Leishmania tropica in children: A retrospective study

Solomon, Michal; Schwartz, Eli; Pavlotsky, Felix; Sakka, Nicole; Barzilai, Aviv; Greenberger, Shoshana

doi:10.1016/j.jaad.2013.12.047

Cited by 36 publications

(29 citation statements)

References 31 publications

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“…As evidence of long-term efficacy, mention should be made of the observational study performed by Oliveira-Neto et al . [ 20 ], where patients treated by Sb v intralesional approach were re-assessed for 10 years, and no cases of relapse or development of mucosal lesions was identified. Another interesting observation was the occurrence of mucosal complications even after systemic antimony treatment [ 63 ].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of pentavalent antimoniate intralesional infiltration therapy for cutaneous leishmaniasis: A systematic review

2017

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BackgroundThe mainstays of cutaneous leishmaniasis (CL) treatment, in several world regions, are pentavalent antimony (Sbv) compounds administered parenterally, despite their recognized toxicity, which requires frequent laboratory monitoring and complicates their use in areas with scarce infrastructure. As result of these drawbacks, the WHO Expert Committee on leishmaniasis has expanded the recommendations for the use of local therapies, including Sbv intralesional infiltration (IL-Sbv), as CL therapy alternatives even in the New World. However, the efficacy of these approaches has never been compiled. The aim of this study was to critically and systematically assess the efficacy of IL-Sbv for CL treatment.MethodologyThe PRISMA guidelines for systematic reviews and the Cochrane manual were followed. The sources used were the MEDLINE and LILACS databases and the International Clinical Trials Registry Platform of the World Health Organization. The outcome of interest was a clinical cure, defined as complete re-epithelialization of all lesions. The IL-Sbv pooled cure rate was estimated for several subgroups and direct comparisons were performed when possible.ResultsThirty nine articles (40 studies) involving 5679 patients treated with IL-Sbv infiltration were included. In direct comparison, only three studies involving 229 patients compared IL-Sbv infiltration versus placebo and no difference was observed (OR: 1,9; 95%IC 0,93 to 3,82) based on cure rate 69.6% (95%CI 17.6–96.1%) and 83,2% (95%CI 66–92.7%) for placebo and IL-Sbv, respectively. In an alternative and non-comparative analysis, gathering all study arms using the intervention, the pooled IL-Sbv efficacy rate was 75% (95%CI 68–81%). In the Old World, the observed overall IL-Sbv efficacy rate was 75% (95%CI 66–82%), and the cure rates were significantly higher with sodium stibogluconate (SSG) than with meglumine antimoniate (MA): 83% (95%CI 75–90%) versus 68% (95%CI 54–79%), p = 0.03. Studies directly comparing IL-Sbv with topical 15% paromomycin ointment, IL hypertonic saline, radiofrequency-induced heat therapy, topical trichloroacetic acid and cryotherapy showed no significant difference in efficacy between the interventions. The analyses suggested a higher efficacy of IL-Sbv combined with cryotherapy (81.8%, 95%IC 62.4–92.4%) when compared with IL-Sbv alone (53.3%, 95%IC 46.1–66%), OR: 3.14 (95%CI 1.1–8.9), p = 0.03. In the New World, the global IL-Sbv efficacy was 77%(95%CI 66–85%). In contrast with the Old World, a significant difference favoring MA in relation to SSG was observed: 61% (95%CI 49–73%) versus 82% (95%CI 70–89%).By comparing IL infiltration schedules, it was determined that patients submitted to IL-Sbv treatments longer than 14 days had higher cure rates.ConclusionsDespite the high heterogeneity and low methodological quality of studies, an indirect comparison shows that the antimony infiltration efficacy rate is similar to that reported for antimony systemic use. The evidence gathered thus far is insufficient to identify the ideal IL the...

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Section: Discussionmentioning

confidence: 99%

Efficacy of pentavalent antimoniate intralesional infiltration therapy for cutaneous leishmaniasis: A systematic review

2017

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“…6,7 In such cases, systemic treatment with intravenous PA or L-Amb, oral miltefosine or oral imidazoles is recommended. 8 Intravenous PA is most commonly used, but it requires long hospitalization and has potential severe sideeffects. 6 In a recent retrospective study of 70 children with CL caused by L. tropica, efficacy and safety of intravenous PA and L-Amb were evaluated; the authors observed a superior cure rate and a shorter hospitalization period with L-AmB, proposing L-AmB as the first-line systemic therapy.…”

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confidence: 99%

Cutaneous Leishmania tropica in children: report of three imported cases successfully treated with liposomal amphotericin B

Knöpfel

Noguera‐Morel

Azorín

et al. 2017

Acad Dermatol Venereol

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“…Solomon et al conducted a prospective nonrandomized study wherein complete clinical cure was achieved with intravenous L‐AmB in 11 of 13 L. tropica infected patients some of whom had previously failed treatment with intralesional SSG and topical paromomycin. Another retrospective study reported safe and effective use of intravenous L‐AmB in paediatric population infected by L. tropica . A recent study by Goyonlo et al concluded promising results of weekly intralesional injection of AmB (2mg/ml) for CL in Iran with 61.4% patients showing complete recovery, 21.6% partial remission without any major adverse affects.…”

Section: Discussionmentioning

confidence: 99%

Clinical Response with intralesional Amphotericin B in the treatment of old world cutaneous leishmaniasis: a preliminary report

Mushtaq

Dogra

2016

Dermatologic Therapy

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Cutaneous leishmaniasis (CL) is a vector-borne tropical disease caused by a heterogeneous group of protozoan parasites that belong to the genus Leishmania. With an annual incidence of 1.5 million new cases, CL is a global health concern mainly in developing countries. The treatment options for CL are numerous but none is optimal. Pentavalent antimonials despite their side effects remain the preferred choice since decades. Alternate new treatment options are being explored to expand the therapeutic armamentarium of CL. In this study, we intend to describe our therapeutic experience with intralesional amphotericin B in the treatment of CL in a series of Indian patients, hitherto not commonly used in old world CL (OWCL). We also endeavour to review the literature on the use of amphotericin B in OWCL. Five consecutive patients diagnosed with cutaneous leishmansis at the out-patient department of Dermatology, Government Medical College, Jammu were treated with weekly injections of intralesional amphotericin B (2.5 mg/mL). Treatment response was assessed at each visit and the cases were followed up for 6 months. All the five patients responded well to the treatment and remained recurrence-free during follow-up. Intralesional amphotericin B was found to be safe and effective treatment for OWCL. Large randomized control trials need to be conducted to establish its efficacy.

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Leishmania tropica in children: A retrospective study

Cited by 36 publications

References 31 publications

Efficacy of pentavalent antimoniate intralesional infiltration therapy for cutaneous leishmaniasis: A systematic review

Efficacy of pentavalent antimoniate intralesional infiltration therapy for cutaneous leishmaniasis: A systematic review

Cutaneous Leishmania tropica in children: report of three imported cases successfully treated with liposomal amphotericin B

Clinical Response with intralesional Amphotericin B in the treatment of old world cutaneous leishmaniasis: a preliminary report

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