Clinical practice guidelines for the diagnosis and treatment of cutaneous leishmaniasis in Turkey (original) (raw)
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Clinical and Epidemiological Characteristics of Cutaneous Leishmania Cases in Istanbul
Eskişehir Türk Dünyası Uygulama ve Araştırma Merkezi Halk Sağlığı Dergisi, 2021
Cutaneous leishmaniasis (CL) is a vector-borne disease characterized by skin lesions healing with an atrophic scar. Istanbul is a high risk province for CL due to internal and international immigrants. The aim of this study is to determine the clinical and epidemiological characteristics of CL cases in Istanbul. In this descriptive study, we evaluated the Cutaneous leishmaniasis cases in Istanbul between June 1 st , 2014 and May 31 st , 2015. The ethics committee and instutional permissions were received. Frequency analysis were used for data analysis. The study was carried out with 197 CL cases. Percentage of patients under 18 years old was 52%. Seventy seven percent of cases were Syrian and most of them had no passports. Household avarage number was six. Percentage of individuals with a CL lesion at household in the last year was 23%. Sixteen percent of cases reported a recent visit to Southeastern Anatolia and 55% of them reported that the lesions appeared after the visit. About half of cases had more than one lesion. Face (43.7%) was the most commonly affected. The lesions of 74 cases (38%) appeared before living in Istanbul. Health Directorates of the districts where Syrian immigrants live in Istanbul should screen Syrian immigrants in terms of CL periodically. Also improving living conditions, drying of stagnant water areas, use of mosquito nets, wearing long-sleeved clothes, diagnosis and effective treatment of CL are recommended methods for CL control.
Clinicopathological evaluation of cutaneous leishmaniasis in the mediterranean region of turkey
Turkish Journal of Pathology, 2015
Objective: Cutaneus leishmaniasis, a chronic self-limited disease of the skin, is usually caused by Leishmania Tropica. It is endemic in Southeastern Anatolia. The definitive diagnosis depends on demonstration of the parasites by smear and culture or its identification in tissue section. This study aimed to evaluate clinical and histopathological skin lesions in cutaneous leishmaniasis cases in Antalya, Turkey.
A clinical study of cutaneous leishmaniasis in a new focus in the Kurdistan region, Iraq
PLOS ONE, 2019
Leishmaniasis is caused by protozoan parasites of the genus Leishmania and is a major health problem in various parts of the world. Cutaneous leishmaniasis (CL) occurs, among others, in unpredictable outbreaks after wars and disasters. After the last war in Iraq, the collapse of the health system led to the spread of infectious diseases, including CL. Between September 2016 and November 2017, all patients with confirmed CL having one or more skin lesion(s) were referred to a regional health center in Musol City within the Rabeea District. During this period, 1539 patients visited the clinic. A total of 190 patients were excluded from the study because of poor follow-up. The treatment success rate was 97.7% (1319/ 1349). Statistically significant associations were found between number of lesions and treatment failure (p = 0.0018; OR = 1.4430; CI = 1.1466-1.8161), number of doses and number of lesions (Pearson's correlation coefficient = 0.095; p = 0.001), and the lack of municipality services and number of doses used for the treatment (p = 0.008; OR = 1.0629; CI = 1.0158-1.1122). To conclude, the highest number of patients with CL in the city of Musol was recorded after the war in Iraq. The treatment success rate was high, which reflected the strict treatment and follow-up program. An urgent plan is needed to stop the spread of infection.
Cutaneous Leishmaniasis in Pediatric Patients in a Single Tertiary Hospital in Ankara
Turkiye parazitolojii dergisi, 2017
Leishmaniasis is an infectious disease that is caused by a protozoan parasite of the Leishmania genus and that occurs worldwide. Leishmaniasis is endemic in southeastern Turkey and the neighboring Middle Eastern countries. The purpose of this study was to describe the clinical characteristics of patients admitted to our hospital with a diagnosis of cutaneous leishmaniasis (CL). A total of 16 CL patients [11 (69%) boys and five (31%) girls] were admitted between January 2014 and December 2015. The data of the patients were retrospectively recorded from their medical records. Their mean age was 74.3±32.3 months (range: 1-10.5 years). Double lesions were most commonly seen in eight (50%) patients. The face and neck was the most commonly involved site (87.5% of the patients). Skin smears for a parasitological examination were positive in nine (56%) patients. Two patients (12.5%) with limb lesions were treated with intralesional meglumine antimoniate. Fourteen patients were treated with ...
Acta Parasitologica, 2020
Objective The aim of this study was to evaluate the epidemiology, clinical presentation and types of treatment of cutaneous leishmaniasis (CL) in the province of Ilam (Western Iran) in 5 years (from May 2013 to January 2018). This cross-sectional study involved patients diagnosed with CL who were referred to Mehran City Health center. Methods All patients were diagnosed by clinical and parasitological (Giemsa staining of lesion to observe the parasite) methods. Moreover, a structured questionnaire on demographic data including age, sex, occupation, number and site of the lesions, treatment regimen was administered to each case. Results In total, 2001 positive CL cases were observed in this study. The highest prevalence of CL was reported in the autumn season and mainly among male subjects residing in urban communities. The prevalence of CL varied with the age group: higher in the age group of 1-10 years than other groups. Besides, hands and faces were the most affected regions of the body. Most of the cases (47.35%) were managed by topical treatment (glucantime) and cryotherapy followed by systemic treatment (pentavalent antimony) 26.85%. Conclusions The prevalence of disease varied with age, increasing the prevalence rate in children due to their habitats, the highest prevalence in autumn due to climatic conditions. These findings help to better discuss the prevention and treatment of infections.
Manual for case management of cutaneous leishmaniasis in the WHO Eastern Mediterranean Region
This publication represents a key step forward in translating Control of the leishmaniases (WHO Technical Report Series, No. 949) into a more practical tool for health personnel directly involved in the case management of cutaneous leishmaniasis. With this manual, countries will have, for the first time, standardized diagnosis and treatment protocols, case definitions and indicators to enable them to easily track progress on cutaneous leishmaniasis case management across the Region. It will provide support to professionals in charge of cutaneous leishmaniasis, in order to alleviate the suffering of affected populations from this appalling disfiguring and stigmatizing neglected tropical disease.
Acta Tropica, 2019
Highlights Cutaneous leishmaniasis cases caused by zoonotic Leishmania species, L. major and L. infantum, is now increasing in Turkey. A new diagnostic, treatment and recording system based on species typing need to be established for endemic areas in Turkey The sensitivity of NNN culture can be increased by enriched culture ABSTRACT Leishmaniases are a group of vector-borne diseases caused by the members of Leishmania genus, and there are three main clinical forms of the infection as visceral, cutaneous, and mucocutaneous. Cutaneous leishmaniasis is a growing public health problem in Turkey due to increasing detection of autochthonous cases caused by L. major and L. donovani in some
A Retrospective Study of Cutaneous and Visceral Leishmaniasis in Istanbul, Turkey
Journal of infection in developing countries, 2021
INTRODUCTION Leishmaniasis is a vector-borne disease caused by flagellated protozoans of the genus Leishmania. This study aimed to evaluate the epidemiological status of Visceral Leishmaniasis (VL) and Cutaneous Leishmaniasis (CL) among patients admitted to a university hospital in Istanbul, located in western Turkey. METHODOLOGY This study included 160 and 77 patients with a pre-diagnosis of VL and CL, respectively, between January 2001 and December 2017. Detailed demographic data, including age, gender, nationality and the number and location of lesions were collected and recorded from the patient registries. RESULTS Among 160 bone marrow specimens that suspected as VL, 22 (13.7%) of the specimens that were evaluated with both culture and Giemsa staining detected as positive. Furthermore, 29 (37.7%) of the 77 patients suspected for CL showed evidence of Leishmania. CONCLUSIONS The increase in human immigration from neighbouring countries (with a high incidence of leishmaniasis) to...
Cutaneous Leishmaniasis: Recent Developments in Diagnosis and Management
American Journal of Clinical Dermatology, 2015
This review focuses on recent developments in the diagnosis, treatment, management, and strategies for the prevention and control of cutaneous leishmaniasis (CL) caused by both Old and New World Leishmania species. CL is caused by the vector-borne protozoan parasite Leishmania and is transmitted via infected female sandflies. The disease is endemic in more than 98 countries and an estimated 350 million people are at risk. The overall prevalence is 12 million cases and the annual incidence is 2-2.5 million. The World Health Organization considers CL a severely neglected disease and a category 1 emerging and uncontrolled disease. The management of CL differs from region to region and is primarily based on local experience-based evidence. Most CL patients can be treated with topical treatments, but some Leishmania species can cause mucocutaneous involvement requiring a systemic therapeutic approach. Moreover, Leishmania species can vary in their sensitivity to available therapeutic options. This makes species determination critical for the choice of treatment and the clinical outcome of CL. Identification of the infecting parasite used to be laborious, but now the Leishmania species can be identified relatively easy with new DNA techniques that enable a more rational therapy choice. Current treatment guidelines for CL are based on poorly designed and reported trials. There is a lack of evidence for potentially beneficial treatments, a desperate need for large wellconducted studies, and standardization of future trials. Moreover, intensified research programs to improve vector control, diagnostics, and the therapeutic arsenal to contain further incidence and morbidity are needed. Key Points Cutaneous leishmaniasis is an emerging uncontrolled and neglected infection affecting millions yearly. With modern molecular techniques, Leishmania species determination is increasingly common and critical for the choice of treatment and the clinical outcome. Current cutaneous leishmaniasis management is for a considerable part non-evidence based; therefore, intensified research programs to improve vector control, diagnostics, and the therapeutic arsenal are needed.
Cutaneous Leishmaniasis: A 2022 Updated Narrative Review into Diagnosis and Management Developments
American Journal of Clinical Dermatology, 2022
This review is an update of an earlier narrative review published in 2015 on developments in the clinical management of cutaneous leishmaniasis (CL) including diagnosis, treatment, prevention and control measurements. CL is a vector-borne infection caused by the protozoan parasite Leishmania. The vector is the female sandfly. Globally, CL affects 12 million cases and annually 2 million new cases occur. CL is endemic in almost 100 countries and the total risk population is approximately 350 million people. WHO lists CL an emerging and uncontrolled disease and a neglected tropical disease. Local experience-based evidence remains the mainstay for the management of CL. Whereas intralesional therapeutic options are the first treatment option for most CL patients, those with mucocutaneous and disseminated involvement require a systemic therapeutic approach. Moreover, different Leishmania species can vary in their treatment outcomes. Therefore, species determination is critical for optimal CL clinical management. New DNA techniques allow for relatively easy Leishmania species determination, yet they are not easily implemented in resource-limited settings. There is a desperate need for novel, less toxic, and less painful treatment options, especially for children with CL. Yet, the large and well conducted studies required to provide the necessary evidence are lacking. To further control and potentially eliminate CL, we urgently need to improve vector control, and diagnostics, and we require efficient and safe vaccines. Alas, since CL primarily affects poor people, biotechnical companies dedicate little investment into the research programs that could lead to diagnostic, pharmaceutical, and vaccine innovations. Key Points WHO acknowledges cutaneous leishmaniasis is an emerging, uncontrolled, and neglected infection affecting millions yearly. Leishmania species determination based on molecular diagnostics is key in the clinical management of cutaneous leishmaniasis, but is unavailable in many low-and middle-income endemic settings. The required evidence for novel, less toxic, and less painful cutaneous leishmaniasis management is currently lacking.