Treatment Patterns and Effectivness of Anti-Leishmaniasis Agents for Patients with Cutaneous Leishmaniasis at Boru Meda Hospital, South Wollo, North East Ethiopia, 2017/18

Abstract

Background: Cutaneous leishmaniasis (CL) is one of the endemic and neglected diseases known to exist in Ethiopian highlands. However, a neglected tropical disease overshadowed by lack of effective anti-leishmaniasis agent in Ethiopia. Thus, high number of population is faced for various degree of socio-economical and psychosocial morbidity. Hence, this study was initiated and conducted from July-February, 2017/18 to assess the patterns and effectiveness of different types of anti-leishmaniasis agents in Boru Meda Hospital, Dessie District.

Cutaneous Leishmaniasis Due to Leishmania aethiopica

“…# of single lesions NAAll Giemsa and/or histopathology confirmed (no numbers reported)No15·0% < 3 months18·4% 4–6 months7·7% 7–9 months16·7% 10–12 months42·3% > 12 monthsThe locations described are not detailed enough to map, so for this article only the cases in Addis are displayed on the map[56] Tilahun 2014Ayder Referral Hospital, Mekele, (N Ethiopia)Case series with passive case findingCL cases diagnosed at Ayder Referral Hospital35 diagnosed from 486 patents visiting the dermatology OPDBy category6 (17·1%) 1–1524 (68·6%) 16–455 (14·3%) > 46Male 26 (74·3%) Female 9 (25·7%)18 LCL(51·4%), 9 (25·7%) MCL, 8 (22·9%) DCL.16(45·7%) had facial, 16 (45·7) had mucosal lesions, and 3 (8·6%) had lesions on extremities.11 (31·4%) were confirmed with skin slit microscopy, while 24 (68·6%) were negative for skin slit microsocpyNoNAThe numbers and percentages indicated for overall prevalence and prevalence per type of disease are not consistent, therefore there is some doubt regarding the numbers reported here.[59] Fikre 2017Leishmania Research and Treatment Center, Gondar (NW Ethiopia)Case series with passive case findingCases of confirmed CL (one with strong clinical suspicion but negative smear) presenting to the LRTC154Median 23, IQR 16–38. By category:6·5% < 1020·1% 11–1754·5% 18–4418·8% > 45Male 110 (71·4)Female 44 (28·6%)80 LCL (51·9%), 67 MCL (43·5%), 7 DCL (4·6%), 4 concomitant leprosy; 5 (3·2%) HIV +, 80·5% of lesions on head/neck, 61% had 1 lesionParasitological (99·3%), 0·7% (1 case) clinical diagnosis with negative aspirateNoMedian: 12 months (IQR 6–24), for MCL 12 (6–24), for DCL 13 (12–84)[106] Seife, 2018Boru Meda Hospital, dessie (NE Ethiopia)Case series with passive case findingLeishmaniasis patients presenting at Boru Meda dermatology department97By category < 15: 33 (35%)16–45: 45 (45.4%)>45: 19 (19.6%)Male 62 (63.9%) Female 35 (36.1%)52 (53.6%) LCL, 28 (28.9%) MCL, 17 (17.5%) DCL.91 (93.8%) parasitologically confirmed 82 (84.5%) with skin slit smear, 9 (9.3%) with negative skin slit smear but positive FNAC, 6 (6.2%) negative for skin slit and FNAC (clinical diagnosis).NoNANumbers for age are inconsistent, whether the numbers reported here are correct is not certain.…”

“…Several other combination treatments have also been tried. A small poorly documented descriptive study [106] from Eastern Ethiopia reported that 19/24 MCL and DCL patients were successfully treated with a combination of systemic SSG and allopurinol. 14 MCL patients were treated with a combination of systemic and intralesional SSG, of which 12 were cured, while six of seven DCL patients treated with a combination of systemic SSG, intralesional SSG and cryotherapy were treated successfully.…”

“…Three studies have reported on efficacy of cryotherapy using liquid nitrogen. Cure was achieved in 80·5% of patients in southern Ethiopia [32], 60·8% in Addis Ababa [107], and 92·3% in Eastern Ethiopia [106] after treatment with cryotherapy, although treatment duration varied widely and is not always reported. The efficacy of intralesional SSG alone is not described, as one study only stated that the efficacy of systemic SSG and intralesional SSG taken together was 69% [57], while another reported that 25/26 patients treated with a combination of cryotherapy and intralesional SSG were cured [106].…”

Cutaneous leishmaniasis in north-central Ethiopia: trend, clinical forms, geographic distribution, and determinants

“…Furthermore, people with cured scars or active CL lesions are visible in schools, on the street, markets, and other places in the town. However, there is no recent information on the magnitude of CL in and around Dessie, except an attempt on the treatment efficacy of anti-leishmaniasis agents on a limited number of patients (n = 97) in BMH [34]. This study was aimed at assessing the prevalence of CL among the patients attending BMH and the associated risk factors.…”

Epidemiological and clinical profiles of cutaneous leishmaniasis in Amhara National Regional State, Northwest Ethiopia: A multicenter study

“…They have shown a higher (71.4%) incidence of CL in males than females (28.6%). Besides, a study conducted at Boru Meda Hospital reported a similar result (19). In a study conducted in the Silte Zone, southern Ethiopia, the frequency of CL infection between males and females was nearly the same (20).…”