학술논문
Associated-risk determinants for anthroponotic cutaneous leishmaniasis treated with meglumine antimoniate: A cohort study in Iran.
Document Type
article
Author
Mohammad Reza Aflatoonian; Iraj Sharifi; Behnaz Aflatoonian; Mehdi Bamorovat; Amireh Heshmatkhah; Zahra Babaei; Pooya Ghasemi Nejad Almani; Mohammad Ali Mohammadi; Ehsan Salarkia; Abbas Aghaei Afshar; Hamid Sharifi; Fatemeh Sharifi; Ahmad Khosravi; Mehrdad Khatami; Nasir Arefinia; Alireza Fekri; Saeideh Farajzadeh; Ali Khamesipour; Mehdi Mohebali; Mohammad Mehdi Gouya; Mohammad Reza Shirzadi; Rajender S Varma
Source
PLoS Neglected Tropical Diseases, Vol 13, Iss 6, p e0007423 (2019)
Subject
Language
English
ISSN
1935-2727
1935-2735
23130466
1935-2735
23130466
Abstract
BackgroundThe control of cutaneous leishmaniasis (CL) is facilitated by knowledge of factors associated with the treatment failures in endemic countries. The aim of this evaluation was to identify the potential risk determinants which might affect the significance of demographic and clinical characteristics for the patients with anthroponotic CL (ACL) and the outcome of meglumine antimoniate (MA) (Glucantime) treatment.Methodology/principal findingsThis current was executed as a cohort spanning over a period of 5 years which centered in southeastern part of Iran. Altogether, 2,422 participants were evaluated and 1,391 eligible volunteer patients with ACL caused by Leishmania tropica were included. Overall, 1,116 (80.2%) patients received MA intraleisionally (IL), once a week for 12 weeks along with biweekly cryotherapy, while 275 (19.8%) patients received MA alone (20 mg/kg/day for 3 weeks) (intramuscular, IM). The treatment failure rate in ACL patients was 11% using IL combined with cryotherapy plus IM alone, whilst 9% and 18.5% by IL along with cryotherapy or IM alone, respectively. Multivariate logistic regression model predicted 5 major associated-risk determinants including male (odds ratio (OR) = 1.54, confidence interval (CI) = 1.079-2.22, p = 0.018), lesion on face (OR = 1.574, CI = 1.075-2.303, p = 0.02), multiple lesions (OR = 1.446, CI = 1.008-2.075, p = 0.045), poor treatment adherence (OR = 2.041, CI = 1.204-3.46, p = 0.008) and disease duration > 4 months (OR = 2.739, CI = 1.906-3.936, p≤0.001).Conclusions/significanceThe present study is the original and largest cohort of ACL patients who treated with MA. A comprehensive intervention and coordinated action by the health authorities and policy-makers are crucial to make sure that patients strictly follow medical instructions. Early detection and effective therapy < 4 months following the onset of the lesion is critical for successful treatment of the patients. Since a significant number of patients are still refractory to MA, reducing man-vector exposure and development of new effective alternative drugs are essential measures against ACL due to L. tropica.