TY - JOUR
T1 - Old World cutaneous leishmaniasis treatment response varies depending on parasite species, geographical location and development of secondary infection
AU - Al-Salem, Waleed S.
AU - Solórzano, Carla
AU - Weedall, Gareth D.
AU - Dyer, Naomi
AU - Kelly-Hope, Louise
AU - Casas Sanchez, Aitor
AU - Alraey, Yasser
AU - Alyamani, Essam J.
AU - Halliday, Alice
AU - Balghonaim, Salah M.
AU - Alsohibany, Khalid S.
AU - Alzeyadi, Zeyad
AU - Alzahrani, Mohamed H.
AU - Al-Shahrani, Ali M.
AU - Assiri, Abdullah M.
AU - Memish, Ziad
AU - Acosta-Serrano, Alvaro
PY - 2019/5/2
Y1 - 2019/5/2
N2 - BackgroundIn 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.ResultsOverall, 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.ConclusionsThe 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.
AB - BackgroundIn 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.ResultsOverall, 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.ConclusionsThe 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.
KW - Cutaneous leishmaniasis
KW - Epidemiology
KW - Saudi Arabia
KW - Secondary infections
KW - Treatment response
U2 - 10.1186/s13071-019-3453-4
DO - 10.1186/s13071-019-3453-4
M3 - Article
SN - 1756-3305
VL - 12
JO - Parasites and Vectors
JF - Parasites and Vectors
IS - 1
M1 - 195
ER -