Efficacy of cryotherapy for the treatment of cutaneous leishmaniasis: meta-analyses of clinical trials

BACKGROUND: Cryotherapy is a local treatment for cutaneous leishmaniasis with variable efficacy and greater safety than conventional treatment. The objective of this study is to evaluate the efficacy and safety of cryotherapy for the treatment of cutaneous leishmaniasis and to compare it with pentavalent antimonials. METHODS: A meta-analysis based on a search of nine databases with eight strategies was conducted. Inclusion and exclusion criteria were applied, the methodological quality of each article was evaluated, and the reproducibility of the study selection and information extraction from each clinical trial was assured. The per lesion and per patient efficacy was calculated, and a meta-analysis of relative risks with the random effects model and the Dersimonian and Laird's, Begg, and Egger tests, along with a sensitivity analysis, were performed. A meta-regression based on the methodological quality of the trials included was also performed. RESULTS: Eight studies were included in which respective per lesion efficacies of 67.3 % and 67.7 % were reported for cryotherapy and pentavalent antimonials. In 271 patients treated with cryotherapy and in 199 with pentavalent antimonials, respective per protocol and intent to treat efficacies of 63.6 % and 54.2 % were found in the first group, and per protocol and intent to treat efficacies of 74.7 % and 68.3 % were found in the second group. The relative risk for the comparison of efficacy in the two groups was 0.73 (0.42–1.29). The results of the sensitivity analysis and the meta-regression analysis of relative risks were statistically equal to the overall results. CONCLUSION: This investigation provides evidence in favor of the use of cryotherapy given that its efficacy is similar to that of pentavalent antimonials. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12879-016-1663-3) contains supplementary material, which is available to authorized users

Three research perspectives on transmission related risk factors for cutaneous leishmaniasis in Costa Rica

In IDL-1097

Educação em saúde: ensinando sobre a leishmaniose tegumentar americana Health education: teaching about American tegumentary leishmaniasis

Os conhecimentos sobre a circulação da leishmaniose tegumentar americana (LTA), assim como sua percepção pela população local, são de grande valia para o estabelecimento de campanhas de controle, pois mobiliza a comunidade em ações sanitárias. Este trabalho teve como objetivo esclarecer alunos e professores do ensino fundamental (1ª a 4ª série) das Escolas Municipais de Maricá sobre a LTA, por meio de palestras, cartazes e cartilhas com atividades, visando à conscientização do grupo. Em sete Escolas Municipais, foram ministradas palestras e atividades a 1.314 alunos do ensino fundamental e 56 professores. Foram também distribuídas cartilhas aos alunos com atividades para a fixação do assunto. Após dois meses, uma escola foi eleita para avaliação (Escola E), sendo que, dos 213 alunos que assistiram a palestra, 198 responderam ao questionário, 178 (89,9%) lembravam da doença, e 125 (63,1%) responderam corretamente como ocorria a transmissão. Assim, crianças e professores informados podem funcionar como difusores da informação em Saúde na sua comunidade, sendo capazes de atuar de forma relevante no controle de endemias.<br>Knowledge on the circulation of American tegumentary leishmaniasis (ATL) and perception by the local population are highly relevant for developing a control program, since they mobilize the community for effective health measures. This work aimed to orient primary school teachers and pupils (grades 1 through 4) in the public school system in Maricá, Rio de Janeiro State, Brazil, on ATL, using talks, posters, and leaflets with an interactive approach. Talks were given in seven municipal schools, and activities were held with 1,314 pupils and 56 teachers. Leaflets were distributed to the pupils with activities to help consolidate the content. Two months later one school was chosen for post-evaluation. Of the 213 pupils who had attended the talk, 198 answered a questionnaire, of whom 178 (89.9%) could remember the disease and 125 (63.1%) provided correct answers on transmission. Thus, informed children and teachers can function as information disseminators in health within their community and are therefore capable of contributing to control of endemic diseases

Leishmaniasis-Vector Surveillance and Control in Brazil: A Challenge to Control Programs

This is the first English-language book dedicated to Brazilian sand flies and their medical importance. No other country has so many species of these haematophagous insects as Brazil and their diversity has reached an astonishing level. The book contains comprehensive chapters, written by Brazilian experts on their regional distribution, their ecology and their importance as vectors of pathogens and parasites. Methods for sampling, processing and preserving phlebotomines are reviewed as are perspectives on surveillance and leishmaniasis vector control. A novel classification is presented whose aim is to help investigators identify the species that they are working with more efficiently.Fil: Maia Elkhoury, Ana Nilce S.. Pan American Health Organization; BrasilFil: Albuquerque, Rafaella. Ministry of Health. Communicable Diseases General Office; BrasilFil: Salomón, Oscar Daniel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste; Argentina. Ministerio de Salud. Instituto Nacional de Medicina Tropical; Argentin