Clinical Characteristics and Determinants of Treatment Duration in Cutaneous and Mucocutaneous Leishmaniasis: A Comparative Analysis.

BACKGROUND

OBJECTIVES

Cutaneous (CL) and mucocutaneous leishmaniasis (MCL) are vector-borne infections with overlapping etiologies but distinct clinical presentations and therapeutic challenges. Data on factors influencing treatment duration in these forms remain limited, particularly in endemic regions. To compare clinical characteristics of CL and MCL and to identify predictors of treatment duration among patients treated with intramuscular pentavalent antimonials.

METHODS

This retrospective cohort study analyzed 306 laboratory-confirmed leishmaniasis cases (274 CL, 32 MCL) diagnosed via smear, biopsy, or PCR from 2007 to 2023. Demographic and clinical data, lesion characteristics, and treatment responses were compared using nonparametric statistical methods.

RESULTS

Among 306 patients (54.9% female; median age 22 years), MCL cases exhibited significantly smaller lesion diameters (1.73 cm vs. 2.2 cm, p = 0.001), more frequent papular lesions (25.0% vs. 11.3%, p = 0.024), and unclear lesion margins (34.4% vs. 10.2%, p = 0.001). Facial involvement was universal in MCL (100%) and common in CL (85.8%, p = 0.021). Median treatment duration was 15 days [IQR: 12-18]; secondary infection was significantly associated with prolonged treatment (p = 0.042). Clinical improvement was achieved in 97.4% of cases; recurrence occurred in 3.9%.

INTERPRETATION

CONCLUSION

This study identifies distinct lesion features in MCL and underscores secondary infection as a key modifiable factor associated with prolonged therapy. These findings support the need for early recognition, infection control, and tailored clinical strategies to improve leishmaniasis outcomes in endemic settings.