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Article Dans Une Revue PLoS Neglected Tropical Diseases Année : 2023

Self-application of aminoglycoside-based creams to treat cutaneous leishmaniasis in travelers

Oussama Mouri
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Romain Guery
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Alice Pérignon
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Marc Thellier
Emmanuelle Bourrat
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Résumé

Background: In endemic foci, the use of an aquaphilic cream containing paromomycin with/without gentamicin to treat cutaneous leishmaniasis (CL) is safe, painless and cures 78-82% of patients with New and Old World CL. Self-application in travelers requires evaluation.Methods: Travelers with 1-10 lesions of confirmed CL were prospectively treated with the paromomycin-gentamicin formulation (WR279396, 2012-2017, Group 1) and carefully follow up, or treated with a locally produced paromomycin-only cream (2018-2022, Group 2). The cream was applied once under supervision, then self-applied daily for 20-30 days. A cured lesion was defined as 100% re-epithelialization at day 42 without relapse at three months. Results: Medical features were similar in Group 1 (17 patients), and Group 2 (23 patients). Patients were infected with either Leishmania major, L. infantum, L. killicki, L. guyanensis, L. braziliensis, or L. naiffi. Intention-to-treat and per-protocol cure rates were 82% (95% confidence interval (CI) [64.23;100.00]) and 87% (95% CI [71,29;100.00]) in Group 1, and 69% (95% CI [50.76; 88.37]) and 76% (95% CI [57.97; 94.41]) in Group 2. In the pooled Group 1 and 2, 75% (95% CI [61.58;88.42]) (30/40) and 81% (95% CI [68,46;93.6]) (30/37) of patients were cured in intention-to-treat and per-protocol, respectively. There were no significant differences observed in the success rates between Old World and New World CL (83.3% vs. 60%, p = 0.14). Prospective observations in Group 1 showed that adverse events were mainly pruritus (24%) and pain (18%) on lesions (all mild or moderate). No mucosal involvement was observed in either group.Discussion: In this representative population of travelers who acquired CL either in the Old or New World, the 81% per-protocol cure rate of a self-applied aminoglycoside cream was similar to that observed in clinical trials.
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hal-04197812 , version 1 (06-09-2023)

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Oussama Mouri, Clea Melenotte, Romain Guery, Camille Cotteret, Arnaud Schweitzer-Chaput, et al.. Self-application of aminoglycoside-based creams to treat cutaneous leishmaniasis in travelers. PLoS Neglected Tropical Diseases, 2023, 17 (8), pp.e0011492. ⟨10.1371/journal.pntd.0011492⟩. ⟨hal-04197812⟩
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