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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Species-Directed Therapy for Leishmaniasis in Returning Travellers: A Comprehensive Guide
PLoS Neglected Tropical Diseases, Volume 8, No. 5, Article e2832, Year 2014
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Description
Background:Leishmaniasis is increasingly reported among travellers. Leishmania species vary in sensitivity to available therapies. Fast and reliable molecular techniques have made species-directed treatment feasible. Many treatment trials have been designed poorly, thus developing evidence-based guidelines for species-directed treatment is difficult. Published guidelines on leishmaniasis in travellers do not aim to be comprehensive or do not quantify overall treatment success for available therapies. We aimed at providing comprehensive species-directed treatment guidelines.Methodology/Principal Findings:English literature was searched using PubMed. Trials and observational studies were included if all cases were parasitologically confirmed, the Leishmania species was known, clear clinical end-points and time points for evaluation of treatment success were defined, duration of follow-up was adequate and loss to follow-up was acceptable. The proportion of successful treatment responses was pooled using mixed effects methods to estimate the efficacy of specific therapies. Final ranking of treatment options was done by an expert panel based on pooled efficacy estimates and practical considerations. 168 studies were included, with 287 treatment arms. Based on Leishmania species, symptoms and geography, 25 clinical categories were defined and therapy options ranked. In 12/25 categories, proposed treatment agreed with highest efficacy data from literature. For 5/25 categories no literature was found, and in 8/25 categories treatment advise differed from literature evidence. For uncomplicated cutaneous leishmaniasis, combination of intralesional antimony with cryotherapy is advised, except for L. guyanensis and L. braziliensis infections, for which systemic treatment is preferred. Treatment of complicated (muco)cutaneous leishmaniasis differs per species. For visceral leishmaniasis, liposomal amphotericin B is treatment of choice.Conclusions/Significance:Our study highlights current knowledge about species-directed therapy of leishmaniasis in returning travellers and also demonstrates lack of evidence for treatment of several clinical categories. New data can easily be incorporated in the presented overview. Updates will be of use for clinical decision making and for defining further research. © 2014 Hodiamont et al.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC4006727/bin/pntd.0002832.s001.doc
https://efashare.b-cdn.net/share/pmc/articles/PMC4006727/bin/pntd.0002832.s002.doc
https://efashare.b-cdn.net/share/pmc/articles/PMC4006727/bin/pntd.0002832.s003.pdf
Authors & Co-Authors
Kager, Petrus A.
Netherlands, Amsterdam
Amsterdam Umc - University of Amsterdam
Bart, Aldert
Netherlands, Amsterdam
Amsterdam Umc - University of Amsterdam
de Vries, Henry J.C.
Netherlands, Amsterdam
Amsterdam Umc - University of Amsterdam
Leenstra, Tjalling
Netherlands, Amsterdam
Amsterdam Umc - University of Amsterdam
Netherlands, The Hague
Ministerie Van Defensie
de Vries, Peter J.
Netherlands, Amsterdam
Amsterdam Umc - University of Amsterdam
Netherlands, Hilversum
Tergooi Hospitals
van Vugt, Michèle V.
Netherlands, Amsterdam
Amsterdam Umc - University of Amsterdam
Grobusch, Martín Peter
Netherlands, Amsterdam
Amsterdam Umc - University of Amsterdam
van Gool, Tom
Netherlands, Amsterdam
Amsterdam Umc - University of Amsterdam
Statistics
Citations: 82
Authors: 8
Affiliations: 3
Identifiers
Doi:
10.1371/journal.pntd.0002832
ISSN:
19352727
Study Design
Cohort Study