Treatment outcomes of cutaneous leishmaniasis due to Leishmania aethiopica: A systematic review and meta-analysis

Abebaw Yeshambel Alemu; Lemma Derseh; Mirgissa Kaba; Endalamaw Gadisa; Kassahun Alemu

doi:10.1371/journal.pone.0293529

Treatment outcomes of cutaneous leishmaniasis due to Leishmania aethiopica: A systematic review and meta-analysis

PLoS One. 2023 Nov 2;18(11):e0293529. doi: 10.1371/journal.pone.0293529. eCollection 2023.

Authors

Abebaw Yeshambel Alemu^{1

2

3}, Lemma Derseh², Mirgissa Kaba⁴, Endalamaw Gadisa³, Kassahun Alemu²

Affiliations

¹ Department of Pediatrics and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia.
² Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
³ Armauer Hansen Research Institute, Addis Ababa, Ethiopia.
⁴ School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.

Abstract

Background: Leishmania aethiopica is a unique species that causes cutaneous leishmaniasis (CL), and studies evaluating treatment outcomes for this condition reported inconsistent findings. This study aimed to summarize the evidence on treatment outcomes of CL caused by L. aethiopica to support decisions or propose further study.

Methods: We searched PubMed, Scopus, and ScienceDirect. In addition, we searched grey literature on Google Scholar and performed manual searching on the reference list of articles. Two authors did the screening, selection, critical appraisal, and data extraction. With the narrative synthesis of evidence, we performed a random effects model meta-analysis using the metaprop package in Stata 17. We did sensitivity and subgroup analyses after assessing heterogeneity using the I-squared test and forest plots. The funnel plot and Egger's test were used to assess publication bias.

Results: The review included 22 studies with 808 participants, and the meta-analysis included seven studies with 677 participants. Most studies documented treatment outcomes with antimonial monotherapy, and only one study reported outcomes with combination therapy. The overall pooled proportion of cure was 63% (95% CI: 38-86%). In the subgroup analysis, systemic antimonial monotherapy showed a cure rate of 61%, and the proportion of cure was 87% with topical therapy. Topical therapy showed a better cure for the localized clinical phenotype. A cohort study documented a cure rate of 94.8% with combination therapy for the localized, mucocutaneous, and diffuse clinical phenotypes. The pooled proportion of unfavourable outcomes was partial response (19%), relapse (17%), discontinuation (19%), and unresponsiveness (6%).

Conclusions: The pooled proportion of cure is low with antimonial monotherapy. Despite limited evidence, combination therapies are a promising treatment option for all clinical phenotypes of CL caused by L. aethiopica. Future high-quality randomized control trials are needed to identify effective monotherapies and evaluate the effectiveness of combination therapies.

Copyright: © 2023 Alemu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication types

Meta-Analysis
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Cohort Studies
Combined Modality Therapy
Humans
Leishmania*
Leishmaniasis, Cutaneous* / drug therapy
Treatment Outcome

Grants and funding

The author(s) received no specific funding for this work. However, the Skin Health Africa Research Program project financially supported the first author in the form of a student stipend, but the project did not decide on the design, analysis and reporting of this study.