Clinical features and treatment response of cutaneous leishmaniasis in North-West Ethiopia

Objective: Cutaneous leishmaniasis (CL) receives far less attention than visceral leishmaniasis. Nevertheless, CL is predominantly caused by a unique species in Ethiopia (L. aethiopica), which is known to cause severe forms such as diffuse (DCL) and mucocutaneous leishmaniasis (MCL). We report on the number and type of CL cases diagnosed, the clinical features, the treatments and treatment outcomes in North-West Ethiopia. Methods: This is a retrospective chart record analysis of CL patients treated at the Leishmania Research and Treatment Center (LRTC) of the University of Gondar, Ethiopia. Results: From 178 CL patients seen between January 2014 and December 2015, a total of 154 chart records were retrieved. These included 80 localised CL (LCL), 7 DCL and 67 MCL. The median age was 23 years; 71.4% were male. Most (n = 121, 78.6%) of the lesions were on the face. The median time since onset was 12 months (6–24 months), and 28.6% presented after a trial of traditional medicine. The treatment of all forms of CL mainly consisted of 30 days of IM antimonial injections. Of these, 51/133 (38.3%) required treatment extension or change due to nonresponse. Three cases were treated with liposomal amphotericin B or miltefosine (two received the combination), of which two responded well. Conclusion: CL was found to be complicated and difficult to treat. MCL was common, and patients presented after long delays. There is an urgent need to look for better treatment options for CL and improve access to care.