| کلیدواژههای انگلیسی مقاله |
leishmaniasis, treatment failure, glucantime, INTRODUCTIONLeishmaniasis is one of the most neglected infectious diseases with widespread clinical spectrums from the fatal type, visceral leishmaniasis (VL), to the less threatening type, cutaneous leishmaniasis (CL). CL is the most prevalent type of leishmaniasis, accounting for three-quarters of cases. Although CL is not a life-threatening disease, permanent disfiguring scars may lead to lower quality of life 1,- 4, . Iran is one of the endemic regions of CL, with an estimated annual incidence of approximately 20,000 cases 4,, 5, . Two main types of CL are recognized, anthroponotic CL (ACL) and zoonotic CL (ZCL), caused by Leishmania tropica and Leishmania major, respectively. In old-world CL, ACL or urban type and ZCL or rural type are transmitted to the host by the bite of the female sandfly (Phlebotomus sergenti and Phlebotomus papatasi, respectively) 6,, 7, . Based on a previous survey, Kerman is an endemic region for ACL 8. According to the World Health Organization (WHO) and national leishmaniasis treatment guidelines, early detection and efficient treatment are recommended to prevent the spread of ACL. First-line therapy for ACL is pentavalent antimonials, including meglumine antimonate (Glucantime) and sodium stibogluconate (Pentostam) administered intralesionally (IL) or parenterally as intravenous (IV) or intramuscular (IM) depending upon the Leishmania species, clinical features of the lesions (site, size, and the number of lesions), and host&apos,s immune system status. Both methods of drug administration can result in noticeable adverse effects. Local administration is painful and can lead to erythema, edema, and swelling. Parenteral administration can have toxic effects on the heart, pancreas, kidney, and liver, leading to elevated pancreas and liver enzyme levels, cardiac arrhythmia, leukopenia, thrombocytopenia, myalgia, and abdominal pain 8,- 10, . Considerable numbers of recalcitrant cases have been reported in recent years. Several factors, such as the type of Leishmania species, demographic features of patients, clinical features of lesions, and host&apos,s immune system status, can influence treatment failure or success 11, . In this study, we investigated predictive factors associated with treatment failure in ACL in Kerman, southeast Iran.PARTICIPANTS AND METHODSStudy designThis case-control study was conducted retrospectively at Shahid Davari Health Center in Kerman, Iran, for ten years (2011 to 2020). This study was approved by the Ethics Committee of the Kerman University of Medical Sciences (IR.KMU.AH.REC.1399.173). Study populationInclusion criteria were patients suffering from ACL referred to this center from 2011 to 2020, those who have completed records of demographic characteristics and clinical features of lesions, received a complete treatment course, and were followed for three months afterward. Only patients who lived in Kerman city and presented with new leishmaniasis lesions were enrolled. Exclusion criteria were patients with either an incomplete treatment course or incomplete data. The case group included patients whose lesions failed to resolve after one treatment course. The control group included those whose lesions were cured after one treatment course. Complete cure was described as complete re-epithelialization of the lesion and absence of any induration or inflammation. The treatment course consisted of weekly IL administration of meglumine antimonate (0.1 ml/cm2, maximum 5 ml) and biweekly cryotherapy with liquid nitrogen for a maximum of 12 weeks or until complete healing of the lesions. A 21-day treatment course of IM administration of meglumine antimonate (20 mg/kg/day, maximum 3 ampoules) with biweekly cryotherapy was prescribed for those with lesions on the face, digits, genitalia, and joints, &,amp gt 4 lesions, or &,ge 3 cm lesion diameter. Demographic characteristics (age, sex, nationality, job, and history of chronic disease), clinical features of lesions (date of onset, site, number, diameter, duration, and type of lesion), type of treatment, and response to therapy were recorded and statistically analyzed with SPSS.Statistical analysisData were analyzed by SPSS 16 (IBM, Armonk, NY, USA). Quantitative and qualitative data were described by mean &,plusmn standard deviation and frequency, respectively. Initially, univariate logistic regression analysis was used to assess the correlation of lesions&apos, diameter or number as well as treatment response with the patients&apos, demographic characteristics and clinical features. Subsequently, multivariate logistic regression analysis was performed to omit confounding factors and confirm the results. P-values of less than 0.05 were regarded as significant.RESULTSFrom 3,765 cases, 2,128 ACL cases were enrolled in the study. The highest rates of infection occurred in 2015 (20.3%), March (12.3%), and the autumn season (28.4%) (Table 1,).VariablesNumberPercentageSexFemale1,06850.2Male1,06049.8Age (years)0-41939.15-934516.210-1939818.720-2927012.730-3934316.140-492109.950-591888.860-691165.570-79452.1&,ge 80200.9NationalityIranian186487.6Afghan26712.4OccupationStudent56426.7Others55526.3Housewife53225.2Child35516.8Worker622.9Employee321.3Farmer110.5History of chronic diseaseYes703.3No205896.7Season of onsetSpring57927.2Summer44821.1Autumn60428.4Winter49723.4Type of treatmentIL + cryotherapy196992.5IM + cryotherapy1597.5Site Face61428.9Body151171.1Type of lesionUlcerated203395.7Non-ulcerated914.3Treatment responseCure184186.5Failure28713.5Duration (months)&,le 4 44020.7&,gt 4 168879.3Size (mm)&,le 10 176182.8&,gt 10 36717.2Abbreviations, IL, intralesional IM, intramuscular |
| نویسندگان مقاله |
Maryam Khalili |
Department of Dermatology,
Kerman University of Medical
Sciences, Kerman, Iran
Saman Mohammadi |
Department of Dermatology,
Kerman University of Medical
Sciences, Kerman, Iran
Mohamadhosein Saeidi |
Department of Dermatology,
Kerman University of Medical
Sciences, Kerman, Iran
Rezvan Amiri |
Leishmaniasis Research Center,
Kerman University of Medical
Sciences, Kerman, Iran
Amireh Heshmatkhah |
Shahid Davari Clinic, Kerman
University of Medical Sciences,
Kerman, Iran
Simin Shamsi Meymandi |
Pathology and Stem Cell Research
Center, Afzalipour Hospital, Kerman
University of Medical Sciences,
Kerman, Iran
Mahin Aflatoonian |
Department of Dermatology,
Kerman University of Medical
Sciences, Kerman, Iran
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