Diffuse cutaneous leishmaniasis in ethiopia: II Treatment

Abstract

The treatment of 33 cases of diffuse cutaneous leishmaniasis in Ethiopia is presented. Pentamidine isethionate and amphotericin B have proved the two drugs to which the parasite is consistantly sensitive. Both are seriously toxic and better drugs are needed. Weekly or fortnightly pentamidine at the lowest dose that will produce a response is probably the best treatment; the glucose tolerance test should be performed weekly. Antimonals are usually ineffective but N-methylglucamine antimoniate shows some activity in high, approaching toxic, doses. The apparent effect of chloroquine may be due to its anti-inflammatory properties. Cycloguanil pamoate, primaquine and its analogue 349-C59 and macrocyclon may be useful if given in much higher doses than generally recommended. Toxic effects of these drugs have not so far been encountered. Relapse almost inevitably follows treatment and can occur repeatedly and up to 15 months later. Treatment must be repeated or prolonged for several months after the apparent elimination of the parasite in order to achieve cure. Before the patient is “cured,” the disease in relapse usually shows a tuberculoid histology and is accompanied by a positive leishmanin test, after which a further course of any effective drug will “cure” him. Without such an immune conversion it is very difficult to cure the patient.