RESUMEN
Local therapies have been proposed as safe and effective alternatives to systemic drugs in cutaneous leishmaniasis (CL), especially among less severe cases. However, they are not widely available and used in endemic places, including Colombia, which has a high burden of disease. Further complicating the uptake of local therapies is that different treatment guidelines have been established by the World Health Organization (WHO) and Pan American Health Organization (PAHO). Using data from a large referral center in Colombia, we determined the proportion of patients who would be eligible for and potentially benefit from local therapies according to both international guidelines. The sample included 1,891 confirmed cases of CL aged ≥ 12 years, mostly infected with Leishmania Viannia panamensis (91%, n = 601/660), between 2004 and 2014. Overall, 57% of the sample had one lesion, whereas another 31% had two to three lesions. For 74% of patients, all lesions were in an area other than head or neck. The maximum lesion size was ≤ 3 cm for 58% and < 5 cm for 88% of the sample. Based on our data, up to 56% of patients could have been eligible for local therapies according to the WHO criteria. By contrast, only 23% were eligible according to the more restrictive PAHO criteria. Regardless, these data suggest that a substantial proportion of CL patients in Colombia may benefit from local therapies given their relatively mild presentation of disease and low risk of complications. Individualized risk-benefit assessment and guideline adjustments may increase local therapy eligibility and benefit a large number of patients.
Asunto(s)
Antimonio/uso terapéutico , Antiprotozoarios/uso terapéutico , Leishmania braziliensis/efectos de los fármacos , Leishmania guyanensis/efectos de los fármacos , Leishmaniasis Cutánea/terapia , Paromomicina/uso terapéutico , Pentamidina/uso terapéutico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Colombia/epidemiología , Estudios Transversales , Crioterapia/métodos , Femenino , Humanos , Hipertermia Inducida/métodos , Leishmania braziliensis/crecimiento & desarrollo , Leishmania braziliensis/patogenicidad , Leishmania guyanensis/crecimiento & desarrollo , Leishmania guyanensis/patogenicidad , Leishmaniasis Cutánea/epidemiología , Leishmaniasis Cutánea/parasitología , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Índice de Severidad de la EnfermedadRESUMEN
Chronic skin lesions constitute a clinical diagnostic challenge. We report the case of a patient whose facial lesion was histopathologically compatible with squamous cell carcinoma and hence programmed for Mohs surgery. However, review of the clinical and epidemiological history led to laboratory diagnosis of cutaneous leishmaniasis, treatment with miltefosine, and complete resolution of the lesion.