Oral rifampicin in cases of cutaneous leishmaniasis with multiple lesions (A pilot study)

Introduction

Cutaneous leishmaniasis is a protozoan disease caused by different species of leishmania. The clinical manifestations of the disease vary depending upon species of leishmania and host′s immune response to the parasite.[1] The patients with multiple lesions refrain from established intralesional therapies with sodium antiomony gluconate or berberine sulphate. Various oral therapies like ketoconazole,[2] itraconazole,[3] terbinafine[4] etc have been tried with variable response. Vasquez[5] used rifampicin orally in cutaneous leishmaniasis with promising results.

Materials and Methods

Twelve patients of age ranging between 11 - 50 years, out of which 9 males and 3 females, were included in the present study. They were having more than three lesions of more than 2 months duration. All patients were positive for LT bodies in skin smear. They did not have any treatment in the past. Pregnant or lactating females, elderly, debilitated patients or patients having concomitant hepatic pathology were not included in the study.

Morphology of the lesions varied from nodules, plaques and ulcerated plaques, mainly on the exposed parts of body. Routine haemogram and LFTs were done prior to therapy. History, clinical descriptions, progress etc were recorded on the initial visit and weekly follow-ups in printed proforma. Patients were given rifampicin in the dose of 20mg/ kg body weight in two divided doses for four weeks. They were called for weekly follow up for 4 weeks then fortnightly for 3 months and lastly at the end of 6 months.

Results

All the twelve patients completed the study. Out of 12, eight patients (66.6%) showed complete healing after 6 weeks, whereas in two patients (16.6%) at the end of 8 weeks. All ten patients were smear negative after 6 weeks. Two persons did not show any response both clinically and parasitologically. The ten patients who showed complete clinical cure, the healing did not leave any scar, only hyperpigmented patches were left.

There was no intolerable side effect so as to discontinue the therapy except red orange colouring of urine. Three patients felt loss of appetite after 2 weeks of therapy. None of the patients showed any abnormality in laboratory investigations after four weeks of therapy.

Discussion

Cutaneous leishmaniasis is the vector born disease prevalent in this area as an endemic. Many of the patients develop multiple lesions on the exposed parts of the body. Therapeutic modality of intralesional injections of sodium antimony gluconate or berberine sulfate is cumbersome to the patients with multiple lesions. Rifampicin is well tolerated microbicidal drug acting at p450 cytochrome of the organism′s metabolism with minimal side effects.

The observations made in our study show promising results in 10 out of 12 (83.3%) showing parasitological cure and complete clinical recovery after 4 weeks of therapy. More so with no scar marks at the site of the lesions.

We propose the use of oral rifampicin to be given in 20mg/kg body weight BID dose schedule for the cases with multiple lesions of cutaneous leishmaniasis. The statement requires to be substantiated in larger group of populations after this pilot study.