Major risk factors and histopathological profile of treatment failure, relapse and chronic patients with anthroponotic cutaneous leishmaniasis: A prospective case-control study on treatment outcome and their medical importance

Abstract

Over the last years, there has been a remarkable increase in the number of unresponsive patients with anthroponotic cutaneous leishmaniasis (ACL) reported worldwide. The primary objective of this study was to explore the role of demographic, clinical and environmental risk related-factors in the development of treatment failure, relapse and chronic cases compared to responsive patients with ACL. Moreover, molecular, histopathological and immunohistochemical (IHC) findings between these forms were explored. This work was undertaken as a prospective and case-control study in southeastern Iran. Culture media and nested PCR were used to identify the causative agent. Univariate multinomial and multiple multinomial logistic regression models and the backward elimination stepwise method were applied to analyze the data. A P<0.05 was defined as significant. Also, for different groups, skin punch biopsies were used to study the histopathological and immunohistochemical (IHC) profile. All samples showed that L. tropica was the only etiological agent in all unresponsive and responsive patients with ACL. Data analysis represented that 8 major risk factors including nationality, age groups, occupation, marital status, history of chronic diseases, duration of the lesion, the lesion on face and presence of domestic animals in the house were significantly associated with the induction of unresponsive forms. The histopathological and immunohistochemical findings were different from one form to another. The present findings clearly demonstrated a positive relation between ACL and distinct demographic, clinical and environmental risk determinants. Knowledge of the main risk factors for ACL infection is crucial in improving clinical and public health strategies and monitor such perplexing factors.

Determinants of Unresponsiveness to Treatment in Cutaneous Leishmaniasis: A Focus on Anthroponotic Form Due to Leishmania tropica

“…This poor adherence to treatment might play a significant role in treatment failure (Aflatoonian et al, 2019). Marital status and occupation may affect treatment outcomes (Reithinger et al, 2010;Bamorovat et al, 2018aBamorovat et al, , 2021Aflatoonian et al, 2019).…”

“…Clinical factors -Location of the lesion; history of chronic diseases; the number of lesions; the size of the lesion; treatment course (complete or incomplete) (Bamorovat et al, 2018a(Bamorovat et al, , 2021Aflatoonian et al, 2019) Poor treatment adherence factors Patient-related factors -Long distance from treatment setting; poor delivery of care education to family and caregivers; family support; poverty and low socioeconomic status; cultural and lay beliefs about illness and treatment; recent immigrant status; long duration of the lesion; adverse effects of treatment; absence of treatment for any reason; self-management of disease and treatment; unstable living conditions; forgetfulness; life stress; hopelessness and negative feelings; active participation in monitoring; belief of lack and poor effective drug and irregular treatment (Dunbar-Jacob and Mortimer-Stephens, 2001;WHO et al, 2003;DiMatteo, 2004) Health services-related factors -Lack of knowledge of health professionals about pain management; poor delivery of care education to the patient; the relationship between patient and health personnel; poorly developed health services; complex treatment regimens; inadequate treatment doses; a mistake in initial diagnosis; lack of clear instructions from health professionals; lack of knowledge and training for healthcare providers on managing chronic diseases (Dunbar-Jacob and Mortimer-Stephens, 2001;WHO et al, 2003;DiMatteo, 2004).…”

“…Environmental factors -Building condition; wall condition; door and window net; interior housing condition; external toilet; the presence of small garden; hygienic dwelling condition; the presence of trees in the home; the presence of domestic animals (dog) in the home; the presence of manure in the home; lack of solid waste management; the presence of dogs in the region; the number of rooms and number of windows (Bamorovat et al, 2018a(Bamorovat et al, , 2021Aflatoonian et al, 2019).…”

Treatment outcome of imported cutaneous leishmaniasis among travelers and migrants infected with Leishmania major and Leishmania tropica: a retrospective study in European centers 2013 to 2019

“…After the onset of the Syrian Civil War, the number of reported cases of CL in Syria and neighboring countries has increased Du et al, 2016 ;Kanani et al, 2019 ), and because of migration, it also became more common in European countries ( United Nations High Commission for Refugees, 2017 ). L. tropica can cause chronic manifestations, lack of healing, and recurrence as late as 12 months after resolution ( Bamorovat et al, 2021 ;Khosravi et al, 2017 ).…”

Early Leukocyte Responses in Ex-Vivo Models of Healing and Non-Healing Human Leishmania (Viannia) panamensis Infections

“…We hypothesize that these initial PBMC-promastigote interactions contribute to define the nature and magnitude of activated or repressed host functions, ultimately determining the clinical outcome of infection. Identification of immunological signatures associated with development of more severe disease manifestations and triggered during the early phases of infection, will serve as a knowledge base for the development of prognostic tools, ultimately allowing timely intervention for these cases, known to be more refractory to first-line antileishmanial drugs (Amato et al, 2008;Maurer-Cecchini et al, 2009;Bamorovat et al, 2021).…”