van Henten Saskia, Pareyn Myrthe, Tadesse Dagimawie, Kassa Mekidim, Techane Mehret, Kinfe Eyerusalem, Girma Nigatu, Demeke Degnet, Mesay Mebratu, Kassa Mekibib, Temesgen Rodas, Shewangizaw Misgun, Massebo Fekadu, van Griensven Johan, Wegayehu Teklu, Merdekios Behailu
Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium.
Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia.
Front Med (Lausanne). 2023 Oct 10;10:1196063. doi: 10.3389/fmed.2023.1196063. eCollection 2023.
Cutaneous leishmaniasis (CL) is a common, yet massively underreported skin morbidity in Ethiopia. Most patients never seek treatment, as this is offered only in specialized treatment centers. Early diagnosis and treatment through decentralization is crucial to decrease transmission and to reach the NTD roadmap goals. However, little information is available on outcomes and challenges of community-based treatment initiatives.
A community-based prospective cohort study was conducted in Ochollo. Patients with clinically or microscopy confirmed CL were included. Cryotherapy was (to be) given weekly with at least four sessions for uncomplicated lesions, and miltefosine was given for 4 weeks for complicated lesions. Miltefosine adherence was assessed by counting pill strips. Clinical and patient-reported outcomes (dermatological life quality index and patient-global assessment) were assessed at month 6 (M6).
A total of 107 patients were included, with a median age of 6 years. Two patients refused, and 15 could not be treated as they were too young (<4 years) for miltefosine. Giving cryotherapy to patients weekly was not feasible due to long wound healing times and required use of topical antibiotics. Only 52.4% of miltefosine patients finished >90% of their tablets by M1. Among 46 patients treated with cryotherapy, 24 (52.2%) were cured at M6, and 9 (19.6%) had substantial improvement. The cure rate was 16/39 (41.0%) for miltefosine with 28.2% (11/39) substantial improvement. Before treatment, more than half (57.8%) of patients reported that CL did not negatively impact their life, which significantly increased to 95.2% at M6. At this time, 61.7% of patients said their lesion was clear, which was 1% before treatment.
Our study is the first to identify the challenges and opportunities of miltefosine and cryotherapy for community treatment of CL. Although overall cure rates were lower than expected, patient-reported outcomes were generally positive and quite some patients had good improvement.
皮肤利什曼病（CL）在埃塞俄比亚是一种常见但报告严重不足的皮肤疾病。大多数患者从不寻求治疗，因为只有在专门的治疗中心才提供治疗。通过权力下放实现早期诊断和治疗对于减少传播以及实现被忽视热带病路线图目标至关重要。然而，关于基于社区的治疗举措的结果和挑战的信息很少。
在奥乔洛开展了一项基于社区的前瞻性队列研究。纳入临床或显微镜检查确诊为CL的患者。对于无并发症的皮损，每周进行冷冻疗法，至少进行4次；对于有并发症的皮损，给予米替福新治疗4周。通过清点药条评估米替福新的依从性。在第6个月（M6）评估临床和患者报告的结果（皮肤病生活质量指数和患者整体评估）。
共纳入107例患者，中位年龄为6岁。2例患者拒绝治疗，15例因年龄太小（<4岁）无法使用米替福新而未接受治疗。由于伤口愈合时间长且需要使用局部抗生素，每周为患者进行冷冻疗法并不可行。到M1时，只有52.4%的米替福新治疗患者服用了超过90%的药片。在46例接受冷冻疗法的患者中，24例（52.2%）在M6时治愈，9例（19.6%）有显著改善。米替福新的治愈率为16/39（41.0%），有28.2%（11/39）显著改善。治疗前，超过一半（57.8%）的患者报告CL对他们的生活没有负面影响，这一比例在M6时显著增加到95.2%。此时，61.7%的患者表示皮损已清除，治疗前这一比例为1%。
我们的研究首次确定了米替福新和冷冻疗法用于社区治疗CL的挑战和机遇。尽管总体治愈率低于预期，但患者报告的结果总体呈阳性，相当一部分患者有良好改善。
