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Abstract：
BACKGROUND: American Cutaneous Leishmaniasis (ACL) shows variable response to therapy, but data on species-specific treatment efficacy is scarce. We describe the clinical characteristics and outcome of patients with ACL imported to a tertiary centre in Germany and determine whether species-specific therapy according to the 2014 \"LeishMan\" group recommendations is associated with cure.
METHODS: A retrospective chart review was conducted at the Charité Institute of International Health in Berlin. We analysed data on PCR-confirmed ACL cases collected between 2000 and 2023. Systemic therapy included liposomal amphotericin B, miltefosine, pentavalent antimony, ketoconazole or itraconazole. Localized therapy included perilesional pentavalent antimony or paromomycin ointment. Cure was defined as re-epithelialization of ulcers or disappearance of papular-nodular lesions after 3 months of treatment. Logistic regression models were used to quantify the effect of species-specific systemic therapy on the outcome.
RESULTS: 75 cases were analysed. Most patients were male (62%), median age was 35 years, no patient had a history of immunosuppression. The most common reason for travel was tourism (60%), the most common destination was Costa Rica (28%), the median duration of illness was 8 weeks, and most patients presented with ulcers (87%). Lesions were complex in 43%. The most common Leishmania (L.) species was L. braziliensis (28%), followed by L. panamensis (21%). 51/73 (70%) patients were cured after initial therapy and 17/21 (81%) after secondary therapy. Cure after systemic therapy was more frequent when species-specific treatment recommendations were followed (33/45; 73%), compared to when not followed, (6/17; 35%, P = 0.008). This association was independent of age, sex, previous therapy, complex lesions, and Leishmania species (adjusted OR, 5.06; 95% CI, 1.22-24.16).
CONCLUSIONS: ACL is a rare, imported disease in Germany. Complex lesions were common, challenging successful therapy. This study highlights the importance of identifying the parasite species and suggests that a species-specific approach to treatment leads to better outcomes.
METHODS: A retrospective chart review was conducted at the Charité Institute of International Health in Berlin. We analysed data on PCR-confirmed ACL cases collected between 2000 and 2023. Systemic therapy included liposomal amphotericin B, miltefosine, pentavalent antimony, ketoconazole or itraconazole. Localized therapy included perilesional pentavalent antimony or paromomycin ointment. Cure was defined as re-epithelialization of ulcers or disappearance of papular-nodular lesions after 3 months of treatment. Logistic regression models were used to quantify the effect of species-specific systemic therapy on the outcome.
RESULTS: 75 cases were analysed. Most patients were male (62%), median age was 35 years, no patient had a history of immunosuppression. The most common reason for travel was tourism (60%), the most common destination was Costa Rica (28%), the median duration of illness was 8 weeks, and most patients presented with ulcers (87%). Lesions were complex in 43%. The most common Leishmania (L.) species was L. braziliensis (28%), followed by L. panamensis (21%). 51/73 (70%) patients were cured after initial therapy and 17/21 (81%) after secondary therapy. Cure after systemic therapy was more frequent when species-specific treatment recommendations were followed (33/45; 73%), compared to when not followed, (6/17; 35%, P = 0.008). This association was independent of age, sex, previous therapy, complex lesions, and Leishmania species (adjusted OR, 5.06; 95% CI, 1.22-24.16).
CONCLUSIONS: ACL is a rare, imported disease in Germany. Complex lesions were common, challenging successful therapy. This study highlights the importance of identifying the parasite species and suggests that a species-specific approach to treatment leads to better outcomes.
摘要：
背景：美国皮肤利什曼病（ACL）对治疗的反应不同，但是关于物种特异性治疗效果的数据很少。我们描述了进口到德国三级中心的ACL患者的临床特征和结果，并根据2014年“LeishMan”小组建议确定物种特异性治疗是否与治愈相关。
方法：在柏林的Charité国际卫生研究所进行了回顾性图表审查。我们分析了2000年至2023年之间收集的PCR确认ACL病例的数据。全身治疗包括脂质体两性霉素B，米替福辛,五价锑,酮康唑或伊曲康唑。局部治疗包括外周五价锑或巴龙霉素软膏。治愈定义为治疗3个月后溃疡再上皮化或丘疹结节病变消失。使用Logistic回归模型来量化物种特异性全身治疗对结果的影响。
结果：75例。大多数患者为男性（62%），中位年龄为35岁,无患者有免疫抑制史.旅行的最常见原因是旅游（60％），最常见的目的地是哥斯达黎加（28％），中位病程为8周,大多数患者出现溃疡（87％）。43％的病变复杂。最常见的利什曼原虫（L.)种为巴西乳杆菌(28%)，其次是L.panamensis（21%）。51/73（70％）患者在初始治疗后治愈，17/21（81％）在二次治疗后治愈。当遵循特定物种的治疗建议时，全身治疗后的治愈频率更高（33/45;73％），与未遵循的情况相比，（6/17；35%，P=0.008)。这种联系与年龄无关，性别,以前的治疗，复杂的病变，和利什曼原虫种类(调整后的OR，5.06；95%CI，1.22-24.16）。
结论：ACL是一种罕见的，进口疾病在德国。复杂的病变很常见，具有挑战性的成功治疗。这项研究强调了识别寄生虫物种的重要性，并表明特定物种的治疗方法可以带来更好的结果。
方法：在柏林的Charité国际卫生研究所进行了回顾性图表审查。我们分析了2000年至2023年之间收集的PCR确认ACL病例的数据。全身治疗包括脂质体两性霉素B，米替福辛,五价锑,酮康唑或伊曲康唑。局部治疗包括外周五价锑或巴龙霉素软膏。治愈定义为治疗3个月后溃疡再上皮化或丘疹结节病变消失。使用Logistic回归模型来量化物种特异性全身治疗对结果的影响。
结果：75例。大多数患者为男性（62%），中位年龄为35岁,无患者有免疫抑制史.旅行的最常见原因是旅游（60％），最常见的目的地是哥斯达黎加（28％），中位病程为8周,大多数患者出现溃疡（87％）。43％的病变复杂。最常见的利什曼原虫（L.)种为巴西乳杆菌(28%)，其次是L.panamensis（21%）。51/73（70％）患者在初始治疗后治愈，17/21（81％）在二次治疗后治愈。当遵循特定物种的治疗建议时，全身治疗后的治愈频率更高（33/45;73％），与未遵循的情况相比，（6/17；35%，P=0.008)。这种联系与年龄无关，性别,以前的治疗，复杂的病变，和利什曼原虫种类(调整后的OR，5.06；95%CI，1.22-24.16）。
结论：ACL是一种罕见的，进口疾病在德国。复杂的病变很常见，具有挑战性的成功治疗。这项研究强调了识别寄生虫物种的重要性，并表明特定物种的治疗方法可以带来更好的结果。
