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

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  • 1 Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia;
  • | 2 Universidad Icesi, Cali, Colombia;
  • | 3 Yale School of Public Health, New Haven, Connecticut;
  • | 4 European Vaccine Initiative, UniversitätsKlinikum Heidelberg, Heidelberg, Germany

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.

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