Unité d'Immunologie Moléculaire des Parasites, Institut Pasteur de Paris, Paris, France.
Clin Infect Dis. 2013 Aug;57(3):370-80. doi: 10.1093/cid/cit269. Epub 2013 Apr 30.
Cutaneous leishmaniasis (CL) is a disfiguring but not life-threatening disease. Because antileishmanial drugs are potentially toxic, the World Health Organization (WHO) recommends simple wound care or local therapy as first-line treatment, followed or replaced by systemic therapy if local therapy fails or cannot be performed.
To determine the feasibility and impact of the recommended approach, we analyzed the results of a centralized referral treatment program in 135 patients with parasitologically proven CL.
Infections involved 10 Leishmania species and were contracted in 29 different countries. Eighty-four of 135 patients (62%) were initially treated without systemic therapy. Of 109 patients with evaluable charts, 23 of 25 (92%) treated with simple wound care and 37 of 47 (79%) treated with local antileishmanial therapy were cured by days 42-60. In 37 patients with large or complex lesions, or preexisting morbidities, or who had not been cured with local therapy, the cure rate with systemic antileishmanial agents was 60%. Systemic adverse events were observed in 15 patients, all receiving systemic therapy.
In this population of CL patients displaying variable degrees of complexity and severity, almost two-thirds of patients could be initially managed without systemic therapy. Of these, 60 were cured before day 60. The WHO-recommended stepwise approach favoring initial local therapy therefore resulted in at least 44% of all patients being cured without exposure to the risk of systemic adverse events. Efforts are needed to further simplify local therapy of CL and to improve the management of patients with complex lesions and/or preexisting comorbidities.
皮肤利什曼病（CL）是一种毁容但不会危及生命的疾病。由于抗利什曼原虫药物具有潜在毒性，世界卫生组织（WHO）建议采用简单的伤口护理或局部治疗作为一线治疗，如果局部治疗失败或无法进行，则采用全身治疗。
为了确定推荐方法的可行性和影响，我们分析了在 135 例寄生虫学证实的 CL 患者集中转诊治疗方案的结果。
感染涉及 10 种利什曼原虫，在 29 个不同国家感染。135 例患者中，84 例（62%）最初未经全身治疗。在可评估病历的 109 例患者中，25 例单纯伤口护理治疗中有 23 例（92%），47 例局部抗利什曼治疗中有 37 例（79%）在第 42-60 天治愈。在 37 例存在大或复杂病变、或存在先前疾病、或局部治疗未治愈的患者中，全身抗利什曼药物的治愈率为 60%。15 例患者观察到全身不良反应，均接受全身治疗。
在这群 CL 患者中，他们表现出不同程度的复杂性和严重性，近三分之二的患者最初可以不接受全身治疗。其中，60%在第 60 天前治愈。因此，WHO 推荐的逐步治疗方法，即优先采用局部治疗，至少使 44%的患者在不接触全身不良反应风险的情况下治愈。需要努力进一步简化 CL 的局部治疗，并改善复杂病变和/或合并症患者的管理。
