Risk factors and histopathological profile for unresponsivecases with anthroponotic cutaneous leishmaniasis: A case-control studyon treatment outcome

Background and Aim : Negligible data are present related to anthroponotic cutaneousleishmaniasis (ACL) treatment outcome and resultant unresponsiveness risk determinants. Overthe last years, there has been a remarkable increase in the number of unresponsive patients withACL reported worldwide. The primary objective of this study was to explore the role ofdemographic, clinical and environmental risk related-factors in the development of treatmentfailure, relapse and chronic cases compared to responsive patients with ACL. Moreover,molecular, histopathological and immunohistochemical (IHC) findings between these forms wereexplored.Methods : This work was undertaken as a prospective and case-control study in southeastern Iran.Culture media and nested PCR were used to identify the causative agent. Univariate multinomialand multiple multinomial logistic regression models and the backward elimination stepwisemethod were applied to analyze the data. A P<۰.۰۵ was defined as significant. Also, for differentgroups, skin punch biopsies were used to study the histopathological and immunohistochemical(IHC) profile.Results : All samples showed that L. tropica was the only etiological agent in all unresponsive andresponsive patients with ACL. Data analysis represented that ۸ major risk factors includingnationality, age groups, occupation, marital status, history of chronic diseases, duration of thelesion, the lesion on face and presence of domestic animals in the house were significantlyassociated with the induction of unresponsive forms. The histopathological andimmunohistochemical findings were different from one form to another.Conclusion : Poor treatment adherence has a strong negative impact on treatment outcomes.Regular monitoring of unresponsiveness to drugs and recognition of leading factors linked withchronic, treatment failure and relapse forms of ACL is crucial for proper prophylactic andtherapeutic strategic plans. The present findings clearly showed a positive association betweenACL and distinct demographic, clinical and environmental risk determinants. Also, thehistopathological and immunohistochemical findings will be helpful to improve our knowlegeabout the several clinical forms of ACL and its diverse histophatogical changes. Therefore, toovercome this serious public health problem, clinical practitioners and health surveillance staffshould be aware of and monitor such perplexing factors to be able to achieve a comprehensivecontrol program and treatment strategy.

کلیدواژه ها:

Risk factors ، Unresponsive ، Treatment ، Leishmaniasis ، Case-control study