Comparative study of testing the efficacy of injection meglumine antimoniate with oral itraconazole as first line treatment of cutaneous leishmaniasis
Treatment options for cutaneous leishmaniasis
Keywords:
Itraconazole, Meglumine antimoniate, Cutaneous leishmaniasisAbstract
Background Cutaneous Leishmaniasis is caused by different species of a protozoa.1 The disease is endemic in some areas of Pakistan like Baluchistan, Sindh, Khyber Pakhtunkhwa.2 There are many treatment options including meglumine antimoniate, rifampicin, tetracyclines, sodium sitbogluconate and itraconazole etc.3 Objective The objective of our study was to compare the efficacy of injection meglumine antimoniate with cap Itraconazole as 1st line treatment of cutaneous leishmaniasis. Methods This study on cutaneous leishmaniasis was conducted in the Dermatology Department at Punjab Ranger Teaching Hospital Lahore. All 20 male patients referred to us from the endemic area (Kashmore) were divided into two groups A and B after positive Slit Skin Smear test. Group A were given meglumine antimoniate 400mg/day intramuscular injection, group B were given Cap Itraconazole 200 mg per day for 4 weeks. Patients assessment was done on three criteria; 1: clinical resolution of lesions 2: side effects seen during the treatment 3: report of slit skin smear at 4 weeks. Results According to study results Slit Skin Smear test was 100% positive for all 20 patients before treatment, but came negative for all 10 patients of group A and negative for only 2 patients of group B after 4 weeks. Some side effects were observed during treatment in both groups but they were more in group A patients. Clinical resolution of lesions was 100% in Group A as compared to group B 20%. Conclusion Injection meglumine antimoniate is the preferred treatment of cutaneous leishmaniasis regards to its efficacy as compared to oral Itraconazole based on the clinical resolution & negative slit smear at the end of the course but the limitations to treatment are the poor patient tolerance & the increased side effects seen in this group.References
Bailey, Mark S., and Diana NJ Lockwood. "Cutaneous leishmaniasis." Clinics in dermatology 25.2 (2007): 203-211.
Klaus SN, Frankenburg S, Ingber A: Epidemiology of cutaneous leishmaniasis. Clin Dermatol (1999)17(3):257-260
Ashford RW, Desjeux P, de Raadt P. Estimation of population at risk of infection and number of cases of leishmaniasis. Parasitol Today 1992;8:104-5.
Gonzalez R, De Sousa L, Devera R JA, Ledezema E. Seasonal and nocturnal domiciliary human landing/biting behaviour of Lutzomyia (lutzomyia) evansi and Lutzomyia (Psychodopygus) panamensis (diptera; Psychodidae) in a periurban area of a city on the Caribbean coast of eastern Venezuela (Barcelona; Anzoategui State). Trans R Soc Trop Med Hyg 1999;93:361-4.
Khan SJ, Muneeb S. Cutaneous leishmaniasis in Pakistan. Dermatol Online J. 2005;11(1)
Article Google Scholar
Afghan AK, Kassi M, Kasi PM, Ayub A, Kakar N, Marri SM. Clinical manifestations and distribution of cutaneous Leishmaniasis in Pakistan. J Trop Med. 2011;2011:359145.
Article Google Scholar
Rowland M, Munir A, Durrani N, Noyes H, Reyburn H. An outbreak of cutaneous leishmaniasis in an Afghan refugee settlement in north-West Pakistan. Trans R Soc Trop Med Hyg. 1999;93(2):133–6. https://doi.org/10.1016/S0035-9203(99)90285-7.
Article CAS PubMed Google Scholar
Hepburn NC. Cutaneous leishmaniasis: an overview. J Postgrad Med. 2003 Jan-Mar;49(1):50-4. doi: 10.4103/0022-3859.928. PMID: 12865571.
