Intralesional pentostam versus intralesional metronidazole in treating cutaneous leishmaniasis: A comparison study
Background and objectives: Cutaneous leishmaniasis can be classified into two different syndromes; New World and Old World. The later is acquired in Asia, Africa, the Middle East, or Europe. This study aimed to compare the effectiveness of intralesional pentostam with intralesional metronidazole in the treatment of cutaneous leishmaniasis.
Methods: An analytical observational study was carried out in the Dermatology Consultancy Department of Erbil Teaching Hospital in Erbil city from April to October 2017. A convenience sampling method was used to recruit 50 study participants who were diagnosed with having cutaneous leishmaniasis. A questionnaire was designed for data collection, and the size with the degree of in duration of the cutaneous lesions was measured. Patients received three injections of either intralesional pentostam or intralesional metronidazole on a two-weekly basis.
Results: The mean ± SD age of the participants was 32.38 ± 15.05 years. Most of the participants were male (72%). The mean diameter difference ± SD after receiving three intralesional injections on a two-weekly basis was 0.7692 ± 0.62017 cm for pentostam, compared to 0.4211 ± 0.62413 cm for metronidazole (P = 0.070).The mean difference in lesion's induration ± SD was 0.9091 ± 0.83121 for pentostam, compared to 0.6875 ± 0.70415 for metronidazole (P = 0.128).
Conclusion: Intralesional injection with metronidazole has shown some degree of cure in terms of decrease in the size and induration of the lesions. Although statistically insignificant, intralesional injection of metronidazole was less effective than intralesional injection of pentostam. Further studies are needed with a larger sample size to better understand the effectiveness of metronidazole in the treatment of cutaneous leishmaniasis.
WHO. Leishmaniasis. Fact sheet, April 2017. (Accessed on November 20, 2017, at http://www.who.int/mediacentre/factsheets/fs375/en/). 2. Downing C, Tyring S. Parasitic diseases. In: Griffiths C, Barker J, Blelker T, Chalmers R, Creamer D editors. Rook's Textbook of Dermatology. 9th ed. UK: John Wiley & Sons, Ltd; 2016. P. 1058–69.
Alvar J, Velez ID, Bern C, Herrero M, Desjeux P, Cano J et al. Leishmaniasis worldwide and global estimates of its incidence. PLoS One 2012; 7(5):e35671.
Lee SA, Hasbun R. Therapy of cutaneous leishmaniasis. Int J Infect Dis 2003; 7:86–93.
Malek JM, Ghosn SH. Leishmaniasis and other protozoan infections. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K editors. Fitzpatrick's Dermatology in General Medicine. 8th ed. United States: The McGraw-Hill Companies; 2012. P. 2527–37.
Al-Hassnawi HH, Al-Saeed MS, Al-Yassari HF, Al-Qaysi SI. The use of intralesional metronidazole in the treatment of cutaneous leishmaniasis. Med J Babylon 2006; 3(4):260–4.
Aronson N, Herwaldt BL, Libman M, Pearson R, Lopez-Velez R, Weina P, et al. Guidelines diagnosis and treatment of leishmaniasis: Clinical practice guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH). Am J Trop Med Hyg 2017; 96(1):24–45.
Faber WR, Oskam L, VanGool T, Kroon NC, Knegt-Junk KJ, Hofwegen H, et al. Value of diagnostic techniques for cutaneous leishmaniasis. J AM Acad Dermatol 2003; 49:70–4.
Markle WH, Makhoul K. Cutaneous leishmaniasis: Recognition and treatment. Am Fam Physician 2004; 69(6):1455–60.
Mendonça-Filho RR, Rodrigues IA, Alviano DS, Santos AL, Soares RM, Alviano CS, et al. Leishmanicidal activity of poly-phenolic-rich extract from husk fiber of Co-cos nucifera Linn (Palmae). Res Microbiol 2004; 155(3):136–43.
Salman MT, Khan RA, Shukla I. Antibac-terial Activity of Nigella sativa Linn. Seed oil against multi-drug resistant bacteria from clinical isolates. Nat Prod Radiance 2008; 7(1):10–4.
Mapar MA, Omidian M. Intralesional injections of metronidazole versus meglumineantimoniate for the treatment of cutaneous leishmaniasis. Jundishapur J Microbiol 2010; 3(2):79–83.
Khademvatan S, Salmanzadeh S, Foroutan-Rad M, Bigdeli S, Hedayati-Rad F, Saki J, et al. Spatial distribution and epidemiological features of cutaneous leishmaniasis in Southwest of Iran. Alexandria J Med 2017; 53:93–8.
Norouzinezhad F, Ghaffari F, Norouzinejad A, Kaveh F, Gouya MM. Cutaneous leishmaniasis in Iran: Results from an epidemiological study in urban and rural provinces. Asian Pac J Trop Biomed 2016; 6(7):614–9.
Al-Tawfiq JA, Abukhamsin A. Cutaneous leishmaniasis: A 46-year study of the epidemiology and clinical features in Saudi Arabia (1956-2002). Int J Infect Dis 2004; 8:244–50.
Khan W, Zakai HA. Epidemiology, pathology and treatment of cutaneous leishmaniasis in Ta'if region of Saudi Arabia. Iran J Parasitol 2014; 9:365–73.
Kellapatha IP, Wijesinghe WAMS, Ranatunga RAWC, Athapathu W, Bandara MRCK, Sumanasena JAMB, et al. Randomized double blind study on efficacy of intralesional metronidazole versus intralesional sodium stibogluconate in cutaneous leishmaniasis. AMJ 2015; 9(2 Supp):S03
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The copyright on any article published in Zanco J Med Sci is retained by the author(s) in agreement with the Creative Commons Attribution Non-Commercial ShareAlike License (CC BY-NC-SA 4.0).