCT] and 2 non-randomized studies). Most of the articles excluded in full-text review did not report outcomes separately for children. In American CL (ACL), 5 studies evaluated miltefosine and/or meglumine antimoniate (MA). Their efficacy varied from 68-83% and 17-69%, respectively. In Old-World CL (OWCL), two studies evaluated systemic therapies: rifampicin and MA; and one study assessed efficacy of cryotherapy (42%, Per Protocol [PP]) vs intralesional MA (72%, PP). Few studies (4) provided information on adverse events (AEs) for children, and no serious AEs were reported in participants. Risk of bias was generally low to unclear in ACL studies, and unclear to high in OWCL studies. CONCLUSION Information on efficacy of treatment for CL in children is scarce. There is an unmet need to develop specific formulations, surveillance of AEs, and guidelines both for the management of CL and clinical trials involving the pediatric population. REGISTRATION The protocol of this review was registered in the PROSPERO International register of systematic reviews, number CRD42017062164.
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Affiliation(s)
- Andrés Uribe-Restrepo
- Departamento de Salud Pública, Universidad Icesi, Cali, Colombia
- Unidad Clínica de Leishmaniasis, Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia
| | - Alexandra Cossio
- Unidad Clínica de Leishmaniasis, Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | - Mayur M. Desai
- Yale School of Public Health, New Haven, CT, United States of America
| | - Diana Dávalos
- Departamento de Salud Pública, Universidad Icesi, Cali, Colombia
| | - María del Mar Castro
- Unidad Clínica de Leishmaniasis, Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia
- Universidad Icesi, Cali, Colombia
- EDCTP/TDR Fellow. European Vaccine Initiative, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
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Abstract
Leishmaniasis is a poverty-related disease with two main clinical forms: visceral leishmaniasis and cutaneous leishmaniasis. An estimated 0·7-1 million new cases of leishmaniasis per year are reported from nearly 100 endemic countries. The number of reported visceral leishmaniasis cases has decreased substantially in the past decade as a result of better access to diagnosis and treatment and more intense vector control within an elimination initiative in Asia, although natural cycles in transmission intensity might play a role. In east Africa however, the case numbers of this fatal disease continue to be sustained. Increased conflict in endemic areas of cutaneous leishmaniasis and forced displacement has resulted in a surge in these endemic areas as well as clinics across the world. WHO lists leishmaniasis as one of the neglected tropical diseases for which the development of new treatments is a priority. Major evidence gaps remain, and new tools are needed before leishmaniasis can be definitively controlled.
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Affiliation(s)
- Sakib Burza
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium; Médecins Sans Frontières, Delhi, India
| | - Simon L Croft
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Marleen Boelaert
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
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de Aguiar MG, Gonçalves JE, Souza MD, de Silva RE, Silveira JN, Cota G. Plasma antimony determination during cutaneous leishmaniasis treatment with intralesional infiltration of meglumine antimoniate. Trop Med Int Health 2018; 23:1110-1117. [DOI: 10.1111/tmi.13130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Marta Gontijo de Aguiar
- Departamento de Produtos Farmacêuticos; Faculdade de Farmácia; Universidade Federal de Minas Gerais; Belo Horizonte Brazil
| | - José Eduardo Gonçalves
- Departamento de Produtos Farmacêuticos; Faculdade de Farmácia; Universidade Federal de Minas Gerais; Belo Horizonte Brazil
| | - Mirna d'Auriol Souza
- Departamento de Análises Clínicas e Toxicológicas; Faculdade de Farmácia; Universidade Federal de Minas Gerais; Belo Horizonte Brazil
| | - Rosiana Estefáne de Silva
- Fundação Oswaldo Cruz-Fiocruz; Instituto René Rachou; Centro de Referência em Leishmanioses; Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias; Belo Horizonte MG Brazil
| | - Josianne Nicacio Silveira
- Departamento de Análises Clínicas e Toxicológicas; Faculdade de Farmácia; Universidade Federal de Minas Gerais; Belo Horizonte Brazil
| | - Gláucia Cota
- Fundação Oswaldo Cruz-Fiocruz; Instituto René Rachou; Centro de Referência em Leishmanioses; Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias; Belo Horizonte MG Brazil
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Bennis I, Verdonck K, El Khalfaoui N, Riyad M, Fellah H, Dujardin JC, Sahibi H, Bouhout S, Van der Auwera G, Boelaert M. Accuracy of a Rapid Diagnostic Test Based on Antigen Detection for the Diagnosis of Cutaneous Leishmaniasis in Patients with Suggestive Skin Lesions in Morocco. Am J Trop Med Hyg 2018; 99:716-722. [PMID: 29988004 PMCID: PMC6169188 DOI: 10.4269/ajtmh.18-0066] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
In rural areas in Morocco, diagnosing cutaneous leishmaniasis (CL) can be challenging. We evaluated the accuracy of a rapid diagnostic test (RDT) based on antigen detection, CL Detect Rapid Test™ (Inbios International Inc., Seattle, WA), in this setting. We consecutively recruited patients with new skin ulcers in nine primary health centers. We took a dental broach sample for the RDT and two other tissue samples by scraping the border and center of the lesion with a scalpel and smearing it on a slide. We duplicated each smear by pressing a clean slide against it and processed the slides by microscopy, polymerase chain reaction (PCR) internal transcribed spacer 1, and kDNA minicircle PCR. In a subgroup with positive PCR, the Leishmania species was identified using PCR-restriction fragment length polymorphism and PCR-sequencing of hsp70 genes. A participant with positive microscopy and/or PCR was considered a confirmed CL case. We computed sensitivity (Se) and specificity (Sp) of the RDT compared with this reference standard (ClinicalTrials.gov registration: NCT02979002). Between December 2016 and July 2017, we included 219 patients, 50% of them were under 18 years old. Rapid diagnostic test Se was 68% [95% confidence interval (CI): 61–74], Sp 94% [95% CI: 91–97], positive predictive value 95% [95% CI: 92–98], and negative predictive value 64% [95% CI: 58–70]. Despite its low Se, this novel RDT is a useful addition to clinical management of CL in Morocco, especially in isolated localities. Rapid diagnostic test–positive lesions can be treated as CL; but when RDT negative, microscopy should be done in a second step. The Se of the RDT can probably be optimized by improving the sampling procedure.
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Affiliation(s)
- Issam Bennis
- Department of Biomedical Sciences, Faculty of Pharmaceutical, Biomedical and Veterinary Sciences, University of Antwerp, Antwerp, Belgium.,Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,National School of Public Health, Ministry of Health, Rabat, Morocco
| | - Kristien Verdonck
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Nora El Khalfaoui
- Research Team on Immunopathology of Infectious and Systemic Diseases, Faculty of Medicine and Pharmacy, University Hassan II of Casablanca, Casablanca, Morocco.,Laboratory of Parasitology, Faculty of Medicine and Pharmacy, University Hassan II of Casablanca, Casablanca, Morocco
| | - Myriam Riyad
- Research Team on Immunopathology of Infectious and Systemic Diseases, Faculty of Medicine and Pharmacy, University Hassan II of Casablanca, Casablanca, Morocco.,Laboratory of Parasitology, Faculty of Medicine and Pharmacy, University Hassan II of Casablanca, Casablanca, Morocco
| | - Hajiba Fellah
- National Reference Laboratory of Leishmaniasis, Parasitology Department, National Institute of Hygiene, Rabat, Morocco
| | - Jean-Claude Dujardin
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.,Department of Biomedical Sciences, Faculty of Pharmaceutical, Biomedical and Veterinary Sciences, University of Antwerp, Antwerp, Belgium
| | - Hamid Sahibi
- Department of Parasitology, Hassan II Agronomy, and Veterinary Institute, Rabat, Morocco
| | - Souad Bouhout
- Unit of Parasitic Diseases, Directorate of Epidemiology and Disease Control, Ministry of Health, Rabat, Morocco
| | - Gert Van der Auwera
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Marleen Boelaert
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Ramalho DB, Silva RED, Senna MCRD, Moreira HSA, Pedras MJ, Avelar DMD, Saraiva L, Rabello A, Cota G. Meglumine antimoniate intralesional infiltration for localised cutaneous leishmaniasis: a single arm, open label, phase II clinical trial. Mem Inst Oswaldo Cruz 2018; 113:e180200. [PMID: 29947651 PMCID: PMC6012678 DOI: 10.1590/0074-02760180200] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 06/06/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Cutaneous leishmaniasis (CL) is a world-wide health problem which currently lacks effective, affordable and easy to use therapy. Recently, the meglumine antimoniate (MA) intralesional infiltration was included among the acceptable therapies for New World leishmaniasis. While this approach is attractive, there is currently little evidence to support its use in Americas. OBJECTIVES The aim of this study was to provide information about effectiveness and safety of a standardised MA intralesional infiltration technique for the treatment of CL. METHODS It is a single-arm phase II clinical trial conducted at a Brazilian referral centre. CL cases with parasitological confirmation presenting a maximum of three CL-compatible skin lesions were treated with weekly MA intralesional infiltration by using a validated technique, up to a maximum of eight infiltrations. RESULTS A total of 53 patients (62 lesions) were included. Overall, patients received a median of seven infiltrations (IQR25-75% 5-8) over a median treatment period of 43 days (IQR25-75% 28-52 days). The definitive cure rate at D180 was 87% (95% CI:77-96%). The majority of adverse events were local, with mild or moderate intensity. Bacterial secondary infection of the lesion site was observed in 13% of the treated patients, beside two intensity-three adverse events (hypersensitivity reactions).
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Affiliation(s)
- Dario Brock Ramalho
- Fundação Hospitalar do Estado de Minas Gerais, Hospital Eduardo de Menezes, Belo Horizonte, MG, Brasil
| | - Rosiana Estéfane da Silva
- Fundação Oswaldo Cruz, Instituto René Rachou, Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias, Belo Horizonte, MG, Brasil
| | - Maria Camilo Ribeiro de Senna
- Fundação Oswaldo Cruz, Instituto René Rachou, Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias, Belo Horizonte, MG, Brasil
| | - Hugo Silva Assis Moreira
- Fundação Oswaldo Cruz, Instituto René Rachou, Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias, Belo Horizonte, MG, Brasil
| | - Mariana Junqueira Pedras
- Fundação Oswaldo Cruz, Instituto René Rachou, Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias, Belo Horizonte, MG, Brasil
| | - Daniel Moreira de Avelar
- Fundação Oswaldo Cruz, Instituto René Rachou, Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias, Belo Horizonte, MG, Brasil
| | - Lara Saraiva
- Fundação Oswaldo Cruz, Instituto René Rachou, Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias, Belo Horizonte, MG, Brasil
| | - Ana Rabello
- Fundação Oswaldo Cruz, Instituto René Rachou, Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias, Belo Horizonte, MG, Brasil
| | - Gláucia Cota
- Fundação Oswaldo Cruz, Instituto René Rachou, Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias, Belo Horizonte, MG, Brasil
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Erber AC, Arana B, Bennis I, Ben Salah A, Boukthir A, Castro Noriega MDM, Cissé M, Cota GF, Handjani F, Kebede MG, Lang T, López Carvajal L, Marsh K, Martinez Medina D, Plugge E, Olliaro P. An international qualitative study exploring patients' experiences of cutaneous leishmaniasis: study set-up and protocol. BMJ Open 2018; 8:e021372. [PMID: 29909372 PMCID: PMC6009565 DOI: 10.1136/bmjopen-2017-021372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Lack of investments in drug development, lack of standardisation of clinical trials and the complexity of disease presentations contribute to the current lack of effective, safe and adapted treatments for cutaneous leishmaniasis (CL). One aspect concerns outcomes affecting patients' quality of life (QoL): these are hardly assessed in trials, despite potential functional and/or aesthetic impairment caused by CL, which typically affects disadvantaged and vulnerable people living in rural areas. Here, we describe the approach used to bring perspectives of patients with CL into designing and assessing treatments. METHODS AND ANALYSIS This international qualitative study uses interviews with patients to explore their experiences with CL to (1) elicit outcomes and eligibility criteria for clinical trials important to them and (2) to better understand their needs and views about the disease and their requirements and expectations from treatment. Here, we describe the set-up of this collaborative study and the protocol. Data collection is ongoing.The protocol includes study design, preparation, conduct and analysis of individual interviews with approximately 80 patients in seven countries (Burkina Faso, Brazil, two sites in Colombia, Iran, Morocco, Peru and Tunisia) where CL is prevalent. Principal investigators and sites were selected through an open call, and two workshops were organised for protocol development and training in conduct and analysis of qualitative health research. Patient recruitment aims at covering a maximum variation of experiences. Transcripts will be analysed to identify outcomes and eligibility criteria as well as further topics that are expected to emerge from the interviews, such as direct and indirect costs related to CL, its psychological impact, preferred modes of drug administration and traditional treatments. ETHICS AND DISSEMINATION The study received ethical approval by the responsible committees of each of the participating institutions. Findings will be disseminated through publication in peer-reviewed journals, scientific meetings and to participants and their communities.
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Affiliation(s)
- Astrid Christine Erber
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Byron Arana
- Drugs for Neglected Diseases Initiative (DNDi), Geneva, Switzerland
| | - Issam Bennis
- National School of Public Health, Rabat, Morocco
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Afif Ben Salah
- Institut Pasteur de Tunis, Tunis, Tunisia
- Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University (AGU), Manama, Bahrain
| | | | - Maria del Mar Castro Noriega
- Centro Internacional de Entrenamiento de Investigaciones Médicas (CIDEIM), Cali, Colombia
- EDCTP/TDR Fellow, European Vaccine Initiative (EVI), Heidelberg, Germany
| | | | - Gláucia Fernandes Cota
- Centro de Pesquisa René Rachou (CPqRR), Fundação Oswaldo Cruz (FIOCRUZ), Minas Gerais, Brazil
| | - Farhad Handjani
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mairie Guizaw Kebede
- Ayder Referral Hospital, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Trudie Lang
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Liliana López Carvajal
- Programa de Estudio y Control de Enfermedades Tropicales (PECET), Universidad de Antioquia, Medellín, Colombia
| | - Kevin Marsh
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Dalila Martinez Medina
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Departamento de Enfermedades Infecciosas, Dermatológicas y Tropicales, Hospital Cayetano Heredia, Lima, Peru
| | - Emma Plugge
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Piero Olliaro
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Special Programme for Research & Training in Tropical Diseases (WHO/TDR), Geneva, Switzerland
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López-Carvajal L, Vélez I, Arbeláez MP, Olliaro P. Eligibility criteria and outcome measures adopted in clinical trials of treatments of cutaneous leishmaniasis: systematic literature review covering the period 1991-2015. Trop Med Int Health 2018. [PMID: 29524291 DOI: 10.1111/tmi.13048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To document the sources of heterogeneity in outcomes and shortcomings in trial designs reported by previous systematic reviews. METHODS Systematic review of clinical trials of CL treatments published since 1991, to assess and compare eligibility criteria and outcome measures in trials (any type of treatment) of CL (any form) reported before and after the publication of the CONSORT statement. RESULTS We identified 106 eligible trials published between 1991 and 2015, 74% after the 2001 CONSORT statement; 58% (n = 63) were on Old-World CL and 37% (n = 40) in New-World CL; overall, 11 531 patients enrolled in 243 treatment groups on 30 different treatments. Both requirements and definitions for eligibility and outcome criteria varied. Compliance with CONSORT requirements increased for studies published after the 2010 update. As for entry criteria, 94% of studies had a requirement for sex (74% of those enrolling also women excluded those who were pregnant or lactating), 69% for age (variable age ranges), 99% parasitological confirmation, 43% prior duration of illness (14% excluded cases with previous episodes), 46% defined the number, 28% the size and 13% the type of lesions (27% with restrictions as to their anatomical location). Follow-up ranged 1-24 months, with 14% and 91% of studies, respectively, having defined initial and final cure. CONCLUSIONS This review documents changes in reporting before and after the publication of the CONSORT statement. Lack of standardisation, compounded with the small number of trials relative to the magnitude of the disease in its multiple forms, and with the range of treatments tested explains why evidence to inform treatment guidelines is generally weak for CL. Adopting standardised methodologies will improve the quality and consistency of clinical trials, and ultimately yield better treatments for CL.
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Affiliation(s)
- Liliana López-Carvajal
- Programa de Estudio y Control de Enfermedades Tropicales, Universidad de Antioquia, Medellín, Colombia
| | - Iván Vélez
- Programa de Estudio y Control de Enfermedades Tropicales, Universidad de Antioquia, Medellín, Colombia
| | | | - Piero Olliaro
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases, Geneva, Switzerland.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Health economic evaluation of moist wound care in chronic cutaneous leishmaniasis ulcers in Afghanistan. Infect Dis Poverty 2018; 7:12. [PMID: 29444705 PMCID: PMC5812215 DOI: 10.1186/s40249-018-0389-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 01/12/2018] [Indexed: 11/26/2022] Open
Abstract
Background The present health economic evaluation in Afghanistan aims to support public health decision makers and health care managers to allocate resources efficiently to appropriate treatments for cutaneous leishmaniasis (CL) elicited by Leishmania tropica or Leishmania major. Methods A decision tree was used to analyse the cost and the effectiveness of two wound care regimens versus intra-lesional antimony in CL patients in Afghanistan. Costs were collected from a societal perspective. Effectiveness was measured in wound free days. The incremental cost-effectiveness ratio (ICER) and incremental net monetary benefit (NMB) were calculated. The model was parameterized with baseline parameters, sensitivity ranges, and parameter distributions. Finally, the model was simulated and results were evaluated with deterministic and probability sensitivity analyses. Final outcomes were the efficiency of the regimens and a budget impact analysis in the context of Afghanistan. Results Average costs per patients were US$ 11 (SE = 0.016) (Group I: Intra-dermal Sodium Stibogluconate [IL SSG]), US$ 16 (SE = 7.58) (Group II: Electro-thermo-debridement [ETD] + Moist wound treatment [MWT]) and US$ 25 (SE = 0.48) (Group III: MWT) in patients with a single chronic CL ulcer. From a societal perspective the budget impact analysis shows that the regimens’ drug costs are lower than indirect disease cost. Average effectiveness in wound free days are 177 (SE = 0.36) in Group II, 147 (SE = 0.33) in Group III, and 129 (SE = 0.27) in Group I. The ICER of Group II versus Group I was US$ 0.09 and Group III versus Group I US$ 0.77, which is very cost-effective with a willingness-to-pay threshold of US$ 2 per wound free day. Within a Monte-Carlo probabilistic sensitivity analysis Group II was cost-effective in 80% of the cases starting at a willingness-to-pay of 80 cent per wound free day. Conclusions Group II provided the most cost-effective treatment. The non-treatment alternative is not an option in the management of chronic CL ulcers. MWT of Group III should at least be practiced. The cost-effectiveness of Group III depends on the number of dressings necessary until complete wound closure. Electronic supplementary material The online version of this article (doi: 10.1186/s40249-018-0389-4) contains supplementary material, which is available to authorized users.
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Francesconi VA, Francesconi F, Ramasawmy R, Romero GAS, Alecrim MDGC. Failure of fluconazole in treating cutaneous leishmaniasis caused by Leishmania guyanensis in the Brazilian Amazon: An open, nonrandomized phase 2 trial. PLoS Negl Trop Dis 2018; 12:e0006225. [PMID: 29481560 PMCID: PMC5854414 DOI: 10.1371/journal.pntd.0006225] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 03/15/2018] [Accepted: 01/09/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The treatment of Leishmaniasis caused by Leishmania (Viannia) guyanensis is based on a weak strength of evidence from very few clinical trials and some case series reports. Current treatment guidelines recommend pentamidine isethionate or meglumine antimoniate (Glucantime) as the first-line choices. Both are parenteral drugs with a low therapeutic indexes leading to a high risk of undesired effects. Imidazole derivatives interfere with the production of leishmanial ergosterol, an essential component of their membrane structure. One drug that has been studied in different clinical presentations of Leishmania is fluconazole, a hydrophilic bis-triazole, which is easily absorbed through the oral route with a low toxicity profile and is considered safe for children. This drug is readily available in poor countries with a reasonable cost making it a potential option for treating leishmaniasis. METHODS AND FINDINGS An adaptive nonrandomized clinical trial with sequential groups with dose escalation of oral fluconazole was designed to treat adult men with localized cutaneous leishmaniasis (LCL) in Manaus, Brazil. Eligible participants were patients with LCL with confirmed Leishmania guyanensis infection. RESULTS Twenty adult male patients were treated with 450 mg of fluconazole daily for 30 days. One patient (5%) was cured within 30 days of treatment. Of the 19 failures (95%), 13 developed a worsening of ulcers and six evolved lymphatic spreading of the disease. Planned dose escalation was suspended after the disappointing failure rate during the first stage of the trial. CONCLUSION/SIGNIFICANCE Oral fluconazole, at the dose of 450mg per day, was not efficacious against LCL caused by Leishmania guyanensis in adult men. TRIAL REGISTRATION Brazilian Clinical Trial Registration (ReBec)-RBR-8w292w; UTN number-1158-2421.
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Affiliation(s)
- Valeska Albuquerque Francesconi
- Department of Dermatology, Academic and Research Division at the Tropical Medicine Foundation - Dr Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Fabio Francesconi
- Department of Dermatology, Academic and Research Division at the Tropical Medicine Foundation - Dr Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Rajendranath Ramasawmy
- Department of Molecular Biology, Division of Immunogenetics, at the Tropical Medicine Foundation - Dr Heitor Vieira Dourado and Universidade Nilton Lins, Manaus, Amazonas, Brazil
| | | | - Maria das Graças Costa Alecrim
- Department of Infectology, Division of Malaria and Neglected Tropical Diseases at the Tropical Medicine Foundation - Dr Heitor Vieira Dourado, Manaus, Amazonas, Brazil
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da Silva RE, Carvalho JDP, Ramalho DB, Senna MCRD, Moreira HSA, Rabello A, Cota E, Cota G. Towards a standard protocol for antimony intralesional infiltration technique for cutaneous leishmaniasis treatment. Mem Inst Oswaldo Cruz 2018; 113:71-79. [PMID: 29236929 PMCID: PMC5722261 DOI: 10.1590/0074-027601700125] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 07/05/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Despite its recognised toxicity, antimonial therapy continues to be the first-line drug for cutaneous leishmaniasis (CL) treatment. Intralesional administration of meglumine antimoniate (MA) represents an alternative that could reduce the systemic absorption of the drug and its side effects. OBJECTIVES This study aims to validate the standard operational procedure (SOP) for the intralesional infiltration of MA for CL therapy as the first step before the assessment of efficacy and safety related to the procedure. METHODS The SOP was created based on 21 trials retrieved from the literature, direct monitoring of the procedure and consultation with experts. This script was submitted to a formal computer-aided inspection to identify readability, clarity, omission, redundancy and unnecessary information (content validation). For criterion and construct validations, the influence of critical condition changes (compliance with the instructions and professional experience) on outcome conformity (saturation status achievement), tolerability (pain referred) and safety (bleeding) were assessed. FINDINGS The median procedure length was 12 minutes and in 72% of them, patients classified the pain as mild. The bleeding was also classified as mild in 96.6% of the procedures. Full compliance with the SOP was observed in 66% of infiltrations. Despite this, in 100% of the inspected procedures, lesion saturation was observed at the end of infiltration, which means that it tolerates some degree of modification in its execution (robustness) without prejudice to the result. CONCLUSIONS The procedure is reproducible and can be used by professionals without previous training with high success and safety rates.
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Affiliation(s)
- Rosiana Estéfane da Silva
- Fundação Oswaldo Cruz-Fiocruz, Centro de Pesquisas René Rachou,
Centro de Referência em Leishmanioses, Pesquisa Clínica e Políticas Públicas em
Doenças Infecto-Parasitárias, Belo Horizonte, MG, Brasil
| | - Janaína de Pina Carvalho
- Fundação Oswaldo Cruz-Fiocruz, Centro de Pesquisas René Rachou,
Centro de Referência em Leishmanioses, Pesquisa Clínica e Políticas Públicas em
Doenças Infecto-Parasitárias, Belo Horizonte, MG, Brasil
| | - Dario Brock Ramalho
- Fundação Oswaldo Cruz-Fiocruz, Centro de Pesquisas René Rachou,
Centro de Referência em Leishmanioses, Pesquisa Clínica e Políticas Públicas em
Doenças Infecto-Parasitárias, Belo Horizonte, MG, Brasil
| | - Maria Camilo Ribeiro De Senna
- Fundação Oswaldo Cruz-Fiocruz, Centro de Pesquisas René Rachou,
Centro de Referência em Leishmanioses, Pesquisa Clínica e Políticas Públicas em
Doenças Infecto-Parasitárias, Belo Horizonte, MG, Brasil
| | - Hugo Silva Assis Moreira
- Fundação Oswaldo Cruz-Fiocruz, Centro de Pesquisas René Rachou,
Centro de Referência em Leishmanioses, Pesquisa Clínica e Políticas Públicas em
Doenças Infecto-Parasitárias, Belo Horizonte, MG, Brasil
| | - Ana Rabello
- Fundação Oswaldo Cruz-Fiocruz, Centro de Pesquisas René Rachou,
Centro de Referência em Leishmanioses, Pesquisa Clínica e Políticas Públicas em
Doenças Infecto-Parasitárias, Belo Horizonte, MG, Brasil
| | - Erika Cota
- Universidade Federal do Rio Grande do Sul, Instituto de
Informática, Porto Alegre, RS, Brasil
| | - Gláucia Cota
- Fundação Oswaldo Cruz-Fiocruz, Centro de Pesquisas René Rachou,
Centro de Referência em Leishmanioses, Pesquisa Clínica e Políticas Públicas em
Doenças Infecto-Parasitárias, Belo Horizonte, MG, Brasil
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Cardona-Arias JA, López-Carvajal L, Tamayo-Plata MP, Vélez ID. Comprehensive economic evaluation of thermotherapy for the treatment of cutaneous leishmaniasis in Colombia. BMC Public Health 2018; 18:185. [PMID: 29378537 PMCID: PMC5789596 DOI: 10.1186/s12889-018-5060-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 01/10/2018] [Indexed: 11/21/2022] Open
Abstract
Background Cutaneous 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. Methods Cost-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. Results Thermotherapy 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%. Conclusion In 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.
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Affiliation(s)
| | - Liliana López-Carvajal
- PECET Program for the Study and Control of Tropical Diseases, University of Antioquia, Medellin, Colombia
| | | | - Iván Darío Vélez
- PECET Program for the Study and Control of Tropical Diseases, University of Antioquia, Medellin, Colombia
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Olliaro P, Grogl M, Boni M, Carvalho EM, Chebli H, Cisse M, Diro E, Fernandes Cota G, Erber AC, Gadisa E, Handjani F, Khamesipour A, Llanos-Cuentas A, López Carvajal L, Grout L, Lmimouni BE, Mokni M, Nahzat MS, Ben Salah A, Ozbel Y, Pascale JM, Rizzo Molina N, Rode J, Romero G, Ruiz-Postigo JA, Gore Saravia N, Soto J, Uzun S, Mashayekhi V, Vélez ID, Vogt F, Zerpa O, Arana B. Harmonized clinical trial methodologies for localized cutaneous leishmaniasis and potential for extensive network with capacities for clinical evaluation. PLoS Negl Trop Dis 2018; 12:e0006141. [PMID: 29329311 PMCID: PMC5785032 DOI: 10.1371/journal.pntd.0006141] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 01/25/2018] [Accepted: 11/29/2017] [Indexed: 11/27/2022] Open
Abstract
Introduction Progress with the treatment of cutaneous leishmaniasis (CL) has been hampered by inconsistent methodologies used to assess treatment effects. A sizable number of trials conducted over the years has generated only weak evidence backing current treatment recommendations, as shown by systematic reviews on old-world and new-world CL (OWCL and NWCL). Materials and methods Using a previously published guidance paper on CL treatment trial methodology as the reference, consensus was sought on key parameters including core eligibility and outcome measures, among OWCL (7 countries, 10 trial sites) and NWCL (7 countries, 11 trial sites) during two separate meetings. Results Findings and level of consensus within and between OWCL and NWCL sites are presented and discussed. In addition, CL trial site characteristics and capacities are summarized. Conclusions The consensus reached allows standardization of future clinical research across OWCL and NWCL sites. We encourage CL researchers to adopt and adapt as required the proposed parameters and outcomes in their future trials and provide feedback on their experience. The expertise afforded between the two sets of clinical sites provides the basis for a powerful consortium with potential for extensive, standardized assessment of interventions for CL and faster approval of candidate treatments. The term ‘cutaneous leishmaniasis’ (CL) includes a range of manifestations affecting the skin caused by Leishmania parasites across several continents. While not life-threatening, CL can be invalidating and disfiguring, or become complicated. Today, there is no satisfactory treatment for CL that is effective and safe. Faced with no investments into developing drugs for CL, clinical researchers have tried many treatments over the years, but little progress has been made. One of the reasons is the lack of standardized methodologies in conducting these trials which makes it difficult to collate and compare results. Clinical researchers now realize that their efforts can be brought to fruition if common methodologies are available and applied. This paper summarizes the principles and parameters agreed upon by researchers of how to identify patients and how to measure treatment effects in a way that will make it possible to gather convincing evidence of whether a treatment works or not. Adhering to these principles will allow faster progress towards offering better care to patients with this neglected disease.
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Affiliation(s)
- Piero Olliaro
- Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization (WHO), Geneva, Switzerland
- Centre for Tropical Medicine and Vaccinology, Nuffield Department of Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom
- * E-mail:
| | - Max Grogl
- U.S. Naval Medical Unit No.6 Peru, Lima, Peru
| | - Marina Boni
- Drugs for Neglected Diseases initiative (DNDi) Latin America, Rio de Janeiro, Brazil
| | | | - Houda Chebli
- Direction de l’Épidémiologie et de Lutte contre les Maladies, Division des Maladies Transmissibles, Service des Maladies Parasitaires, Rabat, Morocco
| | - Mamoudou Cisse
- Université Polytechnique de Bobo-Dioulasso, Bobo-Dioulasso, Burkina Faso
| | - Ermias Diro
- Department of Internal Medicine, University of Gondar, Ethiopia
| | | | - Astrid C. Erber
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Farhad Handjani
- Molecular Dermatology Research Center, Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Khamesipour
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Alejandro Llanos-Cuentas
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Liliana López Carvajal
- Programa de Estudio y Control de Enfermedades Tropicales (PECET), Universidad de Antioquia, Medellin, Colombia
| | - Lise Grout
- Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | | | - Mourad Mokni
- Dermatology Department, La Rabta Hospital, Tunis, Tunisia
| | | | - Afif Ben Salah
- Service d'épidémiologie médicale, Institut Pasteur de Tunis, Tunis, Tunisia
| | - Yusuf Ozbel
- Department of Parasitology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Juan Miguel Pascale
- Instituto Conmemorativo Gorgas de Estudios de la Salud, Panamá, República de Panamá
| | - Nidia Rizzo Molina
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Joelle Rode
- Drugs for Neglected Diseases initiative (DNDi) Latin America, Rio de Janeiro, Brazil
| | - Gustavo Romero
- Núcleo de Medicina Tropical, Universidade de Brasília, Campus Universitário Darcy Ribeiro, Brasília, Brazil
| | | | - Nancy Gore Saravia
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia
| | - Jaime Soto
- Fundación Nacional de Dermatología (FUNDERMA), Santa Cruz de la Sierra, Santa Cruz, Bolivia
| | - Soner Uzun
- Department of Dermatology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | | | - Ivan Dario Vélez
- Programa de Estudio y Control de Enfermedades Tropicales (PECET), Universidad de Antioquia, Medellin, Colombia
| | - Florian Vogt
- Unit of HIV and Neglected Tropical Diseases, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Olga Zerpa
- Instituto Medico la Floresta, Caracas, Venezuela
| | - Byron Arana
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
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Brahim LR, Valete-Rosalino CM, Antônio LDF, Pimentel MIF, Lyra MR, Paes LEDC, Costa ADD, Vieira IF, Dias CMG, Duque MCDO, Marzochi MCDA, Schubach ADO. Low dose systemic or intralesional meglumine antimoniate treatment for American tegumentary leishmaniasis results in low lethality, low incidence of relapse, and low late mucosal involvement in a referral centre in Rio de Janeiro, Brazil (2001-2013). Mem Inst Oswaldo Cruz 2017; 112:838-843. [PMID: 29211245 PMCID: PMC5719553 DOI: 10.1590/0074-02760160478] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 06/23/2017] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND American tegumentary leishmaniasis (ATL) is a non-lethal parasitic disease
that presents with cutaneous (CL) and mucosal (ML) clinical forms. ATL
treatment aims at healing the lesions and preventing the development of the
late mucosal form. Systemic meglumine antimoniate (MA) therapy with 10-20 mg
Sb5+/kg/day is the first choice of treatment. However,
alternative therapies using 5 mg Sb5+/kg/day or intralesional
(IL) MA are the usual regimens at the National Institute of Infectious
Diseases (NIID), Rio de Janeiro, Brazil. OBJECTIVES To evaluate lethality and the incidence of relapse and development of late ML
in CL patients treated at NIID from 2001 until 2013. METHODS Data were recovered from records of all ATL patients diagnosed during that
period. FINDINGS Out of 777 patients, 753 were treated with MA (96.9%). Of those, 89.1%
received alternative therapy of 9.9% IL and 79.2% systemic 5 mg
Sb5+/kg/day. Some patients required 1-3 additional courses of
treatment, thus making a total of 997 courses; 85.2% of them were subjected
to alternative therapies. Lethality was 0.1%, relapse incidence 5.8%, and
late ML incidence 0.25%. As a final outcome for the 777 patients, 95.9% were
cured, 0.1% died and 4.0% were not able to follow-up. MAIN CONCLUSIONS Alternative MA schedules resulted in low lethality without increase of
relapse or late ML incidence.
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Affiliation(s)
- Lucia Regina Brahim
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Rio de Janeiro, RJ, Brasil.,Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório Interdisciplinar de Vigilância Entomológica em Diptera e Hemiptera, Rio de Janeiro, RJ, Brasil
| | - Cláudia Maria Valete-Rosalino
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Rio de Janeiro, RJ, Brasil.,Universidade Federal do Rio de Janeiro, Departamento de Otorrinolaringologia e Oftalmologia, Rio de Janeiro, RJ, Brasil
| | - Liliane de Fátima Antônio
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Rio de Janeiro, RJ, Brasil
| | - Maria Inês Fernandes Pimentel
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Rio de Janeiro, RJ, Brasil.,Secretaria de Estado de Saúde do Rio de Janeiro, Vigilância Epidemiológica, Rio de Janeiro, RJ, Brasil
| | - Marcelo Rosandiski Lyra
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Rio de Janeiro, RJ, Brasil
| | - Luiz Eduardo de Carvalho Paes
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Rio de Janeiro, RJ, Brasil.,Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Pesquisas em Leishmanioses, Rio de Janeiro, RJ, Brasil
| | - Ananda Dutra da Costa
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Rio de Janeiro, RJ, Brasil
| | - Iracema Forni Vieira
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Rio de Janeiro, RJ, Brasil
| | | | - Maria Cristina de Oliveira Duque
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Rio de Janeiro, RJ, Brasil.,Secretaria Municipal de Saúde de Timóteo, Timóteo, MG, Brasil
| | - Mauro Celio de Almeida Marzochi
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Rio de Janeiro, RJ, Brasil
| | - Armando de Oliveira Schubach
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Rio de Janeiro, RJ, Brasil
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