title: Leishmania tropica in northern Israel: a clinical overview of an emerging focus.
abstract: BACKGROUND
  In Israel, most cutaneous leishmaniasis (CL) is caused by Leishmania major. Recently a new focus of CL caused by Leishmania tropica has been described in Tiberias and the surrounding area of northern Israel.
  
  
  OBJECTIVE
  The aim of this study was to evaluate clinical (size, number, location, and type of lesion) and laboratory (culture and polymerase chain reaction [PCR] analysis) parameters at diagnosis, response to treatment, and outcome of patients with CL due to L tropica.
  
  
  METHODS
  Between September 2002 and March 2004, patients with direct smear-confirmed CL were evaluated; clinical records were reviewed and a telephone survey was performed.
  
  
  RESULTS
  Forty nine patients, 34 (69%) male and 15 (31%) female, were studied. Mean age was 31.1 years (median 26 years, range 1-70); 76% of patients live in Tiberias and the surrounding area. The mean number of lesions was 2.6 (median 2, range 1-10). Lesions were commonly located on the face (61%) and upper limbs (57%). PCR analysis was performed in 27 patients and was positive for L tropica in 26. Fifty percent of patients studied received multiple therapeutic regimens because of incomplete response or treatment failure. Topical paromomycin was used in 44 patients (90%), with a complete response reported in only 17 (39%); of the 9 patients treated with intralesional sodium stibogluconate, a complete response was reported in 6 (67%); of the 5 patients treated with intravenous sodium stibogluconate, 4 (80%) were cured.
  
  
  CONCLUSIONS
  The relatively small number of patients studied combined with the fact that some were assessed retrospectively limit our conclusions. In addition, 50% of the patients studied received multiple therapeutic regimens because of failure of, or incomplete responses to, their initial therapy, thereby making comparisons difficult.
  
  
  CONCLUSIONS
  The cure rate in those completing a course of antimony therapy, either 10 or more days of intravenous therapy or therapy administered intralesionally, was 75% (95% confidence interval [CI], 50.5-99.5%) as compared with 45% (95% CI, 28.9-60.5%) among those completing at least 10 days of topical paromomycin. To date, no standardized, simple, safe, and highly effective regimen for treating L tropica exists. Large, controlled clinical trials to evaluate current treatment regimens as well as new medications for CL, and especially CL attributed to L tropica, are urgently needed.
authors.affiliation: Department of Dermatology, Emek Medical Center, Afula, Israel. adir-sh@zahav.net.il
authors.forename: Ayelet
authors.initials: A
authors.lastname: Shani-Adir
authors.forename: Stephanie
authors.initials: S
authors.lastname: Kamil
authors.forename: Dganit
authors.initials: D
authors.lastname: Rozenman
authors.forename: Eli
authors.initials: E
authors.lastname: Schwartz
authors.forename: Michal
authors.initials: M
authors.lastname: Ramon
authors.forename: Lucia
authors.initials: L
authors.lastname: Zalman
authors.forename: Abed
authors.initials: A
authors.lastname: Nasereddin
authors.forename: Charles L
authors.initials: CL
authors.lastname: Jaffe
authors.forename: Moshe
authors.initials: M
authors.lastname: Ephros
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007557:Israel / Q000453:epidemiology; D007895:Leishmania tropica; D016773:Leishmaniasis, Cutaneous / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies