Interventions for American Cutaneous and Mucocutaneous Leishmaniasis: A Systematic Review Update

Abstract

IntroductionLeishmaniasis is an important public health problem in the Americas. A Cochrane review published in 2009 analyzed 38 randomized controlled trials (RCT). We conducted a systematic review to evaluate the effects of therapeutic interventions for American cutaneous and mucocutaneous leishmaniasis.MethodsAll studies were extracted from PubMed, Embase, Lilacs (2009 to July, 2012 respectively), the Cochrane Central Register of Controlled Trials (6-2012) and references of identified publications. RCTs’ risk of bias was assessed.ResultsWe identified 1865 references of interest; we finally included 10 new RCTs. The risk of bias scored low or unclear for most domains. Miltefosine was not significantly different from meglumine antimoniate in the complete cure rate at 6 months (4 RCT; 584 participants; ITT; RR: 1.12; 95%CI: 0.85 to 1.47; I2 78%). However a significant difference in the rate of complete cure favoring miltefosine at 6 months was found in L. panamensis and L. guyanensis (2 RCTs, 206 participants; ITT; RR: 1.22; 95%CI: 1.02 to 1.46; I2 0%). One RCT found that meglumine antimoniate was superior to pentamidine in the rate of complete cure for L. braziliensis (80 participants, ITT; RR: 2.21; 95%CI: 1.41 to 3.49), while another RCT assessing L. guyanensis did not find any significant difference. Although meta-analysis of three studies found a significant difference in the rate of complete cure at 3 months favoring imiquimod versus placebo (134 participants; ITT; RR: 1.45; 95%CI: 1.12 to 1.88; I2 0%), no significant differences were found at 6 and 12 months. Thermotherapy and nitric oxide were not superior to meglumine antimoniate.ConclusionTherapeutic interventions for American cutaneous and mucocutaneous leishmaniasis are varied and should be decided according to the context. Since mucosal disease is the more neglected form of leishmaniasis a multicentric trial should be urgently considered.

Leishmaniosis cutánea verrucosa: inusual presentación

“…En un grupo de militares en la Amazonía peruana se reportó que 76/303 (25%) presentaron lesiones compatibles con leishmaniosis cutánea, y que solo el 3% correspondió a L. (Viannia) guyanensis (5) . Su trasmisión se asocia a actividades forestales, tal como sucedió con el paciente del presente reporte, al internarse en una reserva natural en la selva central del Perú.…”

In Vivo and in Vitro Antileishmanial Effects of Methanolic Extract From Bark of Bursera Aptera

“…Leishmaniasis is an important public health problem in 98 endemic countries, with more than 350 million people at risk (Reveiz et al, 2013;World Health, 2010). Leishmaniasis has traditionally been classified into three major forms based on clinical symptoms (Handman, 2001).…”

Diagnostic Efficacy of Molecular Techniques for Detection and Identification of Leishmania Species in Human Whole Blood and Skin Samples from Ecuador

“…1 Leishmaniasis has become an important public health problem in tropical and subtropical regions of the world. 2 In Ecuador, leishmaniasis infection has been reported in 23 of the 24 provinces (excluding only the Galápagos islands). 3 The clinical presentation and disease progression of leishmaniasis depend on the causative species and the immune status of the patient.…”

“…6 A total of 15 species of Leishmania have been identified as responsible for the infection of humans. 2 In Ecuador, only Leishmania amazonensis, Leishmania braziliensis, Leishmania guyanensis, Leishmania major-like, Leishmania mexicana, Leishmania panamensis, and Leishmania naiffi have been identified. 7,8 Traditionally, microscopic examination has been considered the standard method for diagnosis of CL and MCL.…”