Efficacy of thermotherapy to treat cutaneous leishmaniasis caused by Leishmania tropica in Kabul, Afghanistan: a randomized, controlled trial.
BACKGROUND
Pentavalent antimony is the agent recommended for treatment of cutaneous leishmaniasis (CL). Its use is problematic, because it is expensive and because of the potential for drug-associated adverse effects during a lengthy and painful treatment course.


METHODS
We tested the efficacy of thermotherapy for the treatment of CL due to Leishmania tropica in a randomized, controlled trial in Kabul, Afghanistan. We enrolled 401 patients with a single CL lesion and administered thermotherapy using radio-frequency waves (1 treatment of >or=1 consecutive application at 50 degrees C for 30 s) or sodium stibogluconate (SSG), administered either intralesionally (a total of 5 injections of 2-5 mL every 5-7 days, depending on lesion size) or intramuscularly (20 mg/kg daily for 21 days).


RESULTS
Cure, defined as complete reepithelialization at 100 days after treatment initiation, was observed in 75 (69.4%) of 108 patients who received thermotherapy, 70 (75.3%) of 93 patients who received intralesional SSG, and 26 (44.8%) of 58 patients who received intramuscular SSG. The OR for cure with thermotherapy was 2.80 (95% confidence interval [CI], 1.45-5.41), compared with intramuscular SSG treatment (P=.002). No statistically significant difference was observed in the odds of cure in comparison of intralesional SSG and thermotherapy treatments. The OR for cure with intralesional SSG treatment was 3.75 (95% CI, 1.86-7.54), compared with intramuscular SSG treatment (P<.001). The time to cure was significantly shorter in the thermotherapy group (median, 53 days) than in the intralesional SSG or intramuscularly SSG group (median, 75 days and >100 days, respectively; P=.003).


CONCLUSIONS
Thermotherapy is an effective, comparatively well-tolerated, and rapid treatment for CL, and it should be considered as an alternative to antimony treatment.
Reithinger
R
R
Malaria and Leishmaniasis Control Program, HealthNet International, University Town, Peshawar, Pakistan. rreithinger@yahoo.co.uk
Mohsen
M
M
Wahid
M
M
Bismullah
M
M
Quinnell
R J
RJ
Davies
C R
CR
Kolaczinski
J
J
David
J R
JR
D000293:Adolescent; D000328:Adult; D000346:Afghanistan; D000818:Animals; D000967:Antimony Sodium Gluconate / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D002648:Child; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D007895:Leishmania tropica; D016773:Leishmaniasis, Cutaneous / Q000469:parasitology / Q000532:radiotherapy*; D008297:Male; D016017:Odds Ratio; D013997:Time Factors
D000981:Antiprotozoal Agents; D000967:Antimony Sodium Gluconate