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

: Publicado: 30 Enero 2023; Visto: 245

Nueva Publicación de nuestros investigadores Alejandro Llanos y Fiorella Alvarez

Revista: PLoS Neglected Tropical Diseases SJR:1.45 Q:1

Año: 2023

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

Affiliations

Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia.
Universidad Icesi, Cali, Colombia.
Drugs for Neglected Diseases initiative (DNDi), Rio de Janeiro, Brazil.
Servico de Imunologia, Hospital Universitário Prof. Edgar Santos, Universidade Federal da Bahia, Salvador, Brazil.
Unidad de Leishmaniasis y Malaria, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, and Hospital Cayetano Heredia, Lima, Perú.
Universidade Federal de Mato Grosso, Hospital Universitário Júlio Müller (HUJM), Cuiabá, Mato Grosso, Brazil.
Instituto René Rachou, Fundação Oswaldo Cruz, Fiocruz, Belo Horizonte, Minas Gerais, Brazil.
Centro Dermatológico Federico Lleras Acosta E.S.E (CDFLA), Bogotá, Colombia.
Centro Universitario de Medicina Tropical-Universidad Mayor de San Simón (CUMT), Cochabamba, Bolivia.
PECET-Programa de Estudio y Control de Enfermedades Tropicales, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
FUNDERMA (Fundación Nacional de Dermatología), Santa Cruz de la Sierra, Bolivia.
Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland.

PMID: 36689465

DOI: 10.1371/journal.pntd.0011029

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.

Copyright: © 2023 Castro et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.