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HEALING OF OLD WORLD CUTANEOUS LEISHMANIASIS IN TRAVELERS TREATED WITH FLUCONAZOLE: DRUG EFFECT OR SPONTANEOUS EVOLUTION?

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  • 1 Pôle de Recherche Biomédicale Centre Médical, Institut Pasteur de Paris, Paris, France; Centre Hospitalier de Fréjus, Fréjus,France; Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire Pitié-Salpêtrière, Paris, France; Service de Dermatologie et Vénérologie, Centre Hospitalier Universitaire Vaudois, Lausanne Switzerland, Service de Parasitologie, Centre Hospitalier Universitaire de Nice, Nice, France; Service de Dermatologie Centre Hospitalier Universitaire Necker, Paris, France; Service de Dermatologie et Service de Parasitologie, Centre Hospitalier Universitaire Saint Louis, Paris, France; Institut Pasteur, Tunis, Tunisia; Tripler Army Medical Center, Honolulu, Hawaii; Centre National de Référence des Leishmania, Montpellier, France

The efficacy of fluconazole was evaluated in 35 travelers with parasitologically proven imported Old World cutaneous leishmaniasis (CL). Leishmania major (mainly MON-25) was identified in 15 patients and strongly suspected given the transmission area in 12 of these patients. Daily oral fluconazole (200 mg/day for adults and 2.5 mg/kg/day for children) was prescribed for six weeks. Outcome definition was based on re-epithelialization rate at day 50. Of the 27 L. major-infected patients, 12 (44.4%) were cured. This cure rate is similar to the placebo cure rate from trials in L. major CL in which, as in the present report, the definition of outcome relied exclusively on re-epithelialization. These data question the assumption that oral fluconazole is consistently effective for treatment of CL caused by L. major.

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