BACKGROUND: Cutaneous leishmaniasis (CL) has traditionally been underrecognized and underreported. Improved awareness is warranted as the number of cases has increased as a result of increased travel to endemic countries, the HIV/AIDS pandemic, and the larger number of military and contract workers deployed overseas. OBJECTIVE: We sought to present a systematic review of evidence from a gamut of research trials on the treatment efficacy of different regimens and aggregate this knowledge for use as a guide for clinical practice decisions. METHODS: We performed a comprehensive search of print and electronic sources to identify the accumulated research information on New World CL. RESULTS: Topical treatment of New World CL lesions is generally not recommended. Findings support the systemic administration of pentavalent antimonials as first-line treatment. Exception to this is infection with L guyanensis in French Guiana where systemic pentamidine is suggested as first-line treatment. LIMITATIONS: The reliability of the findings of this review of research evidence is dependent on the individual quality and potential bias in its component principal trials. There was a conscious attempt to only include evidence derived from randomized controlled studies, with adequate randomization, adequate patient numbers, and complete follow-up information. However, because of the relatively small number of such studies on New World CL, evidence from nonrandomized studies and case series studies was also considered. CONCLUSIONS: The pentavalent antimony compounds remain the first-line treatment choice for the treatment of New World CL. Concerns with cost, availability, poor compliance, and systemic toxicity, however, may compel clinicians to opt for alternative treatment modalities. Some advances in the development of an antileishmanial vaccine have been made but none is yet available for clinic use. The increase, over recent years, in the incidence of CL warrants an enhanced effort to increase awareness of the disease, assure timely diagnosis, and implement effective management and treatment strategies. Copyright 2009 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.
BACKGROUND:Cutaneous leishmaniasis (CL) has traditionally been underrecognized and underreported. Improved awareness is warranted as the number of cases has increased as a result of increased travel to endemic countries, the HIV/AIDS pandemic, and the larger number of military and contract workers deployed overseas. OBJECTIVE: We sought to present a systematic review of evidence from a gamut of research trials on the treatment efficacy of different regimens and aggregate this knowledge for use as a guide for clinical practice decisions. METHODS: We performed a comprehensive search of print and electronic sources to identify the accumulated research information on New World CL. RESULTS: Topical treatment of New World CL lesions is generally not recommended. Findings support the systemic administration of pentavalent antimonials as first-line treatment. Exception to this is infection with L guyanensis in French Guiana where systemic pentamidine is suggested as first-line treatment. LIMITATIONS: The reliability of the findings of this review of research evidence is dependent on the individual quality and potential bias in its component principal trials. There was a conscious attempt to only include evidence derived from randomized controlled studies, with adequate randomization, adequate patient numbers, and complete follow-up information. However, because of the relatively small number of such studies on New World CL, evidence from nonrandomized studies and case series studies was also considered. CONCLUSIONS: The pentavalent antimony compounds remain the first-line treatment choice for the treatment of New World CL. Concerns with cost, availability, poor compliance, and systemic toxicity, however, may compel clinicians to opt for alternative treatment modalities. Some advances in the development of an antileishmanial vaccine have been made but none is yet available for clinic use. The increase, over recent years, in the incidence of CL warrants an enhanced effort to increase awareness of the disease, assure timely diagnosis, and implement effective management and treatment strategies. Copyright 2009 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.
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Authors: Michel Muálem de Moraes Alves; Daniel Dias Rufino Arcanjo; Kayo Alves Figueiredo; Jéssica Sara de Sousa Macêdo Oliveira; Felipe José Costa Viana; Elvilene de Sousa Coelho; Glaucia Lais Nunes Lopes; Juan Carlos Ramos Gonçalves; André Luís Menezes Carvalho; Márcia Dos Santos Rizzo; Mariana Helena Chaves; Ivete Lopes de Mendonça; Fernando Aécio de Amorim Carvalho Journal: Antimicrob Agents Chemother Date: 2020-11-17 Impact factor: 5.191
Authors: Kristina M Bacon; Peter J Hotez; Stephanie D Kruchten; Shaden Kamhawi; Maria Elena Bottazzi; Jesus G Valenzuela; Bruce Y Lee Journal: Vaccine Date: 2012-11-20 Impact factor: 3.641
Authors: Ryan Lamm; Clark Alves; Grace Perrotta; Meagan Murphy; Catherine Messina; Juan F Sanchez; Erika Perez; Luis Angel Rosales; Andres G Lescano; Edward Smith; Hugo Valdivia; Jack Fuhrer; Sarah-Blythe Ballard Journal: Am J Trop Med Hyg Date: 2018-05-31 Impact factor: 2.345