, Age and Sex: All ages are affected in 5/9 sites. Men represent approximately two-thirds of patients at 5 sites and 90% at another one, while the other 3 sites have almost equal representation of women and men. Endemicity: All sites have stable transmission Setting: Patients seen at 4/9 sites are from both rural and periurban settings, 4 rural and one periurban. Seasonality: Cases are seen all year-round in all sites, some with seasonal peaks. Number of lesions: Patients tend to present with single or few (up to 3) lesions. Morphology and duration of lesions: Ulcerated lesions predominate at all sites. Other manifestations include lymphangitis (5-35% at 8/9 sites), MCL (3 sites) and DCL (2 sites). Patients present with lesions that have lasted from 3 weeks to 5 months, Seasonality: Cases are seen mostly in fall and winter at 7/10 sites with variable durations. Year-round transmission occurs in Ethiopia. Number of lesions: Patients tend to present with few (1-2) lesions at 4 sites. Several lesions (>5) are seen in Afghanistan (L. tropica) and Burkina-Faso (L. major)
, Choice of treatment may depend on the number of lesions (IL if less than 5 lesions, otherwise IM in Burkina-Faso) or species (IM antimonials are given daily for 14 days in case of L. major and 21 if L. tropica at one site in Iran). In addition, local antiseptics are regularly applied at 2 sites. Cryotherapy and/or thermotherapy are also used at 5 sites (alone or combined with IL injections). Other medications available are liposomal amphotericin B (2 sites in Iran), paromomycin and oral miltefosine at one site in Ethiopia. Duration of follow-up: Practice varies greatly, mg/kg/day for 14-30 days is used at 8/9 sites
, Second-line treatment consists of amphotericin B deoxycholate at 3 sites, oral miltefosine (2 sites), or pentamidine (1 site). Intra-lesional antimonials are used only in one site in Colombia and one in Brazil. Duration of follow-up: Six (6) sites follow patients up for 6 months, mg/kg/day for 20 days is used at all sites
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URL : https://hal.archives-ouvertes.fr/hal-01613478
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