Cutaneous leishmaniasis treatment and therapeutic outcomes in special populations: A collaborative retrospective study

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.

mHealth Monitoring of Treatment of Cutaneous Leishmaniasis Patients: A Community-Based Implementation Study

“…The effectiveness of MA was similar to that reported in other publications. 64 – 66 Among the eight patients who received pentamidine and failed treatment, it is noteworthy that 6/8 patients were children. Clinical trials to evaluate pentamidine’s efficacy in the pediatric population are needed.…”

Anti-leishmanial effects of Eryngium planum and Ecbilliun elaterum methanolic extract against Leishmania major

“…Pentavalent compounds of antimony (Glucantime and Pentostam drugs) are the first and amphotericin B, pentamidine, and ketoconazole (for skin type) are the second line of drug choice for CL (Castro et al 2023 ; de Vries and Schallig 2022 ) but, the use of these drugs has decreased due to their adverse side effects on the heart, liver, and kidney, as well as the painful injection and the drug resistance detected in recent years (Roatt et al 2020 ). There are many drugs for the treatment of infectious diseases, one group of which is drugs extracted from plant compounds and their extracts, which are welcomed due to their low side effects; in this case, the effect of Artemisia annua on Malaria or the effect of Ivermectin on the Strongyloides stercoralis dangerous parasite (Ali 2023 ; Kshirsagar and Rao 2021 ).…”

Local amphotericin B therapy for Cutaneous Leishmaniasis: A systematic review

“…Characterized by non-fatal but potentially disfiguring ulcers distributed across the body, CL is linked with social stigma persisting post-treatment due to the risk of permanent scarring and relapses [3,4]. The optimal treatment is not yet available for leishmaniasis, and meglumine antimoniate and amphotericin B (AmB), both of which are related to significant toxicity, are the most used drugs [5].…”