Clinical Characteristics and Treatment Responses of Patients Diagnosed with Cutaneous Leishmaniasis Treated with Systemic Antimony

Öz

Background: Cutaneous leishmaniasis (CL) is a skin disease caused by protozoan parasites belonging to the Leishmania genus. The most commonly preferred treatment option for CL treatment is pentavalent anti-mony compounds. The aim of this study is to investigate the clinical characteristics and treatment re-sponses of patients diagnosed with CL treated with systemic antimony. Materials and Methods: This retrospective study included 52 patients diagnosed with CL and treated with systemic antimony in our skin and venereal diseases clinic between May 2018 and May 2020. The clinical and demographic characteristics recorded in the patients' files were examined. Systemic antimony (in-tramuscular meglumine antimonate (IM MA)) was administered Results: 30 (57.7%) of the patients in our study were female and 22 (42.3%) were male. The average age of the patients was 26.5±14.23 years. Lesions were most frequently located in the facial region, and noduloulcerative type lesions were most frequently seen. The diagnosis of CL was made by observing amastigotes in the cutaneous smear in 48 (92.3%) patients and in the histopathological examination of the lesioned skin in 4 (7.7%) patients. When the patients receiving IM MA treatment were evaluated at the 12th week in terms of treatment response, complete clinical recovery of the lesions was observed in 50 (96.1%) patients and partial clinical improvement was observed in 2 (3.9%) patients. Conclusions: As a result, the data in our study were similar to the clinical and demographic data on CL previously published in our country.

Anahtar Kelimeler

• clinical features
• Cutaneous leishmaniasis
• Meglumine antimonate
• Antimony

Sistemik Antimon ile Tedavi Edilen Kutanöz Leishmaniasis Tanılı Hastaların Klinik Özellikleri ve Tedavi Yanıtları

Öz

Amaç: Kutanöz leishmaniasis (KL) Leishmania genusuna ait protozoan parazitlerin neden olduğu bir cilt hastalığıdır. KL tedavisi için en sık tercih edilen tedavi seçeneği beş değerli antimon bileşikleridir. Bu çalışmanın amacı sistemik antimon ile tedavi edilen KL tanılı hastaların klinik özellikleri ve tedavi yanıtlarını araştırmaktır. Materyal- metot: Bu retrospektif çalışmaya deri ve zührevi hastalıkları kliniğimizde Mayıs 2018 – Mayıs 2020 tarihleri arasında KL tanısı konulan ve sistemik antimon ile tedavi edilen 52 hasta dahil edildi. Hastaların dosyalarında kayıtlı olan klinik ve demografik özellikleri incelendi. Sistemik antimon (intramüsküler meglumin antimonat (IM MA)) 20 mg/kg /gün dozunda 21 gün boyunca uygulandı. Tedavi yanıtı 12. haftada değerlendirildi. Bulgular: Çalışmamızdaki hastaların 30(%57.7)’u kadın ve 22(%42.3)’si erkek idi. Hastaların ortalama yaşı 26.5±14.23 yıl idi. Lezyonlar en sık yüz bölgesinde yerleşmekteydi ve en sık nodüloülseratif tip lezyonlar görüldü. KL tanısı 48 (%92.3) hastada kutanöz smearde ve 4(%7.7) hastada lezyonlu derinin histopatolojik incelenmesinde amastigotların görülmesi ile konuldu. IM MA tedavisi alan hastalar tedavi yanıtı açısından 12. haftada değerlendirildiğinde 50(%96.1) hastada lezyonlarda tam klinik iyileşme, 2(%3.9) hastada ise kısmi klinik iyileşme görüldü. Sonuç: Sonuç olarak çalışmamızdaki veriler ülkemizde daha önce yayınlanan KL ile ilgili klinik ve demografik veriler ile benzerdi.

Anahtar Kelimeler

• Antimon
• klinik özellikler
• kutanöz leishmaniasis
• meglumin antimonat

Kaynakça

1. 1. Uzun S, Gürel MS, Durdu M, Akyol M, Fettahlıoğlu Karaman B, Aksoy M, et al. Clinical practice guidelines for the diagno-sis and treatment of cutaneous leishmaniasis in Turkey. Int J Dermatol. 2018;57(8):973-982.
2. 2. Gurel MS, Tekin B, Uzun S. Cutaneous leishmaniasis: A great imitator. Clin Dermatol. 2020;38(2):140-151.
3. 3. Ateş F, Or E, Körpınar MA, Gönül R, Bahçeci T. Leishmania-sisin Tedavisinde Antimon Bileşiklerinin Kullanımı. YYU Vet Fak Derg 2011, 22 (1), 53 – 57
4. 4. Lyra MR, Oliveira LFA, Schubach AO, Sampaio RNR, Rodri-gues BC, Hueb M, et al. A Randomized, Controlled, Noninfe-riority, Multicenter Trial of Systemic vs Intralesional Treat-ment With Meglumine Antimoniate for Cutaneous Leishma-niasis in Brazil. Clin Infect Dis. 2023;77(4):574-582.
5. 5. An I, Harman M, Esen M, Çelik H. The effect of pentavalent antimonial compounds used in the treatment of cutaneous leishmaniasis on hemogram and biochemical parameters. Cutan Ocul Toxicol. 2019;38(3):294-297.
6. 6. Alvar J, Vélez ID, Bern C, Herrero M, Desjeux P, Cano J, et al. Leishmaniasis worldwide and global estimates of its inci-dence. PLoS One. 2012;7(5):e35671.
7. 7. David CV, Craft N. Cutaneous and mucocutaneous leishmani-asis. Dermatol Ther. 2009;22(6):491-502.
8. 8. Uzun S, Uslular C, Yucel A, Acar MA, Ozpoyraz M, Memişoğlu HR. Cutaneous leishmaniasis: evaluation of 3,074 cases in the Cukurova region of Turkey. Br J Dermatol 1999;140(2):347-50.

9. 9. Sucakli MB, Saka G. Epidemiology of cutaneous leishmania-sis in Diyarbakir (2002-2006). Turkiye Parazitol Derg 2007;31(3):165-9.
10. 10. Uzun S, Durdu M, Culha G, Allahverdiyev AM, Memişoğlu HR. Clinical features, epidemiology, and efficacy and safety of intralesional antimony treatment of cutaneous leishmania-sis: recent experience in Turkey. J Parasitol 2004;90(4): 853-9.
11. 11. Zeyrek FY, Gürses G, Uluca N, Yentür Doni N, Toprak Ş, Yeşi-lova Y, et al. Is the agent of cutaneous leishmaniasis in San-liurfa changing? First cases of Leishmania majör. Turkiye Pa-razitol Derg. 2014;38(4):270-4.
12. 12. Ertuğ S, Aydın N, Gültekin B, Doyuran SE. Aydın İlindeki Deri Leishmaniasisi Olgularının Retrospektif İncelenmesi. Türkiye Parazitoloji Dergisi 2002;26 (2):140-2
13. 13. Gurel MS, Ulukanligil M, Ozbilge H. Cutaneous leishmaniasis in Sanliurfa: epidemiologic and clinical features of the last four years (1997-2000). Int J Dermatol 2002; 41(1): 32-7.
14. 14. Erat T, An I. Treatment of pediatric cutaneous leishmaniasis with liposomal amphotericin B. Dermatol Ther. 2022;35(9):e15706.
15. 15. Çulha G, Akçalı C. Hatay ve Çevresinde Saptanan Kutanöz Leishmaniasis Olguları. Türkiye Parazitoloji Dergisi, 2006;30 (4): 268-71.
16. 16. Gumurdulu D, Ergin M, Tuncer I, Uzun S, Memisoglu H. Histopathological and clinical evaluation of the cutaneous le-ishmaniasis in Southern Anatolia, Turkey. Aegean Pathology Society 2004;57–61
17. 17. Nezhad HA, Borhani M, Norouzi M, Merzaie M. Cutaneous Leishmaniasis in school children in a border area at so-uthwest of Iran. Sci Parasitol 2012;13(4):153-158
18. 18. An I, Harman M, Çavuş İ, Özbilgin A.The Diagnostic Value of Lesional Skin Smears Performed by Experienced Specialist in Cutaneous Leishmaniasis and Routine Microbiology Labora-tory. Turk J Dermatol 2019;13(Suppl. 1):1-5
19. 19. Khatri ML, Di Muccio T, Gramiccia M. Cutaneous leishmania-sis in North-Western Yemen: a clinicoepidemiologic study and leishmania species identification by polymerase chain reaction-restriction fragment length polymorphism analysis. J Am Acad Dermatol 2009;61(4):e15-21.
20. 20. Rahman SB, Bari AU. Laboratory profile in patients of cuta-neous leishmaniais from various regions of Pakistan. J Coll Physicians Surg Pak 2003;13(6):313-36.
21. 21. Tareen A, Afaq S, Haque AU. Comparative study of the diag-nosis of cutaneous leishmaniasis by slit skin smear and skin biopsy for histopathology. JRMC 2014;18:83-6.
22. 22. Azmi K, Nasereddin A, Ereqat S, Schnur L, Schonian G, Ab-deen Z.Methods incorporatinga polymerase chain reaction and restriction fragment length polymorphism and their use as a’gold standard’ in diagnosing Old World cutaneous le-ishmaniasis. Diagn Microbiol Infect Dis 2011;71(2):151-5.
23. 23. Dar NR, Khurshid T. Comparison of skin smears and biopsy specimens for demonstration of leishmania tropica bodies in cutaneous Leishmaniasis. J Coll Physicians Surg Pak 2005;15(2):765- 67.
24. 24. Aviles H, Belli A, Armijos R, Monroy FP, Harris E. PCR detec-tion and identification of Leishmania parasites in clinical specimens in Ecuador: a comparison with classical diagnos-tic methods. J Parasitol. 1999;85(2):181-7.
25. 25. Rodríguez N, Guzman B, Rodas A, Takiff H, Bloom BR, Convit J. Diagnosis of cutaneous leishmaniasis and species discri-mination of parasites by PCR and hybridization. J Clin Micro-biol. 1994;32(9):2246-52.
26. 26. Khatami A, Firooz A, Gorouhi F, Dowlati Y. Treatment of acute Old World cutaneous leishmaniasis: A systematic review of the randomized controlled trials. J Am Acad Der-matol 2007;57(2):335.e1-29.