Efficacy of Thermotherapy in Cutaneous Leishmaniasis

Hanny Gul; Sara Inayat; Saleha Batool; Sundus Jahangir; Parveen; Jalil Ahmed

doi:10.70749/ijbr.v3i3.2466

Authors

Hanny Gul Department of Dermatology, Sandamen Provincial Hospital (SPH), Quetta, Pakistan
Sara Inayat Department of Dermatology, Sandamen Provincial Hospital (SPH), Quetta, Pakistan
Saleha Batool Department of Dermatology, Sandamen Provincial Hospital (SPH), Quetta, Pakistan
Sundus Jahangir Department of Dermatology, Sandamen Provincial Hospital (SPH), Quetta, Pakistan
Parveen Department of Dermatology, Sandamen Provincial Hospital (SPH), Quetta, Pakistan
Jalil Ahmed Department of Dermatology, Sandamen Provincial Hospital (SPH), Quetta, Pakistan

DOI:

https://doi.org/10.70749/ijbr.v3i3.2466

Keywords:

Thermotherapy, cutaneous leishmaniasis.

Abstract

Background: In many tropical and subtropical areas, cutaneous leishmaniasis (CL), a parasitic skin infection, is endemic. Despite its effectiveness, traditional pentavalent antimonial treatment has serious side effects, is expensive, and presents logistical difficulties. One possible substitute is thermotherapy, a localized heat-based treatment. Objective: The purpose of this study was to evaluate the safety and effectiveness of thermotherapy in the treatment of cutaneous leishmaniasis and compare the results with those of conventional antimonial therapy. Methods: A six-month qualitative study including 130 patients with CL was carried out at a Quetta tertiary care hospital. A targeted heat device was used to give thermotherapy at a temperature of about 50°C. Patient satisfaction, side events, and clinical results were documented and contrasted with a group of 50 patients receiving antimonial treatment. Results: With an average recovery period of 4–6 weeks, thermotherapy produced a full cure in 83.1% of cases. Erythema (34.6%) and discomfort (46.2%) were mild side effects. Antimonial treatment, in contrast, had a cure rate of 82% but a higher prevalence of serious adverse effects (30%). Conclusion: With faster recovery durations and fewer side effects than antimonial therapy, thermotherapy is a safe, efficient, and well-tolerated substitute that can be used more widely in endemic areas.

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References

1. National Institute of Health of Colombia, Ministry of Social Protection of the Republic of Colombia, Pan American Health Organization. Protocol for public health surveillance of Leishmaniasis.

http://www.ins.gov.co/temas-de-interes/Leishmaniasis%20viceral/01%20protocolo% 20Leishmaniasis.pdf.

2. World Health Organization (WHO). Control of the leishmaniases. 949 Trs, editor. Geneva: WHO; 2010.

3. Uribarren T. Leishmaniasis. Department of Microbiology and Parasitology, School of Medicine, UNAM.

http://www.facmed.unam.mx/deptos/microbiologia/parasitologia/leishmaniosis. html.

4. Alvar J, Vélez I, Bern C, Herrero M, Desjeux P, CanoJ, et al. Leishmaniasis worldwide and global esti mates of its incidence. PLoS ONE. 2012; 7(5):1–12.

https://doi.org/10.1371/journal.pone.0035671

5. Desjeux P. Leishmaniasis: current situation and new perspectives. Comp Immunol Microbiol Infect Dis. 2004; 27:305–18. PMID: 15225981

https://doi.org/10.1016/j.cimid.2004.03.004

6. Dowlati Y. Treatment of cutaneous leishmaniasis (Old World). Clin Dermatol. 1996; 14:513–8. PMID: 8889329

https://doi.org/10.1016/0738-081x(96)00047-8

7. Asilian A, Davami M. Comparison betweenthe efficacyof photodynamic therapyand topical paromo mycin in the treatment of Old World cutaneousleishmaniasis: a placebo-controlled, randomized clinical trial. Clin Exp Dermatol. 2006; 31:634–7. PMID: 16780497

https://doi.org/10.1111/j.1365-2230.2006.02182.x

8. Larbi EB, al-Khawajah A, al-Gindan Y, Jain S, Abahusain A, al-Zayer A. A randomized, double-blind, clinical trial of topical clotrimazole versus miconazole for treatment of cutaneous leishmaniasis in the eastern province of Saudi Arabia. Am J TropMed Hyg.1995;52:166–8.PMID:7872446

https://doi.org/10.4269/ajtmh.1995.52.166

9. Firooz A, Khatami A, Khamesipour A, Nassiri-Kashani M, Behnia F, Nilforoushzadeh M, et al. Intrale sional injection of 2% zinc sulfate solution in the treatment of acute Old World cutaneous leishmaniasis: arandomized, double-blind, controlled clinical trial. J Drug Dermatol. 2005; 4:73–7. PMID: 15696988 10.

10. Zerehsaz F, Salmanpour R, Handjani F, Ardehali S, Panjehshahin MR, Tabei SZ, etal. A double-blind randomized clinical trial of a topical herbal extract (Z-HE) vs. systemic meglumine antimoniate for the treatment of cutaneous leishmaniasis in Iran. Int J Dermatol. 1999; 38:610–2. PMID: 10487453.

https://doi.org/10.1046/j.1365-4362.1999.00727.x

11. Murray HW, Berman JD, Davies CR, Saravia NG. Advances in leishmaniasis. Lancet.2005;366:1561 77. PMID:16257344.

https://doi.org/10.1016/s0140-6736(05)67629-5

12. Buffet PA, Morizot, G. Cutaneous leishmaniasis in France: towards the end of injectable therapy? Bull Soc Pathol Exot. 2003;96:383–8. PMID: 15015844

13. Armijos RX, Weigel MM, Calvopina M, Mancheno M, Rodriguez R. Comparison of the effectiveness of two topical paromomycin treatments versus meglumine antimoniate for New World cutaneous leish maniasis. Acta Trop. 2004; 91:153–160. PMID: 15234664

https://doi.org/10.1016/j.actatropica.2004.03.009

14. Correia D, Macedo VO, Carvalho EM, Barral A, Magalhaes AV, etal. Comparative study between meglumineantimoniate, pentamidine isothianate and aminosidine sulphate, in the treatment cutaneous primary lesions, caused by Leishmania (Viannia) braziliensis (L(V)b). Rev Soc Bras Med Trop. 1996; 29:447–53. PMID: 8966308

https://doi.org/10.1590/s0037-86821996000500007

15. Hepburn NC, Tidman MJ, Hunter JA Aminosidine (paromomycin) versussodiumstibogluconate for the treatment of American cutaneous leishmaniasis. Trans R Soc Trop Med Hyg. 1994; 88:700–3. PMID:7886779

https://doi.org/10.1016/0035-9203(94)90237-2

16. SotoJ, Fuya P, Herrera R, Berman J. Topical paromomycin/methy lbenzethonium chloride plus parenteral meglumine antimoniate as treatment for American cutaneous leishmaniasis: controlled study. Clin Infect Dis. 1998; 26:56–8. PMID: 9455509.

https://doi.org/10.1086/516267

17. Grog lM, Thomason TN, Franke ED. Drug resistance in leishmaniasis: its implication in systemic The motherapy of cutaneous and mucocutaneous disease. Am J Trop MedHyg.1992;47:117–26.PMID: 1322070.

https://doi.org/10.4269/ajtmh.1992.47.117

18. Hadighi R, Mohebali M, Boucher P, Hajjaran H, Khamesipour A, Ouellette M: Un responsiveness to Glu cantime treatment in Iranian cutaneous leishmaniasis due to drug-resistant Leishmania tropica para sites. PLoS Med. 2006, 3(5):e162. PMID:16605301

https://doi.org/10.1371/journal.pmed.0030162

19. Hadighi R, Boucher P, Khamesipour A, Meamar AR, Roy G, Ouellette M, et al. Glucantime-resistant Leishmania tropica isolated from Iranian patients with cutaneous leishmaniasis are sensitive to alterna tive antileishmanial drugs. Parasitol Res. 2007; 101(5):1319–22. PMID: 17610079

https://doi.org/10.1007/s00436-007-0638-0

20. LópezL, Robayo M, Vargas M, VélezI. Thermotherapy. Analternative for the treatment of American cutaneous leishmaniasis. Trials. 2012; 13:58. PMID: 22594858

https://doi.org/10.1186/1745-6215-13-58.

21. Gonzalez U, Pinart M, Rengifo-Pardo M, Macaya A, AlvarJ, TweedJ A. Interventions for Americancu taneous and mucocutaneous leishmaniasis. Cochrane Database SystRev. 2009; 2:CD004834.

https://doi.org/10.1002/14651858.cd004834

22. Levine N. Cutaneous leishmaniasis treated with controlled localized heating. Arch Dermatol. 1992; 128 (6):759–61. PMID: 1599262

https://doi.org/10.1001/archderm.1992.01680160041003

23. Moreira Rda C, Rebelo JM, Gama ME, Costa JM. Knowledge level about of American tegumentary leishmaniasis (ATL) and use of alternative therapies in an endemic area in the Amazon Region in the State of Maranhao, Brazil. Cad Saude Publica. 2002; 18(1):187–95. PMID: 11910437

24. Aronson N, Wortmann GW, Byrne WR, Howard RS, Bernstein WB, Marovich MA, et al. Arandomized controlled trial of local heat therapy versus intravenous sodium stibogluconate for the treatment of cutaneous Leishmania major infection. PLoS Negl Trop Dis. 2010;9; 4(3):e628. PMID:20231896

https://doi.org/10.1371/journal.pntd. 0000628.

25. Bumb RA, Prasad N, Khandelwal K, Aara N, Mehta RD, Ghiya BC, et al. Long-term efficacy of single dose radiofrequency-induced heat therapy vs. intralesional antimonials for cutaneous leishmaniasis in India. Br J Dermatol. 2013; 168(5):1114–9. PMID: 23298394

https://doi.org/10.1111/bjd.12205

26. Navin TR, Arana BA, Arana FE, Berman JD, Chajón JF. Placebo-controlled clinical trial of meglumine antimoniate (Glucantime) vs localized controlled heat in the treatment of cutaneous leishmaniasis in Guatemala. Am J Trop Med Hyg. 1990;42(1):43–50.

https://doi.org/10.4269/ajtmh.1990.42.43

27. Soto J, Toledo J, Valda L, Balderrama M, Soto P, Berman J. Treatment of Bolivian mucosal leishmaniasis with miltefosine. Clin Infect Dis. 1993;36(9):1155–61.

https://doi.org/10.1086/510588

28. López- Carvajal L, Holguín-Ruiz F, Cardona-Arias J. Efficacy and safety of thermotherapy in the treatment of cutaneous leishmaniasis: meta-analysis. Rev Soc Bras Med Trop. 2018;51(2):148–56.

29. Monge- Maillo B, López-Vélez R. Therapeutic options for old world cutaneous leishmaniasis and new world cutaneous and mucocutaneous leishmaniasis. Drugs. 2013;73(17):1889–920.

https://doi.org/10.1007/s40265-013-0132-1

30. Reithinger R, Mohsen M, Wahid M, Bismullah M, Quinnell RJ, Davies CR, Kolaczinski JH. Efficacy of thermotherapy to treat cutaneous leishmaniasis caused by Leishmania tropica in Kabul, Afghanistan: a randomized, controlled trial. Clin Infect Dis. 2005;40(8):1148–55.

https://doi.org/10.1086/428736

31. Berman JD, Lee LS, Waddell RD, Hanson BD, Sarefa N, Oster CN. Clinical studies of heat treatment for cutaneous leishmaniasis. J Infect Dis. 1998;158(6):1539–42.

32. Krause G, Kroeger A. Topical treatment of cutaneous leishmaniasis with meglumine antimoniate and heat: a randomized controlled trial in Honduras. Lancet. 1994;344(8935):1230–4.

https://doi.org/10.1086/520249

33. Vélez ID, Gilchrist K, Martinez S, Ramírez-Pineda JR, Robledo SM, Carrillo LM. Thermotherapy for cutaneous leishmaniasis caused by Leishmania panamensis in Colombia: a randomized controlled trial. PLoS Negl Trop Dis. 2015;9(5):e0003605.

34. Aronson NE, Wortmann GW, Byrne WR, Howard RS, Berman JD. Safety and efficacy of a heat device for the treatment of cutaneous leishmaniasis. Am J Trop Med Hyg. 1998;59(5):724–7.

35. Sacks DL, Melby PC. Animal models for the analysis of immune responses to leishmaniasis. Curr Protoc Immunol. 2011;Chapter 19:Unit 19.2.

https://doi.org/10.1002/0471142735.im1902s28

36. WHO Expert Committee on the Control of Leishmaniases. Control of the leishmaniases: report of a WHO expert committee. World Health Organ Tech Rep Ser. 2010;(949):1–186.