COMPARISON OF THE EFFICACY OF CRYOTHERAPY, INTRALESIONAL SODIUM STIBOGLUCONATE AND 7% SODIUM CHLORIDE IN THE TREATMENT OF CUTANEOUS LEISHMANIASIS
Darsim M. Abdalla a, Shirwan H. Omer b and Abdullah M. Dawoud c
Background
Cutaneous leishmaniasis is an endemic disease for which many therapies had been used, aiming to kill the parasite and induce cure with minimum scarring. Intralesional Sodium stibogluconate, cryosurgery and intralesional Sodium Chloride 7% solution were among these therapies.
Objectives
To compare between intralesional Sodium stibogluconate, cryotherapy and intralesional Sodium Chloride 7% solution in treatment of cutaneous leishmaniasis regarding their efficacies and side effects.
Patients and methods
This study involved 82 patients with cutaneous leishmaniasis. The entire subjects met certain inclusion and exclusion criteria. The patients were divided according to the type of treatment into three groups. In group (A) 28 patients were treated with Intralesional Sodium stibogluconate, group (B) Cryosurgery was used for treatment of 29 patients and in group (C) Intralesional Sodium Chloride 7% solution was used for treatment of the remaining 25 patients. We were followed all patients for 12 weeks after completion of the treatments
Results
There were significant association between the following parametres, complete clearance of cutaneous leishmaniasis and the use of intralesional Sodium stibogluconate (p=0.02), lowest pain scores during treatment and the use of cryosurgery in group (p<0.001), and between decreased visits number of treatment and the use of intralesional Sodium Chloride 7% solution in group (C) (p=0.05).
Conclusion
Intralesional Sodium stibogluconate was the most effective treatment of cutaneous leishmaniasis followed by cryosurgery and Sodium Chloride 7% solution was the least effective one.
1. Goto H, Lindoso JA. Current diagnosis and treatment of cutaneous and mucocutaneous leishmaniasis. Expert Rev Anti Infect Ther. 2010; 8: 419-433
2. Reithinger, R., Dujardin, J., Louzir, H., Pirmez, C., Alexander, B. and Brooker, S. Cutaneous leishmaniasis. Lancet Infectious Diseases. 2007;7: 581- 596.
3. McGwire BS, Satoskar AR. Leishmaniasis: clinical syndromes and treatment. QJM. 2014;107(1):7–14. doi:10.1093/qjmed/hct116.
4. Alvar, J., I. D. Ve’lez, C. Bern, M. Herrero, P. Desjeux, J. Cano, J. Jannin, and M. den Boer, WHO Leishmaniasis Control Team. Leishmaniasis world- wide and global estimates of its incidence. 2012; PLoS ONE 7: e35671.
5.Kashif M, Manna PP, Akhter Y, et al.: The Screening of novel inhibitors against Leishmania donovani Calcium ion channel to fight Leishmaniasis. Infect Disord Drug Targets. 2016; 16.
6. Bailey MS, Lockwood DN. Cutaneous leishmaniasis. Clin Der-matol. 2007;25(2):203–11.
7. Seidelin H: Leishmaniasis and Babesiasis in Yucatan. Ann Trop Med Parasit. 2016; 6(2): 295–300.
8.Blum,J.,Hatz,C. & Junghanss,T. The therapy of cutaneous and mucocutaneous leishmaniasis. Deutsche Medizinische Wochenschrift.1994; 119, 1169–72.
9. Hodiamont CJ, Kager PA, Bart A, de Vries HJ, van Thiel PP, Leenstra T, et al. Species-directed therapy for leishmaniasis in returning travellers: a comprehensive guide. PLoS Negl Trop Dis. 2014;8(5):e2832. doi:10.1371/ journal.pntd.0002832.
10. Henry J. C. de Vries, Sophia H. Reedijk, Henk D. F. H. Schallig. Cutaneous Leishmaniasis: Recent Developments in Diagnosis and Management. Am J Clin Dermatol. 2015; 16:99–109.
11.Blum J, Desjeux P, Schwartz E, Beck B and Hatz C. Treatment of cutaneous leishmaniasis among travellers. Journal of Antimicrobial Chemotherapy .2004; 53, 158–166
12. Murray HW, Berman JD, Davies CR, et al.: Advances in leishmaniasis. Lancet. 2005; 366(9496): 1561–77.
13.Hirve S, Boelaert M, Matlashewski G, et al.: Transmission Dynamics of Visceral Leishmaniasis in the Indian Subcontinent - A Systematic Literature Review. PLoS Negl Trop Dis. 2016; 10(8): e0004896.
14. Guerin, P.J.; Olliaro, P.; Sundar, S.; Boelaert, M.; Croft, S.L.; Desjeux, P.; Wasunna, M.K.; Bryceson, A.D. Visceral leishmaniasis: current status of control, diagnosis, and treatment, and a proposed research and development agenda. Lancet Infect. Dis. 2002, 2, 494-501.
15. Singh S, Siva Kumar R. Challenges and new discoveries in the treatment of leishmaniasis. J Infect Chemotherapy. 2004; 10: 307-15.
16. Pandey BD, Pun SB, Kaneko O, et al.: Case report: Expansion of visceral leishmaniasis to the western hilly part of Nepal. Am J Trop Med Hyg. 2011; 84(1): 107–8.
17. Oliveira-Neto, M. P., Schubach, A., Mattos, M. et al. Intra- lesional therapy of American cutaneous leishmaniasis with pentavalent antimony in Rio de Janeiro, Brazil—an area of Leishmania (V.) brazilien- sis transmission. International Journal of Dermatology.1997; 36, 463–8.
18. Alvar J, Vélez ID, Bern C, Herrero M, Desjeux P, Cano J, et al. Leishmaniasis Worldwide and Global Estimates of Its Incidence. PLoS ONE 2012; 7(5): e35671.
19. 65. Salam N, Al-Shaqha WM, Azzi A. Leishmaniasis in the Middle East: Incidence and Epidemiology. PLoS Negl Trop Dis 2014; 8(10): e3208.
20. Al-Samarai AM, Al-Obaidi HS. Cutaneous Leishmaniasis in Iraq. J Infect Developing Countries 2009; 3(2):123-129.
21. Rahi AA. Cutaneous Leishmaniasis at Wasit governorate. Baghdad Science Journal 2011; 8(2): 286-288.
22. UNICEF. 5 things about Iraq's unfolding child crisis. UNICEF-USA. 2014/17376. http://www.uni cefusa. org/ stories/ mission/ emergencies/ conflict/ Iraq/5things knows about Iraq crisis
23. United Nations-Iraq. Internally displaced children in Iraq are at high risk of polio and measles outbreak. UNAMI, 2105. http://www.uniraq.org/index.php.
24. Leishmaniasis. Fact sheet No. 375. Geneva: World Health Organization; 2015 (http://www.who.int/mediacentre/factsheets/fs375/en).
25. El-Deen LD, Abul-Hab J, Abdulah SA. Clinico-epidemiological Study of Cutaneous Leishmaniasis in a Sample of Iraqi Armed Forces. Iraqi J. Comm. Med. 2006; 19 (2): 98-103.
26. Reithinger R, Aadil K, Hami S, Kolaczinski J. Cutaneous Leishmaniasis, Northern Afghanistan. Emerging Infectious Diseases 2004; 10 (5)
27. Markle WH, Makhoul K. Cutaneous leishmaniasis: recognition and treatment. American family physician 2004; 69:1455–60.
28. Waller GD, Renwick AG, Hillier K. Medical pharmacology and therapeutics. Philadelphia, WB Saunders, 2001:653.
29. Gurei MS, Tatli N, Ozbilge H, Erel O, Seyrek A, Kocyigit A, et al. Efficacy of cryotherapy and intralesional pentostam in treatment of cutaneous leishmaniasis. J Egypt Soc Parasitol. 2000; 30(1):169-176.
30. Yesilova Y, Surucu HA, Ardic N, Aksoy M, Yesilova A, Oghumu S, et al. Meglumine antimoniate is more effective than sodium stibogluconate in the treatment of cutaneous leishmaniasis. J Dermatolog Treat 2015 Jun 24:15.
31..Layegh P, Pezeshkpoor F, Soruri AH, Naviafar P, Moghiman T. Efficacy of cryotherapy versus intralesional meglumine antimoniate (glucantime) for treatment of cutaneous leishmaniasis in children. American Journal of Tropical Medicine and Hygiene. 2009; Feb; 80 (2):172-5.
32. Asilian A, Sadeghinia G, Faghihi A, Momeni A, Amini Harandi A. The efficacy of treatment with intralesional meglumine antimoniate alone , compared with that of cryotherapy combined with the meglumine antimoniate or intralesional sodium stibogluconate, in the treatment of Cutaneous Leishmaniasis. Annals of Tropical Medicine & parasitology, 2003, Vol. 97, No. 5, 493-498
33. Al Hamdi KI, Awad AH, Moke HM. Evaluation of intralesional 0.2% ciprofloxacin as a treatment for cutaneous Leishmaniasis. EMHJ 2010; 16 (1): 89-93
34. Asilian A, Sadeghinia A, Faghihi G, Momeni A. Comparative study of the efficacy of combined cryotherapy and intralesional meglumine antimoniate (glucantime) vs. cryothrapy and intralesional meglumine antimoniate (glucantime) alone for the treatment of cutaneous leishmaniasis. International Journal of Dermatology 2004;43:281–3.
35. Al-Mutairi N, Alshiltawy M, El Khalawany M, Joshi A, Eassa BI, Manchanda Y. Treatment of Old World cutaneous leishmaniasis with dapsone, itraconazole, cryotherapy, and imiquimod, alone and in combination. International Journal of Dermatology 2009; 48: 862–869.
36. Den Boer M, Argaw D, Jannin J, Alvar J. Leishmaniasis impact and treatment access. Clin Microbiol Infect 2011; 17: 1471–1477.
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