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

Waleed Al-Salem, Carla Solórzano, Gareth Weedall, Naomi Dyer, Louise Kelly-Hope, Aitor Casas‑Sánchez, Yasser Alraey, Essam Alyamani, Alice Halliday, Salah Balghonaim, Khalid Alsohibany, Zeyad Alzeyadi, Mohamed Alzahrani, Ali Al-Shahrani, Abdullah Assiri, Ziad Memish, Alvaro Acosta-Serrano

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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.

Original languageEnglish
Article number195
Number of pages9
JournalParasites and Vectors
Volume12
Issue number1
Early online date2 May 2019
DOIs
Publication statusPublished - 2 May 2019

Keywords

  • Cutaneous leishmaniasis
  • Epidemiology
  • Saudi Arabia
  • Secondary infections
  • Treatment response

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    Al-Salem, W., Solórzano, C., Weedall, G., Dyer, N., Kelly-Hope, L., Casas‑Sánchez, A., Alraey, Y., Alyamani, E., Halliday, A., Balghonaim, S., Alsohibany, K., Alzeyadi, Z., Alzahrani, M., Al-Shahrani, A., Assiri, A., Memish, Z., & Acosta-Serrano, A. (2019). Old World cutaneous leishmaniasis treatment response varies depending on parasite species, geographical location and development of secondary infection. Parasites and Vectors, 12(1), [195]. https://doi.org/10.1186/s13071-019-3453-4