Improving the evidence base for diagnosis and management of cutaneous leishmaniasis

Cutaneous leishmaniasis (CL) is an infectious skin disease causing chronic lesions which can lead to significant psychosocial harm. In Ethiopia, most patients are diagnosed with microscopy on a painful skin sample, which also misses a substantial number of cases. No uniform treatment practices exist, making it hard to recommend certain regimens. We showed that less-invasive methods to collect a skin sample are just as good, but less painful than the routinely used tools when using PCR. We tried the only available rapid test for CL in Ethiopia, but unfortunately, it detected only around 30% of all cases. We documented routine treatment practices for CL in Ethiopia, and showed that many patients need multiple months of treatment and outcomes are poor. Additionally, drug shortages were common and there were insufficient beds to treat all patients. Miltefosine, a drug in tablet form which could be given outside of the hospital was tried for the first time in Ethiopia. Skin lesions rapidly improved, but the effects of treatment were not sustained, with only around 50% of patients cured after six months. We also tried to treat patients with miltefosine and cryotherapy in a highly endemic village in Ethiopia. There also, only around half the patients were cured. These results indicate that there are no clear cut solutions that can be implemented to improve diagnosis and treatment for CL in Ethiopia. Due to diagnostic uncertainty , poor treatment outcomes and a non-fatal disease, it is vital that doctors carefully weigh the harms and benefits before initiating treatment.