Improving the evidence base for diagnosis and management of cutaneous leishmaniasis in Ethiopia

Cutaneous Leishmaniasis (CL) is a neglected tropical disease caused by infected sandflies, leading to skin lesions that may inflict significant psychosocial suffering. Different Leismania species are present in different parts of the world, and Leishmania aethiopica is the main species causing CL in the Ethiopian highlands. Although the disease is common in Ethiopia, and L. aethiopica is known to cause severe and poorly healing lesions, evidence for diagnosis and treatment is very limited. In practice, diagnosis usually relies on invasive skin samples, which are tested using microscopy which has limited sensitivity. Treatment is mostly done using a class of toxic drugs called antimonials, while patients with smaller lesions are often not treated. In this project we aim to generate evidence on diagnosis and treatment that can be used to improve management for CL in Ethiopia. Study activities will be carried out in two specialized Leishmania treatment centers in Gondar and Boru Meda. We will carry out a diagnostic study investigating less invasive sampling techniques as well as new diagnostic techniques. We will use information from this study to develop a clinical prediction score and diagnostic algorithm to guide who should be tested and which test should be used. The clinical impact of this algorithm will also be assessed. A topical treatment option for localized CL will be piloted in a community based clinical trial. Evidence for the use of miltefosine- a promising oral and safer alternative for antimonials will also be generated in an observational study including both adults and children with complicated CL.

Trefwoorden:B780-tropische-geneeskunde