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Old World cutaneous leishmaniasis treatment response varies depending on parasite species, geographical location and development of secondary infection

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Al-Salem, Waleed, SolorzanoGonzalez, Carla, Weedall, Gareth, Dyer, Naomi, Kelly-Hope, Louise ORCID: https://orcid.org/0000-0002-3330-7629, Casas Sanchez, Aitor, Alraey, Yasser, Alyamani, Essam J., Halliday, Alice, Balghonaim, Salah M., Alsohibany, Khalid S., Alzeyadi, Zeyad, Alzahrani, Mohamed. H, Al-Shahrani, Ali M., Assiri, Abdullah M., Memish, Ziad and Acosta Serrano, Alvaro ORCID: https://orcid.org/0000-0002-2576-7959 (2019) 'Old World cutaneous leishmaniasis treatment response varies depending on parasite species, geographical location and development of secondary infection'. Parasites & Vectors, Vol 12, Issue 1.

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Abstract

Background
In the Kingdom of Saudi Arabia (KSA), Leishmania major and L. tropica are the main causative agents of Old World cutaneous leishmaniasis (CL). The national CL treatment regimen consists of topical 1% clotrimazole/2% fusidic acid cream followed by 1–2 courses of intralesional sodium stibogluconate (SSG); however, treatment efficacy is highly variable and the reasons for this are not well understood. In this study, we present a complete epidemiological map of CL and determined the efficacy of the standard CL treatment regime in several endemic regions of KSA.
Results
Overall, three quarters of patients in all CL-endemic areas studied responded satisfactorily to the current treatment regime, with the remaining requiring only an extra course of SSG. The majority of unresponsive cases were infected with L. tropica. Furthermore, the development of secondary infections (SI) around or within the CL lesion significantly favoured the treatment response of L. major patients but had no effect on L. tropica cases.
Conclusions
The response of CL patients to a national treatment protocol appears to depend on several factors, including Leishmania parasite species, geographical location and occurrences of SI. Our findings suggest there is a need to implement alternative CL treatment protocols based on these parameters.

Item Type: Article
Subjects: WA Public Health > WA 30 Socioeconomic factors in public health (General)
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WC Communicable Diseases > Tropical and Parasitic Diseases > WC 715 Visceral leishmaniasis
WR Dermatology > Parasitic Skin Diseases > WR 350 Tropical diseases of the skin. Mucocutaneous leishmaniasis. Leishmaniasis
Faculty: Department: Biological Sciences > Department of Tropical Disease Biology
Biological Sciences > Vector Biology Department
Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI): https://doi.org/10.1186/s13071-019-3453-4
Depositing User: Cathy Waldron
Date Deposited: 01 Jul 2019 14:40
Last Modified: 27 Sep 2019 15:30
URI: https://archive.lstmed.ac.uk/id/eprint/11109

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