Kutane Leishmaniasis

Behandlung der mukokutanen Leishmaniose – eine systematische Übersicht

Die mukokutane Leishmaniose ist eine schwere Infektionskrankheit, die überwiegend in Zentral‐ und Südamerika endemisch ist und sich klinisch mit granulomatösen, destruierenden Schleimhautläsionen im Mund‐Nasen‐Rachenraum manifestiert. Sie wird durch Protozoen, Leishmania spp., ausgelöst, die durch Sandmücken auf den Menschen übertragen werden. Sie tritt nach vorangegangener kutaner Leishmaniose auf, wenn diese nicht oder nur unzureichend behandelt wurde und kommt gehäuft bei immunsupprimierten Patienten vor. Das Ziel dieser systematischen Übersicht besteht darin, alle publizierten Behandlungsmöglichkeiten für die mukokutane Leishmaniose zusammenzufassen. Sie basiert auf allen englischen, deutschen, französischen, spanischen und portugiesischen Artikeln, die in den Datenbanken „PubMed“ und „Lilacs“ von 1995 bis 2020 veröffentlicht wurden. Die medizinische Literatur beschränkt sich auf Einzelfallberichte, kleine Fallserien, retrospektive Studien und nur wenige randomisierte kontrollierte Studien. Zu den Therapieoptionen gehören pentavalente Antimonverbindungen wie Megluminantimonat oder Natriumstibogluconat, Amphotericin B (liposomal, Desoxycholat, Lipidkomplex, kolloidale Dispersion), Miltefosin und Pentamidin. Weitere mögliche Therapien sind Itraconazol, Fluconazol, Ketoconazol, Aminosidinsulfat und Azithromycin. Die Wahl des geeigneten Medikaments richtet sich in erster Hinsicht nach der Verfügbarkeit im Endemiegebiet und den begleitenden Erkrankungen des Patienten.

Treatment of mucocutaneous leishmaniasis - A systematic review

Mucocutaneous leishmaniasis is a severe infectious disease, predominantly endemic in Central and South America and is characterized by granulomatous, destructive mucosal lesions in the oral, nasal, and pharyngeal cavities. It is caused by protozoa of the genus Leishmania spp. transmitted to humans by sandflies. Mucocutaneous leishmaniasis occurs after untreated or inadequately treated cutaneous leishmaniasis and is more common in immunocompromised patients. The aim of this systematic review is to summarize all reported treatment options for mucocutaneous leishmaniasis. This review is based on all English, German, French, Spanish and Portuguese articles published in the databases "PubMed" and "Lilacs" from 1995 to 2020. Most of the medical literature is limited to case reports, small case series, retrospective studies, and a few randomized controlled trials. Various treatment options include pentavalent antimonates such as meglumine antimonate or sodium stibogluconate, amphotericin B (liposomal, deoxycholate, lipid complex, colloidal dispersion), miltefosine, and pentamidine. Other therapeutic options include itraconazole, fluconazole, ketoconazole, aminosidine sulfate, and azithromycin. The choice of drug depends primarily on its availability in the endemic area and the patient's comorbidities.

Prevalence of Cutaneous Leishmaniasis in Iran (2000-2016): A Systematic Review and Meta-analysis Study

BACKGROUND AND OBJECTIVE

Cutaneous leishmaniasis (CL) is the most common form of leishmaniasis affecting humans. The purpose of this study was to determine the prevalence and epidemiological features of CL in Iran by a systematic review and meta-analysis.

METHODS

The literature search was performed in the SID, Magiran, IranDoc, PubMed, Scopus, Medlib, as well as the Google Scholar search engine databases to find studies on the prevalence of CL. The reference lists of the found articles were also reviewed to obtain additional relevant articles. Studies that were related to treatment and reservoirs of CL were excluded. Forty-four studies were selected for the final analysis.

RESULTS

Meta-analysis with a random-effects model showed that the prevalence of leishmaniasis in Iran was 77 per 100,000 population. Overall, 60% of the patients were men. Most cases of CL occurred in autumn, and the majority of the patients had one lesion, mostly on hands. The most common age group was 20-30 years.

CONCLUSION

In conclusion, CL is an endemic disease in Iran, and its prevalence is largely affected by geographical locations and regional customs. Appropriate preventing measures should be considered to decrease the incidence of CL in Iran.

Leishmaniasis

Infections with Leishmania spp. rank among the top three most common travel-associated dermatoses. Depending on the country where the infection was acquired and the patient's immune status, different disease manifestations may be observed. Ninety percent of cases present as cutaneous leishmaniasis, but the infection may also affect internal organs (visceral leishmaniasis). Without treatment, the latter is often fatal. Intermediate types include recurrent, diffuse, or mucocutaneous forms. Nodular lesions on exposed skin with a tendency to ulcerate over time in combination with a travel history should therefore prompt workup for leishmaniasis. The diagnosis is made through histology, parasite culture, and PCR using biopsy material. Therapeutic options range from local therapies in cases with singular lesions to systemic therapy in patients with more severe forms. The present review discusses the most important clinical features, details about diagnostic measures, and current therapeutic approaches.

[Cutaneous leishmaniasis. Diagnosis and therapy in northern Afghanistan]

BACKGROUND

The German S1 guidelines from 2009 contain a variety of recommendations for the treatment of cutaneous leishmaniasis.

PATIENTS AND METHODS

We report the results of our diagnostic procedures and treatment of 32 international patients in autumn 2010 in northern Afghanistan.

RESULTS

Giemsa stain confirmed the clinical diagnosis within 24 hours. Eleven simple lesions and one larger ulcer responded well to cryotherapy and intralesional sodium stibogluconate. More complex lesions in 19 patients responded well to oral miltefosine. One patient refused outpatient therapy.

CONCLUSIONS

Cryotherapy and intralesional antimony compounds showed good results in early lesions of cutaneous leishmaniasis in northern Afghanistan. Outpatient treatment of complex lesions with miltefosine was successful in all cases.

[Cutaneous leishmaniasis as travelers' disease. Clinical presentation, diagnostics and therapy]

Leishmaniasis is a disease with worldwide increasing incidence, which in Germany is almost exclusively observed in patients who have travelled to classical endemic regions such as the Mediterranean basin. Cause of the disease is an infection with protozoan parasites of the genus Leishmania, which are transmitted by sand flies and replicate intracellularly within mammalian hosts. Depending on the inoculated parasite (sub-) species and the immune status of the host, a local cutaneous, diffuse cutaneous, mucocutaneous or visceral form of leishmaniasis will develop. Cutaneous leishmaniasis, which frequently appears only weeks after the bite of a sand fly, starts with the formation of a papule, which subsequently can turn into a skin ulcer. The latter may heal spontaneously after months leaving behind a scar or persist as chronic, non-healing cutaneous leishmaniasis. If cutaneous leishmaniasis is suspected, a sterile skin biopsy followed by appropriate diagnostic measures in a specialized laboratory to identify the pathogen should be performed. For the decision on the type of therapy, several clinical parameters (e.g. number and localization of lesions, immune status) and, most importantly, the underlying parasite (sub-) species need to be considered. Therapy can consist of a variety of topical measures or systemic drug treatment. A modern and safe vaccine does not yet exist.