Cutaneous leishmaniasis due to Leishmania aethiopica: a therapeutic challenge

Background Cutaneous leishmaniasis (CL) in Ethiopia, caused by Leishmania aethiopica, is often severe and hard to treat compared to CL caused by other species elsewhere. Miltefosine is the only oral anti-leishmanial drug, with a favorable side-effect profile compared to routinely available sodium stibogluconate (SSG), but evidence about its use for L. aethiopica is lacking. Methodology and principal findings In an observational cohort study, treatment outcomes, safety and adherence among CL patients who required systemic treatment and received miltefosine for 28 days in Boru Meda Hospital and University of Gondar Hospital were studied. Patient cure was defined as 100% flattening for non-ulcerated lesions and 100% flattening and 100% re-epithelization for ulcerated lesions. Outcomes were documented for day 28, 90 and 180, both per site, and pooled, adjusting for site as a fixed effect with effect coding. Among 94 included patients (32 in Gondar, 62 in Boru Meda), median lesion duration was 12 months, median size six cm, and mucosal involvement (46.8%) and diffuse (30.9%) lesions were common. Adherence to miltefosine was good, and side-effects were tolerable. Initial outcomes at day 28 were promising, with 68.8% and 94.0% of patients having good improvement or cure in Gondar and Boru Meda respectively. In Boru Meda, outcomes were good with 72.7% and 72.9% cure at day 90 and day 180 respectively. In Gondar, results were less promising, with only 12.5% and 26.7% cure at day 90 and day 180, although confidence intervals were wide. In pooled estimates, 48.7% of patients reached cure at day 180, and 32.3% relapsed. Outcomes were better in Boru Meda Hospital, for smaller lesions and for mucosal lesions. Conclusions/Significance Based on miltefosine’s good initial response, tolerable side-effects, tablet-form, we propose to include miltefosine for future clinical trials using extended treatment schedules, combination therapy, or targeting specific subgroups. Trial registration ClinicalTrials.gov NCT04004754.

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Treatment response of cutaneous leishmaniasis due to Leishmania aethiopica to cryotherapy and generic sodium stibogluconate from patients in Silti, Ethiopia

Transactions of the Royal Society of Tropical Medicine and Hygiene ◽

10.1016/j.trstmh.2012.02.006 ◽

2012 ◽

Vol 106 (8) ◽

pp. 496-503 ◽

Cited By ~ 22

Author(s):

Edessa Negera ◽

Endalamaw Gadisa ◽

Jemal Hussein ◽

Howard Engers ◽

Teklu Kuru ◽

...

Keyword(s):

Cutaneous Leishmaniasis ◽

Treatment Response ◽

Sodium Stibogluconate ◽

Leishmania Aethiopica

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Human immunodeficiency virus and recurrence of cutaneous leishmaniasis long after healed localized cutaneous leishmaniasis due to Leishmania aethiopica

Transactions of the Royal Society of Tropical Medicine and Hygiene ◽

10.1016/0035-9203(95)90027-6 ◽

1995 ◽

Vol 89 (4) ◽

pp. 400-401 ◽

Cited By ~ 13

Author(s):

Nega Berhe ◽

Asrat Hailu ◽

Teferi Gemetchu

Keyword(s):

Human Immunodeficiency Virus ◽

Cutaneous Leishmaniasis ◽

Leishmania Aethiopica ◽

Immunodeficiency Virus

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Treatment of Cutaneous Leishmaniasis Caused by Leishmania aethiopica: A Systematic Review

PLoS Neglected Tropical Diseases ◽

10.1371/journal.pntd.0004495 ◽

2016 ◽

Vol 10 (3) ◽

pp. e0004495 ◽

Cited By ~ 23

Author(s):

Johan van Griensven ◽

Endalamaw Gadisa ◽

Abraham Aseffa ◽

Asrat Hailu ◽

Abate Mulugeta Beshah ◽

...

Keyword(s):

Systematic Review ◽

Cutaneous Leishmaniasis ◽

Leishmania Aethiopica

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Leishmaniasis recidivans in Ethiopia: cutaneous and mucocutaneous features

The Journal of Infection in Developing Countries ◽

10.3855/jidc.8516 ◽

2017 ◽

Vol 11 (01) ◽

pp. 106-110 ◽

Cited By ~ 6

Author(s):

Federica Dassoni ◽

Frehiwot Daba ◽

Bernard Naafs ◽

Aldo Morrone

Keyword(s):

Cutaneous Leishmaniasis ◽

New World ◽

Leishmania Braziliensis ◽

Leishmania Tropica ◽

Clinical Form ◽

Leishmania Aethiopica ◽

Mucosal Involvement ◽

Leishmania Panamensis ◽

First Time ◽

Leishmania Guyanensis

Cutaneous leishmaniasis (CL) is endemic in Ethiopia. An unusual clinical form of this disease is leishmaniasis recidivans (LR), a prolonged, relapsing form of cutaneous leishmaniasis resembling tuberculosis of the skin that may persist for many years with a chronic and relapsing course. This rare variant has been shown to be caused by Leishmania tropica species in the Old World and by Leishmania braziliensis, Leishmania amazonensis, Leishmania panamensis, and Leishmania guyanensis in the New World, as reported in various studies. To our knowledge, there are no reports from Ethiopia, and mucocutaneous involvement of LR has not been described to date. This was a retrospective analysis of the patients seen at the Italian Dermatological Center in Mekelle on the Tigrean highlands over a three-year period (2008–2011). Seven patients with typical clinical features of LR were seen. Two of them presented with signs of mucosal involvement. To date, Leishmania aethiopica is shown to be the only species causing CL that is endemic in the Ethiopian highlands. Therefore, it had to be assumed that the lesions in these patients were caused by this species. The aims of this communication are to report, for the first time, the presence of LR, most likely due to Leishmania aethiopica, in Ethiopia, and to report mucosal involvement in this rare clinical form of CL.

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