Post-treatment Clinical Outcomes of Cutaneous Leishmaniosis in the Bam Area, South Eastern Iran: Analysis of over 9,000 Cases.
BACKGROUND
Knowledge about risk or protective factors for post-treatment outcomes in Cutaneous Lishmaniosis are rare, especially in endemic areas such as Iran. The present study aimed to evaluate the association between the outcome of infection, clinical manifestation, and treatment with adverse post-treatment outcomes in Cutaneous Lishmaniosis patients.


METHODS
This was a cross sectional study based on recently collected data of 9077 Cutaneous Lishmaniosis patients (4585 female and 4492 male) from March 2003 to March 2011 in the Bam area, Iran. Multivariable multinomial logistic regression was applied to assess the effect of outcome of infection, clinical manifestation and treatment on relapse, treatment after interruption, treatment failure and clinical resistance.


RESULTS
Head lesions were strongest risk factor for relapse (Odds Ratio, OR = 4.21; CI 95%: 3.56-4.98), treatment after interruption (2.00; 1.70-2.35), treatment failure (6.61; 5.17-8.45) and clinical resistance (2.62; 2.00-3.44). Family occurrence (yes vs. no), intra lesion therapy method, treatment duration (>3 v. ≤ 3 week) and source of detection by Surveillance (active vs. passive), were the most protective factors for relapse (OR = 0.58; CI 95%: 0.46-0.74), treatment after interruption (0.36; 0.31-0.42) treatment failure (0.24; 0.20-0.29) and clinical resistance (0.24; 0.09-0.67).


CONCLUSIONS
Head lesions and treatment variables (e.g. therapy method and duration) could predict the occurrence of adverse post-term outcomes of Cutaneous Lishmaniosis. Further longitudinal studies have to clarify cause and effect relationships.
Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Erfan
E
Ayubi
Department of Epidemiology, Bam University of Medical Sciences, Bam, Iran.
Ahad
A
Ashrafi-Asgarabad
Department of Public Health, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Maragheh, Iran; Road Traffic Injury Research Center, Department of Statistics and Epidemiology, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Electronic address: S-safiri@razi.tums.ac.ir.
Saeid
S
Safiri
Department of Health Education and Promotion, Tabriz University of Medical Sciences, Tabriz, Iran.
Ahmad
A
Kousha
Department of Epidemiology, Bam University of Medical Sciences, Bam, Iran.
Mohammad
M
Baniasadi
IGGMB - Health Research Institute, University Clinics of the Paracelsus Medical University, Salzburg, Austria.
Christoph
C
Augner
D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007492:Iran / Q000453:epidemiology; D016773:Leishmaniasis, Cutaneous / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012008:Recurrence; D012307:Risk Factors; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult
Cutaneous Leishmaniasis; Epidemiology; Iran; Relapse; Treatment