Diagnosis and therapy of cutaneous and mucocutaneous Leishmaniasis in Germany
Date
2011
Type:
Artículo
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Abstract
The incidence of cutaneous and mucocutaneous Leishmaniasis (CL/MCL) is in-
creasing globally, also in Germany, although the cases are imported and still low
in number.
The current evidence for the different therapies has many limitations due to
lack of sufficient studies on the different Leishmania species with differing
virulence. So far there is no international gold standard for the optimal
management.
The aim of the German joint working group on Leishmaniasis, formed by the so-
cieties of Tropical Medicine (DTG), Chemotherapy (PEG) and Dermatology
(DDG), was to establish a guideline for the diagnosis and treatment of CL and
MCL in Germany, based on evidence (Medline search yielded 400 articles) and,
where lacking, on consensus of the experts.
As the clinical features do not necessarily reflect the involved Leishmania
species and, as different parasite species and even geographically distinct
strains of the same species may require different treatments or varying dosages
or durations of therapy, the guidelines suggest for Germany to identify the
underlying parasite prior to treatment. Because of relevant differences in pro-
gnosis and ensuing therapy species should be identified in i) New World
CL/MCL (NWCL/ MCL) to distinguish between L. mexicana-complex and subge-
nus Viannia, ii) in suspected infections with L. mexicana-complex to distinguish
from L. amazonensis, and iii) in Old World CL (OWCL) to distinguish between
L. infantum and L. major, L. tropica, or L. aethiopica. A state-of-the-art diagnostic
algorithm is presented.
For recommendations on localized and systemic drug treatment and physical
procedures, data from the accessible literature were adjusted according to the
involved parasite species and a clinical differentiation into uncomplicated or
complex lesions.
Systemic therapy was strictly recommended for i) complex lesions (e. g. > 3
infected lesions, infections in functionally or cosmetically critical areas such
as face or hands, presence of lymphangitis), ii) lesions refractory to therapy,
iii) NWCL by the subgenus Viannia or by L. amazonensis, iv) in MCL and v) in
recalcitrant, or disseminating or diffuse cutaneous courses. In e. g. infection with
L. major it encompasses miltefosine, fluconazole and ketoconazole, while anti-
mony or allopurinol were here considered second choice.
Local therapy was considered appropriate for i) uncomplicated lesions of
OWCL, ii) L. mexicana-complex and iii) pregnant women. In e. g. infection with
L. major it encompasses perilesional antimony, combined with cryotherapy,
paromomycin 15 %/in methylbenzethoniumchlorid 12 % and thermotherapy.
The group also stated that there is an urgent need for improving the design
and the way of publishing of clinical trials in leishmaniasis.
Description
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Citation
Journal der Deutschen Dermatologischen Gesellschaft, 2011, vol. 9, p. 1-51, Supplement: 8
Keywords
Leishmaniasis, Cutaneous, Mucocutaneous, Diagnosis, Treatment, Guideline, Clinical disease, Epidemiology