Novel low-cost thermotherapy for cutaneous leishmaniasis in Peru

Braulio M Valencia, David Miller, Richard S Witzig, Andrea K Boggild, Alejandro Llanos-Cuentas, Braulio M Valencia, David Miller, Richard S Witzig, Andrea K Boggild, Alejandro Llanos-Cuentas

Abstract

Thermotherapy is an accepted alternative therapy for new-world cutaneous leishmaniasis, but current heat-delivery modalities are too costly to be made widely available to endemic populations. We adapted a low-cost heat pack named the HECT-CL device that delivers safe, reliable, and renewable conduction heat. 25 patients with cutaneous leishmaniasis completed treatment with the device at an initial temperature of 52°C ± 2°C for 3 minutes to each lesion, repeated daily for 7 days, and were followed up for 6 months by direct observation. The overall definitive clinical cure rate was 60%. Concurrently, 13 patients meeting minimally significant exclusion criteria received identical compassionate use treatment with a cumulative definitive cure rate of 68.4%, 75% for those who had experienced CL relapse after prior antimonial treatment. Therapy was well tolerated. Reversible second-degree burns occurred in two patients and no bacterial super-infections were observed. HECT-CL is a promising treatment and deserves further study to verify its safety and efficacy as adjuvant and mono- therapy.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1. HECT-CL device activation and verification.
Figure 1. HECT-CL device activation and verification.
(a) HECT-CL device before activation; (b) after activation, the supersaturated solution crystallizes; and (c) before application, temperature was measured using an infrared thermometer.
Figure 2. Study flow diagram.
Figure 2. Study flow diagram.
Figure 3. Kaplan-Meier curves.
Figure 3. Kaplan-Meier curves.
Figure 4. Response to HECT-CL therapy.
Figure 4. Response to HECT-CL therapy.
a) Patient 19 (PT) at baseline; b) Patient 19 thirty days after HECT-CL with M4 clinical status; c) Patient 19 six months after HECT-CL with complete re-epithelialization; d)Patient 5 (PT) at baseline; e) Patient 5 fifteen days after HECT-CL with M4 clinical status; f) Patient 5 cured six months after HECT-CL; g) Patient 27 (NT) at baseline; h) Patient 27 fifteen days after HECT-CL with M4 status; i) Patient 27 two months after HECT-CL with complete re-epithelialization of lesion but 2 subcutaneous tracts.

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