Cutaneous and mucocutaneous leishmaniasis in Tigray, northern Ethiopia: clinical aspects and therapeutic concerns.
Leishmaniasis is a worldwide disease, but due to the absence of surveillance systems is under-reported from low- and middle-income countries. In Ethiopia, the disease is found in the rural highlands and the incidence of Leishmania/HIV co-infection is increasing. Although some studies have been carried out in areas of the country with a similar disease/ecological profile this report is, to our knowledge, the first aimed at elucidating the clinical-epidemiological features of cutaneous and mucocutaneous leishmaniasis in Tigray, northern Ethiopia. This study enrolled 167 patients presenting different forms of cutaneous leishmaniasis over an 18 month period, of which 5.6% tested HIV positive. Patients were initially treated with meglumine antimonate and resistant cases with pentamidine isethionate. There was a high rate of resistance to meglumine antimonate (28%) and a less than optimal response to prolonged systemic treatment in relapsed cases. Eight patients affected by severe and resistant forms were treated with pentamidine isethionate, with a cure rate of 87.5% after 6 months. Many atypical and severe presentations were seen, and a poor response to first-line antileishmanial drugs was observed. Resistance to antimonials is of concern and cost-effective therapeutic schemes need to be developed. The cost-effectiveness of pentamidine isethionate has to be determined in a larger population.
International Institute for Social, Medical and Anthropological Sciences (IISMAS), Rome, Italy. pvaleska@hotmail.com
Valeska
V
Padovese
Margherita
M
Terranova
Luigi
L
Toma
Gebre Ab
GA
Barnabas
Aldo
A
Morrone
D000293:Adolescent; D000328:Adult; D000981:Antiprotozoal Agents / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology; D015497:HIV-1; D006801:Humans; D007223:Infant; D016773:Leishmaniasis, Cutaneous / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D007897:Leishmaniasis, Mucocutaneous / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D008297:Male; D008536:Meglumine / Q000008:administration & dosage; D000077485:Meglumine Antimoniate; D008875:Middle Aged; D009942:Organometallic Compounds / Q000008:administration & dosage; D010419:Pentamidine / Q000008:administration & dosage; D012959:Socioeconomic Factors; D055815:Young Adult
D000981:Antiprotozoal Agents; D009942:Organometallic Compounds; D010419:Pentamidine; D008536:Meglumine; D000077485:Meglumine Antimoniate