Diagnosis and therapy of cutaneous and mucocutaneous Leishmaniasis in Germany

Simple item page
dc.contributor.authorBoecken, Gerhard
dc.contributor.authorSunderkoetter, Cord
dc.contributor.authorBogdan, Christian
dc.contributor.authorWeitzel, Thomas
dc.contributor.authorFischer, Marcellus
dc.contributor.authorMueller, Andreas
dc.contributor.authorLoebermann, Micha
dc.contributor.authorAnders, Gerlind
dc.contributor.authorvon Stebut, Esther
dc.contributor.authorSchunk, Mirjam
dc.date.accessioned2016-12-02T22:29:08Z
dc.date.available2016-12-02T22:29:08Z
dc.date.issued2011
dc.description.abstractThe 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.
dc.identifier.citationJournal der Deutschen Dermatologischen Gesellschaft, 2011, vol. 9, p. 1-51, Supplement: 8
dc.identifier.urihttp://hdl.handle.net/11447/863
dc.identifier.urihttp://dx.doi.org/10.1111/j.1610-0379.2011.07820.x
dc.language.isoen_US
dc.subjectLeishmaniasis
dc.subjectCutaneous
dc.subjectMucocutaneous
dc.subjectDiagnosis
dc.subjectTreatment
dc.subjectGuideline
dc.subjectClinical disease
dc.subjectEpidemiology
dc.titleDiagnosis and therapy of cutaneous and mucocutaneous Leishmaniasis in Germany
dc.title.alternativeDiagnostik und Therapie der kutanen und mukokutanen Leishmaniasis in Deutschland
dc.typeArtículo

Files

Original bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
Diagnosis and therapy of cutaneous and mucocutaneous Leishmaniasis in Germany (1).pdf
Size:
5.23 MB
Format:
Adobe Portable Document Format
Description:
Texto completo
Download

Collections

Artículos Medicina y Ciencias de la Salud

Implementado por OpenGeek Services