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    Apr 11, 2021
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    Failure of an Innovative Low-Cost, Noninvasive Thermotherapy Device for Treating Cutaneous Leishmaniasis Caused by in Pakistan.

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    Kamink et al 2019 Failure of an ...
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    Authors
    Kamink, S
    Abdi, A
    Kamau, C
    Ashraf, S
    Ansari, MA
    Qureshi, NA
    Schallig, H
    Grobusch, MB
    Fernhout, J
    Ritmeijer, K
    Issue Date
    2019-10-07
    Submitted date
    2019-11-08
    
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    Journal
    American Journal of Tropical Medicine and Hygiene
    Abstract
    Cutaneous leishmaniasis (CL), a neglected parasitic skin disease, is endemic in Pakistan, where Leishmania tropica and Leishmania major are the causative protozoan species. Standard treatment with antimonial injections is long, painful, and costly; has toxic side effects; and is not always available in public hospitals. Small pilot studies have previously evaluated a low-cost and noninvasive hand-held exothermic crystallization thermotherapy (HECT-CL) device. We aimed to further establish the effectiveness, safety, and feasibility of HECT-CL in L. tropica. In a prospective observational study, patients with parasitological confirmation of CL were treated using the HECT-CL heat pack for 3 minutes with an initial temperature of 52-53°C for 7 consecutive days. Dried blood spot samples were taken for species identification by PCR. Effectiveness was assessed by using medical photographs and measurements of the lesion size at baseline and subsequent follow-up visits, for up to 180 days. We intended to enroll 317 patients. The HECT-CL treatment was easy to apply and well tolerated. Species identification demonstrated the presence of L. tropica. Interim analysis of 56 patients showed a failure rate of 91% at follow-up (median 45 days after treatment, interquartile range 30-60 days). Enrollment of patients was prematurely suspended because of futility. This study showed a high failure rate for HECT-CL thermotherapy in this setting. Leishmania tropica is known to be less sensitive to antileishmanial drugs, more temperature-resistant, and spontaneous healing is slower than that in L. major. More research is needed to identify low-cost, effective, and more patient-friendly treatment for L. tropica.
    Publisher
    The American Society of Tropical Medicine and Hygiene
    URI
    http://hdl.handle.net/10144/619509
    DOI
    10.4269/ajtmh.19-0430
    PubMed ID
    31595864
    Language
    en
    ISSN
    1476-1645
    ae974a485f413a2113503eed53cd6c53
    10.4269/ajtmh.19-0430
    Scopus Count
    Collections
    Leishmaniasis/Kala Azar

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