title: Travelers with cutaneous leishmaniasis cured without systemic therapy.
abstract: BACKGROUND
  Cutaneous leishmaniasis (CL) is a disfiguring but not life-threatening disease. Because antileishmanial drugs are potentially toxic, the World Health Organization (WHO) recommends simple wound care or local therapy as first-line treatment, followed or replaced by systemic therapy if local therapy fails or cannot be performed.
  
  
  METHODS
  To determine the feasibility and impact of the recommended approach, we analyzed the results of a centralized referral treatment program in 135 patients with parasitologically proven CL.
  
  
  RESULTS
  Infections involved 10 Leishmania species and were contracted in 29 different countries. Eighty-four of 135 patients (62%) were initially treated without systemic therapy. Of 109 patients with evaluable charts, 23 of 25 (92%) treated with simple wound care and 37 of 47 (79%) treated with local antileishmanial therapy were cured by days 42-60. In 37 patients with large or complex lesions, or preexisting morbidities, or who had not been cured with local therapy, the cure rate with systemic antileishmanial agents was 60%. Systemic adverse events were observed in 15 patients, all receiving systemic therapy.
  
  
  CONCLUSIONS
  In this population of CL patients displaying variable degrees of complexity and severity, almost two-thirds of patients could be initially managed without systemic therapy. Of these, 60 were cured before day 60. The WHO-recommended stepwise approach favoring initial local therapy therefore resulted in at least 44% of all patients being cured without exposure to the risk of systemic adverse events. Efforts are needed to further simplify local therapy of CL and to improve the management of patients with complex lesions and/or preexisting comorbidities.
authors: Unité d'Immunologie Moléculaire des Parasites, Institut Pasteur de Paris, Paris, France.
authors: G
authors: G
authors: Morizot
authors: E
authors: E
authors: Kendjo
authors: O
authors: O
authors: Mouri
authors: M
authors: M
authors: Thellier
authors: A
authors: A
authors: Pérignon
authors: F
authors: F
authors: Foulet
authors: F
authors: F
authors: Cordoliani
authors: E
authors: E
authors: Bourrat
authors: E
authors: E
authors: Laffitte
authors: I
authors: I
authors: Alcaraz
authors: N
authors: N
authors: Bodak
authors: C
authors: C
authors: Ravel
authors: M
authors: M
authors: Vray
authors: M
authors: M
authors: Grogl
authors: D
authors: D
authors: Mazier
authors: E
authors: E
authors: Caumes
authors: L
authors: L
authors: Lachaud
authors: P A
authors: PA
authors: Buffet
mesh_terms: D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000981:Antiprotozoal Agents / Q000627:therapeutic use*; D001458:Bandages; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D016773:Leishmaniasis, Cutaneous / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D014195:Travel; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000981:Antiprotozoal Agents
keywords: cutaneous leishmaniasis; intralesional antimony; liposomal amphotericin B; miltefosine; systemic antimony