title: Treatment of imported New World cutaneous leishmaniasis in Germany.
abstract: BACKGROUND
  Cutaneous leishmaniasis (CL), a parasitic disease which represents a public health problem, particularly in Central and South America, has become a leading condition in travelers who return from tropical countries with skin disorders. Cutaneous leishmaniasis caused by Leishmania (Viannia) braziliensis, the most common causative agent, requires systemic treatment because it is potentially able to disseminate and to cause mucosal or mucocutaneous disease. Although several drugs are available for the systemic treatment of leishmaniases, a definitive treatment regimen for infection caused by species of the Viannia subgenus has yet to be established in many countries, including Germany.
  
  
  METHODS
  We analyzed treatment outcomes in 23 returnees from Central and South America who were diagnosed with L. (V.) braziliensis CL by polymerase chain reaction.
  
  
  RESULTS
  Complete cure within one month following treatment was observed in 18 patients (78%). Cure was achieved with liposomal amphotericin B in 11 of 13 patients, miltefosine in five of eight patients, and meglumine antimoniate in two (of two) patients. Of the five patients (22%) who failed to respond to initial therapy, four were cured with meglumine antimoniate and one with liposomal amphotericin B.
  
  
  CONCLUSIONS
  In this outcome evaluation of treatment of imported L. (V.) braziliensis infections, liposomal amphotericin B, miltefosine, and meglumine antimoniate proved to be effective. Conventional meglumine antimoniate showed high efficacy as a first-line treatment and cured lesions that failed to respond to the other two drugs. A multi-country study using standardized treatment protocols is needed to establish a definitive regimen.
authors: Institute of Tropical Medicine and International Health, Charité-University Medicine Berlin, Berlin.
authors: Gundel
authors: G
authors: Harms
authors: Department of Tropical Medicine, Paul-Lechler Hospital and Clinic for Tropical Diseases, Tübingen.
authors: Helmut
authors: H
authors: Scherbaum
authors: Institute of Medical Microbiology, Immunology and Parasitology, Friedrich-Wilhelm-University Clinic Bonn, Bonn.
authors: Ingrid
authors: I
authors: Reiter-Owona
authors: Department of Tropical Medicine, Mission Medical Clinic, Würzburg.
authors: August
authors: A
authors: Stich
authors: Tropical Medicine Unit, University Hospital for Gastroenterology, Hepatology and Infectious Diseases, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
authors: Joachim
authors: J
authors: Richter
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D000818:Animals; D000981:Antiprotozoal Agents / Q000627:therapeutic use*; D005260:Female; D005858:Germany; D006801:Humans; D007892:Leishmania braziliensis; D016773:Leishmaniasis, Cutaneous / Q000188:drug therapy* / Q000469:parasitology; D008297:Male; D008536:Meglumine / Q000627:therapeutic use; D000077485:Meglumine Antimoniate; D008875:Middle Aged; D009942:Organometallic Compounds / Q000627:therapeutic use; D010767:Phosphorylcholine / Q000031:analogs & derivatives / Q000627:therapeutic use; D014195:Travel; D055815:Young Adult
chemical_list: D000981:Antiprotozoal Agents; D009942:Organometallic Compounds; C068538:liposomal amphotericin B; D010767:Phosphorylcholine; C039128:miltefosine; D008536:Meglumine; D000077485:Meglumine Antimoniate; D000666:Amphotericin B