Authors

1 General Practitioner, Kerman University of Medical Sciences, Kerman, Iran

2 Professor of Parasitology, Kerman Leishmaniosis Research Center, Kerman University of Medical Sciences, Kerman, Iran

3 Professor of Pediatrics, Department of Pediatrics, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran

4 Postgraduate Student of Laboratory Sciences, Kerman University of Medical Sciences. Kerman, Iran

5 General Practitioner, Dadbin Health Clinic, Kerman, Iran

Abstract

Background & Aims: It is more than half of a century that the drug of choice for treatment of cutaneous leishmaniosis (CL) has been pentavalent antimony compounds such as meglumine antimoniate (Glucantime). The aim of the present study was to evaluate the efficacy, relapse and treatment failure of intralesional Glucantime plus cryotherapy in the treatment of anthroponotic CL (ACL). Methods: The sample of this analytic cross-sectional study included 547 lesions belonged to 322 patients who had referred to Dadbin Health Clinic afilliated to Kerman University of Medical Sciences, from March 2013 to March 2014. They received the local treatment with intralesional Glucantime once a week coupled with cryotherapy using liquid nitrogen once every two weeks and for at most three months. The effectiveness was defined as the proportion of cured lesions to the treatment- received lesions. Results: Of 547 lesions, 399 lesions (73%) were cured, 86 lesions (15.7%) were partially cured, and 62 lesions (11.3%) had treatment failure.From 399 lesions which were cured completely, 21 (5.3%) lesions had developed with relapse. The rates of treatment failure and relapse were not associated with the sex of patients. While, these two variables showed significant relationships with lesions’ location and the age group of patients (p<0.05). Conclusion: This study showed that the efficacy of the intralesional injection of Glucantime combined with cryotherapy was 73%. Since the relapse and treatment failure were mostly observed in the age group of 0-9 year old and in lesions on face and hands, more attention to these lesions is necessary

Keywords

  1. Goto H, Lindoso JA. Current diagnosis and treatment of cutaneous and mucocutaneous leishmaniasis. Expert Rev Anti Infect Ther 2010; 8(4): 419-33.
  2. Control of the leishmaniases: WHO technical report series no. 949. Geneva: World Health Organization, 2010; Available at URL:http://whqlibdoc.who.int/trs/WHO_TRS_949_eng.pdf (last accessed: 1 October 2014).
  3. World Health Organization. Essential leishmaniasis maps. Available at URL:http//www.who.int/leishmaniasis/leishmaniasis_maps/en/ (Accessed on September 06, 2012).
  4. Masmoudi A, Hariz W, Marrekchi S, Amouri M, Turki H. Old World cutaneous leishmaniasis: diagnosis and treatment. J Dermatol Case Rep 2013; 7(2): 31-41.
  5. Jeronimo SB, Sousa A, Pearson RD. Leishmaniasis species.In: Mandell GL, Bennett JE, Dolin R (editors),. Principles and Practice of Infections Diseases., 6th ed., Philadelphia, Churchill Livingston, 2005; PP 3145-65.
  6. Shirzadi MR Mohebali M, Yaghoubi Ershadi MR, Firooz A, Sharifi I, Fekri A. Principles of cutaneous leishmaniasis prevention & surveillance. Department of Zoonotic diseases, center for Contagious Diseases Management, Ministry of Health and Medical Education (I.R.Iran). Tehran, last edition, 2011 [Persian].
  7. Sharifi F, Sharifi I, Zarean M, Hakimi Parizi M, Aflatoonian MR, Fasihi Harandi M et al. Spatial Distribution and Molecular Identification of Leishmania Species from Endemic Foci of South Eastern Iran. Iran J Parasitol 2012;7(1) : 45-52.
  8. Singh S., Sivakumar R. Challenges and new discoveries in the treatment of leishmaniasis. J Infect Chemother 2004; 10(6): 307–15.
  9. Alizadeh R, Hooshyar H, Bandehpor M, Arbabi M, Kazemi F, Talari A et al. Detection of Drug Resistance Gene in Cutaneous Leishmaniasis by PCR in Some Endemic Areas of Iran. Iran Red Crescent Med J 2011; 13(12):863-7.
  10. Hadighi R, Mohebali M, Boucher P, Hajjaran H, Khamesipour A, Ouellette M. Unresponsiveness to Glucantime Treatment in Iranian Cutaneous Leishmaniasis due to Drug-Resistant Leishmania tropica Parasites. PLoS Med 2006; 3(5): e162.
  11. Lira R, Sundar S, Makharia A, Kenney R, Gam A, Saraiva E et al. Evidence that the high incidence of treatment failures in Indian Kala-Azar is due to the emergence of antimony-resistant strains of Leishmania donovani . J Infect Dis 1999;180(2): 564–7.
  12. Saghafipour A, Rassi Y, Norooze M. Comparison of Efficacy of Intercessional Injection of Glucantime and Cryotherapy with Intralesional Injection in the Treatment of Zoonotic Cutaneous leishmaniasis:a Randomized Clinical Trial. Knowledge & Health 2013; 8(2): 62-6.
  13. Asilian A, Sadeghinia A, Faghihi G, Momeni A. Comparative study of the efficacy of combined cryotherapy and intralesional meglumine antimoniate (Glucantime) vs. cryotherapy and intralesional meglumine antimoniate (Glucantime) alone for the treatment of cutaneous leishmaniasis. Int J Dermatol 2004; 43(4): 281-3.
  14. Asilian A, Sadeghinia A, Faghihi G, Momeni A, Amini Harandi A. The efficacy of treatment with intralesional meglumine antimoniate alone, compared with that of cryotherapy combined with the meglumine antimoniate or intralesional sodium stibogluconate, in the treatment of cutaneous leishmaniasis. Ann Trop Med Parasitol 2003; 97(5): 493-8.
  15. Shamsi Meymandi S, Zandi S, Aghaie H, Heshmatkhah A. Efficacy of CO(2) laser for treatment of anthroponotic cutaneous leishmaniasis, compared with combination of cryotherapy and intralesional meglumine antimoniate. J Eur Acad Dermatol Venereol 2011; 25(5): 1587-91.