Eligibility for Local Therapies in Adolescents and Adults with Cutaneous Leishmaniasis from Southwestern Colombia: A Cross-Sectional Study

Andrés Felipe Uribe-Restrepo Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia;
Universidad Icesi, Cali, Colombia;

Search for other papers by Andrés Felipe Uribe-Restrepo in
Current site
Google Scholar
PubMed Close
,
Miguel Dario Prieto Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia;

Search for other papers by Miguel Dario Prieto in
Current site
Google Scholar
PubMed Close
,
Alexandra Cossio Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia;
Universidad Icesi, Cali, Colombia;

Search for other papers by Alexandra Cossio in
Current site
Google Scholar
PubMed Close
,
Mayur M. Desai Yale School of Public Health, New Haven, Connecticut;

Search for other papers by Mayur M. Desai in
Current site
Google Scholar
PubMed Close
, and
María del Mar Castro Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia;
Universidad Icesi, Cali, Colombia;
European Vaccine Initiative, UniversitätsKlinikum Heidelberg, Heidelberg, Germany

Search for other papers by María del Mar Castro in
Current site
Google Scholar
PubMed Close
DOI:
https://doi.org/10.4269/ajtmh.18-0643
Volume/Issue:
Volume 100: Issue 2
Page(s):
306–310
Restricted access
Get Permissions

Local therapies have been proposed as safe and effective alternatives to systemic drugs in cutaneous leishmaniasis (CL), especially among less severe cases. However, they are not widely available and used in endemic places, including Colombia, which has a high burden of disease. Further complicating the uptake of local therapies is that different treatment guidelines have been established by the World Health Organization (WHO) and Pan American Health Organization (PAHO). Using data from a large referral center in Colombia, we determined the proportion of patients who would be eligible for and potentially benefit from local therapies according to both international guidelines. The sample included 1,891 confirmed cases of CL aged ≥ 12 years, mostly infected with Leishmania Viannia panamensis (91%, n = 601/660), between 2004 and 2014. Overall, 57% of the sample had one lesion, whereas another 31% had two to three lesions. For 74% of patients, all lesions were in an area other than head or neck. The maximum lesion size was ≤ 3 cm for 58% and < 5 cm for 88% of the sample. Based on our data, up to 56% of patients could have been eligible for local therapies according to the WHO criteria. By contrast, only 23% were eligible according to the more restrictive PAHO criteria. Regardless, these data suggest that a substantial proportion of CL patients in Colombia may benefit from local therapies given their relatively mild presentation of disease and low risk of complications. Individualized risk–benefit assessment and guideline adjustments may increase local therapy eligibility and benefit a large number of patients.

Author Notes

Address correspondence to María del Mar Castro, Clinical Research Unit, Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cra 125 #19-225, La María, Cali 760031, Colombia. E-mails: mcastro@cideim.org.co or mcastronoriega@gmail.com

Financial support: This work was funded by the U.S. NIH International Fogarty Center Global Infectious Disease Research Training Program (Award Number D43 TW006589), the NIAID-NIH (Award number U19AI129910), and COLCIENCIAS (grant number 222972553501). In addition, María del Mar Castro was a fellow in Clinical Research and Development at European Vaccine Initiative funded by EDCTP/TDR.

Authors’ addresses: Andrés Felipe Uribe-Restrepo, Department of Public Health, Universidad Icesi, Cali, Colombia, and Clinical Research Unit, Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia, E-mail: afur34@live.com. Miguel Darío Prieto and Alexandra Cossio, Clinical Research Unit, Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia, E-mails: mdprieto@cideim.org.co and acossio@cideim.org.co. Mayur Desai, Yale School of Public Health, New Haven, CT, E-mail: mayur.desai@yale.edu. María del Mar Castro, Clinical Research Unit, Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Universidad Icesi, Cali, Colombia, and European Vaccine Initiative, Universitäts Klinikum Heidelberg, Heidelberg, Germany, E-mails: mcastro@cideim.org.co or mcastronoriega@gmail.com.

Copyright:
© The American Society of Tropical Medicine and Hygiene 2019
Received:
04 Aug 2018
|
Accepted:
31 Oct 2018
|
Published Online:
07 Jan 2019
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
  • 1.

    WHO, 2017. Weekly Epidemiological Record, Vol. 92, 38. Available at: http://www.who.int/wer/, 557–572. Accessed February 15, 2018.

  • 2.

    Goto H, Lauletta Lindoso JA, 2012. Cutaneous and mucocutaneous leishmaniasis. Infect Dis Clin North Am 26: 293–307.

  • 3.

    Schwartz E, Hatz C, Blum J, 2006. New world cutaneous leishmaniasis in travellers. Lancet Infect Dis 6: 342–349.

  • 4.

    Instituto Nacional de Salud–Colombia, 2018. Informe Del Evento Leishmaniasis, Hasta El Periodo Epidemiologico XIII, Colombia, 2017. Bogotá, Colombia: INS.

    • Search Google Scholar
    • Export Citation
  • 5.

    Tiuman TS, Santos AO, Ueda-Nakamura T, Filho BPD, Nakamura CV, 2011. Recent advances in leishmaniasis treatment. Int J Infect Dis 15: e525–e532.

  • 6.

    Organización Panamericana de la Salud, 2013. Leishmaniasis En Las Américas: Recomendaciones Para El Tratamiento. Washington, DC: PAHO. Available at: http://www.paho.org/hq/index.php?option=com_content&view=category&id=3835&layout=blog&Itemid=4098&lang=es. Accessed September 16, 2013.

    • Search Google Scholar
    • Export Citation
  • 7.

    Rubiano LC et al. 2012. Noninferiority of miltefosine versus meglumine antimoniate for cutaneous leishmaniasis in children. J Infect Dis 205: 684–692.

    • Search Google Scholar
    • Export Citation
  • 8.

    WHO, 2010. Control of the Leishmaniases: Report of a Meeting of the WHO Expert Committee on the Control of Leishmaniases. Geneva, Switzerland: World Health Organization. Available at: http://apps.who.int/iris/bitstream/10665/44412/1/WHO%7B_%7DTRS%7B_%7D949%7B_%7Deng.pdf. Accessed April 10, 2018.

    • Search Google Scholar
    • Export Citation
  • 9.

    Brito NC, Rabello A, Cota GF, 2017. Efficacy of pentavalent antimoniate intralesional infiltration therapy for cutaneous leishmaniasis: a systematic review. PLoS One 12: e0184777. doi: 10.1371/journal.pone.0184777.

    • Search Google Scholar
    • Export Citation
  • 10.

    Soto J, Paz D, Rivero D, Soto P, Quispe J, Toledo J, Berman J, 2016. Intralesional pentamidine: a novel therapy for single lesions of Bolivian cutaneous leishmaniasis. Am J Trop Med Hyg 94: 852–856.

    • Search Google Scholar
    • Export Citation
  • 11.

    Cardona-Arias JA, Vélez ID, López-Carvajal L, 2015. Efficacy of thermotherapy to treat cutaneous leishmaniasis: a meta-analysis of controlled clinical trials. PLoS One 10: e0122569.

    • Search Google Scholar
    • Export Citation
  • 12.

    Vasconcellos Ede CFE et al. 2012. Intralesional meglumine antimoniate for treatment of cutaneous leishmaniasis patients with contraindication to systemic therapy from Rio de Janeiro (2000 to 2006). Am J Trop Med Hyg 87: 257–260.

    • Search Google Scholar
    • Export Citation
  • 13.

    Blum J et al. 2012. Local or systemic treatment for New World cutaneous leishmaniasis? Re-evaluating the evidence for the risk of mucosal leishmaniasis. Int Health 4: 153–163.

    • Search Google Scholar
    • Export Citation
  • 14.

    Blanco VM, Cossio A, Martinez JD, Saravia NG, 2013. Clinical and epidemiologic profile of cutaneous leishmaniasis in Colombian children: considerations for local treatment. Am J Trop Med Hyg 89: 359–364.

    • Search Google Scholar
    • Export Citation
  • 15.

    Organización Panamericana de la Salud, 2017. Leishmaniasis: Informe Epidemiológico En Las Américas. Washington, DC: PAHO.

  • 16.

    Aronson N, Herwaldt BL, Libman M, Pearson R, Lopez-Velez R, Weina P, Carvalho EM, Ephros M, Jeronimo S, Magill A, 2016. Diagnosis and treatment of leishmaniasis: clinical practice guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH). Clin Infect Dis 63: 1539–1557.

    • Search Google Scholar
    • Export Citation
  • 17.

    Grimaldi GJ, Mcmahon-Pratt D, 1996. Monoclonal antibodies for the identification of New World Leishmania species. Mem Inst Oswaldo Cruz 91: 37–42.

    • Search Google Scholar
    • Export Citation
  • 18.

    Saravia NG, Segura I, Holguin AF, Santrich C, Valderrama L, Ocampo C, 1998. Epidemiologic, genetic, and clinical associations among phenotypically distinct populations of Leishmania (Viannia) in Colombia. Am J Trop Med Hyg 59: 86–94.

    • Search Google Scholar
    • Export Citation
  • 19.

    Berger BA, Cossio A, Saravia NG, Castro MDM, Prada S, Bartlett AH, Pho MT, 2017. Cost-effectiveness of meglumine antimoniate versus miltefosine caregiver DOT for the treatment of pediatric cutaneous leishmaniasis. PLoS Negl Trop Dis 11: e0005459.

    • Search Google Scholar
    • Export Citation
  • 20.

    Cardona-Arias JA, López-Carvajal L, Tamayo Plata MP, Vélez ID, 2017. Cost-effectiveness analysis of thermotherapy versus pentavalent antimonials for the treatment of cutaneous leishmaniasis. J Evid Based Med 10: 81–90.

    • Search Google Scholar
    • Export Citation
  • 21.

    Vanlerberghe V, Diap G, Guerin PJ, Meheus F, Gerstl S, Van der Stuyft P, Boelaert M, 2007. Drug policy for visceral leishmaniasis: a cost-effectiveness analysis. Trop Med Int Heal 12: 274–283.

    • Search Google Scholar
    • Export Citation
  • 22.

    de Oliveira-Neto MP, Mattos MS, Perez MA, Da-Cruz AM, Fernandes O, Moreira J, Gonçalves-Costa SC, Brahin LR, Menezes CR, Pirmez C, 2000. American tegumentary leishmaniasis (ATL) in Rio de Janeiro State, Brazil: main clinical and epidemiologic characteristics. Int J Dermatol 39: 506–514.

    • Search Google Scholar
    • Export Citation
  • 23.

    Machado-Coelho GLL, Caiaffa WT, Genaro O, Magalhães PA, Mayrink W, 2005. Risk factors for mucosal manifestation of American cutaneous leishmaniasis. Trans R Soc Trop Med Hyg 99: 55–61.

    • Search Google Scholar
    • Export Citation
  • 24.

    Martínez-Valencia AJ, Daza-Rivera CF, Rosales-Chilama M, Cossio A, Casadiego Rincón EJ, Desai MM, Saravia NG, Gómez MA, 2017. Clinical and parasitological factors in parasite persistence after treatment and clinical cure of cutaneous leishmaniasis. PLoS Negl Trop Dis 11: e0005713.

    • Search Google Scholar
    • Export Citation
  • 25.

    Mendonça MG, de Brito MEF, Rodrigues EHG, Bandeira V, Jardim ML, Abath FGC, 2004. Persistence of Leishmania parasites in scars after clinical cure of American cutaneous leishmaniasis: is there a sterile cure? J Infect Dis 189: 1018–1023.

    • Search Google Scholar
    • Export Citation
  • 26.

    Netto EM, Marsden PD, Llanos-Cuentas EA, Costa JML, Cuba CC, Barreto AC, Badaró R, Johnson WD, Jones TC, 1990. Long-term follow-up of patients with Leishmania (Viannia) braziliensis infection and treated with Glucantime®. Trans R Soc Trop Med Hyg 84: 367–370.

    • Search Google Scholar
    • Export Citation
  • 27.

    Soto J et al. 2013. Intralesional antimony for single lesions of Bolivian cutaneous leishmaniasis. Clin Infect Dis 56: 1255–1260.

  • 28.

    López L, Robayo M, Vargas M, Vélez ID, 2012. Thermotherapy. An alternative for the treatment of American cutaneous leishmaniasis. Trials 13: 58.

    • Search Google Scholar
    • Export Citation
  • 29.

    López L, Cruz C, Godoy G, Robledo SM, Vélez ID, 2013. Termoterapia efectiva y más segura que la miltefosina en el tratamiento de la leishmaniasis cutánea en Colombia. Rev Inst Med Trop Sao Paulo 55: 197–204.

    • Search Google Scholar
    • Export Citation
  • 30.

    Lobo IMF, Soares MBP, Correia TM, de Freitas LAR, Oliveira MI, Nakatani M, Netto E, Badaro R, David JR, 2006. Heat therapy for cutaneous leishmaniasis elicits a systemic cytokine response similar to that of antimonial (glucantime) therapy. Trans R Soc Trop Med Hyg 100: 642–649.

    • Search Google Scholar
    • Export Citation
  • 31.

    Olliaro P, Vaillant M, Arana B, Grogl M, Modabber F, Magill A, Lapujade O, Buffet P, Alvar J, 2013. Methodology of clinical trials aimed at assessing interventions for cutaneous leishmaniasis. PLoS Negl Trop Dis 7: e2130.

    • Search Google Scholar
    • Export Citation
  • 32.

    Jirmanus L, Glesby MJ, Guimarães LH, Lago E, Rosa ME, Machado PR, Carvalho EM, 2012. Epidemiological and clinical changes in American tegumentary leishmaniasis in an area of Leishmania (Viannia) braziliensis transmission over a 20-year period. Am J Trop Med Hyg 86: 426–433.

    • Search Google Scholar
    • Export Citation
  • 33.

    PAHO/WHO, 2018. Leishmaniasis. Epidemiological Report of the Americas. Washington, DC: PAHO. Available at: http://iris.paho.org/xmlui/handle/123456789/34856. Accessed April 10, 2018.

    • Search Google Scholar
    • Export Citation
  • 34.

    Alvar J, Yactayo S, Bern C, 2006. Leishmaniasis and poverty. Trends Parasitol 22: 552–557.

Past two years Past Year Past 30 Days
Abstract Views 40 40 10
Full Text Views 578 116 0
PDF Downloads 154 35 0
 
Membership Banner
 
 
 
Affiliate Membership Banner
 
 
Research for Health Information Banner
 
 
CLOCKSS
 
 
 
Society Publishers Coalition Banner
Save