Travelers With Cutaneous Leishmaniasis Cured Without Systemic Therapy

Abstract

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

Cutaneous leishmaniasis in a returning UK traveller

“…As he had localised disease confined to the left posterior thigh, he was commenced on intralesional sodium stibogluconate weekly injections for 6 weeks, followed by fortnightly for 4 cycles. This resulted in complete resolution, consistent with existing reports in the literature 3 4…”

Cutaneous Leishmaniasis: Current Treatment Practices in the USA for Returning Travelers

“…Although attempts are now being made by European investigators [11, 12, 13•], the management of CL, an intrinsically diverse disease, has not been standardized for three reasons: (a) the basic heterogeneity of the disease given that multiple different species cause illness; (b) the fact that clinical manifestation, response to treatment, and outcome vary depending on the geographic region of acquisition; and (c) a general lack of high-quality clinical trials from which to draw guidance.…”

“…With patient willingness, observation alone (with adequate wound care) may well be satisfactory if there is evidence of spontaneous regression or well-localized infection caused by L. major (OWCL) and L. mexicana (NWCL). The latter approach is justifiable, as spontaneous healing (albeit with the likelihood of at least some scarring) occurs within 3 to 4 months in 70 and 88 % of localized infections caused by L. major and L. mexicana , respectively [13•]. Widely accepted indications for treatment in all forms of CL are listed in Table 1.…”

“…Antimony is contraindicated in pregnant women and should be avoided, if possible, in patients older than 55 years of age as well as in patients with preexisting cardiac, hepatic, or renal disease [13•]. Toxicity may also be increased in patients coinfected with HIV.…”

Parasite Load Decrease during Application of a Safe and Easily Applied Antileishmanial Aminoglycoside Cream

“…Leishmania parasites enter the skin through a sandfly bite, producing a papule or nodule that generally ulcerates [1]. Spontaneous resolution of CL ulcers may take months to years [2], and both active lesions and scars can engender stigma and cause disability [3].…”