Host Resilience and Cellular Response in Cutaneous Leishmaniasis Treatment: A Pre-Post Study in Ethiopia

Introduction: Leishmania, a protozoan parasite, employs various strategies, including the secretion of surface proteins, to evade the host's immune response, which can lead to severe clinical manifestations, particularly in immunocompromised individuals. In Ethiopia, cutaneous leishmaniasis (CL) presents distinct clinical features, often influenced by different factors. The primary immune responses to Leishmania infections involve neutrophils, macrophages, and dendritic cells, which play crucial roles in both the recognition and elimination of the parasite. Recent research has highlighted the importance of the cytokine environment in modulating these immune responses, as different cytokines can either enhance or hinder the effectiveness of the immune system against Leishmania.

Sodium Stibogluconate (SSG) remains a frontline treatment for cutaneous leishmaniasis in Ethiopia; however, its efficacy can vary due to factors such as parasite resistance and host genetic variability. Studies have suggested that combination therapies, including SSG with immunomodulatory agents, may enhance treatment outcomes by improving the host's immune response while targeting the parasite more effectively.

Aim: This study aimed to evaluate the host cellular profile of cutaneous Leishmaniasis patients before treatment, in two weeks of treatment and at the end of treatment. Assessing changes in immune cell populations, hematological parameters, and overall host resilience against anti-leishmania treatment, thereby contributing to a more comprehensive understanding of therapeutic strategies in CL management.

Methods: A longitudinal Pre-Post study was conducted at Adiss Alem Primary Hospital in Bahir Dar, Ethiopia, spanning from September 2022 to August 2024. Data analysis, interpretation and synthesis were done for three month period between September to November 2024 G.C. Blood samples were collected from participants and analyzed using the CC20 Plus automated hematology machine, ensuring prompt investigation to maintain sample integrity.

Participants received an initial dosage of SSG at 20 mg/kg/day for a duration of 28 days. To assess the treatment's impact, blood analyses were conducted at three distinct time points: prior to the initiation of SSG treatment, in two weeks of therapy, and at the conclusion of the 28-day treatment period. This longitudinal approach allowed for a comprehensive evaluation of hematological changes over the course of the treatment.

Statistical analysis was performed using one-way ANOVA to compare the mean values of relevant blood parameters across the three-time points. A significance level was set at p < 0.05, corresponding to a 95% confidence interval, to ensure that the findings were statistically robust. This methodological framework aimed to provide valuable insights into the cellular and hematological effects of SSG treatment in CL patients, contributing to the understanding of treatment efficacy in endemic regions.

Results: In a comprehensive two-year study involving 96 individuals diagnosed with cutaneous leishmaniasis (CL), a notable predominance of male patients was observed. The treatment regimen utilizing sodium stibogluconate demonstrated significant hematological effects, leading to marked reductions in white blood cell counts, lymphocyte levels, and hemoglobin concentrations, all with a p-value of less than 0.05, indicating statistical significance. While the treatment negatively diminished these parameters, it is important to note that several other hematological indicators showed signs of recovery on treatment.

Conclusion: Careful monitoring of hematological parameters during CL treatment is needed, as sodium stibogluconate may contribute to notable changes in the blood profiles of affected individuals. To ensure homeostasis and immune function in CL patients on SSG treatment, supplementary medications should be included. Exploring alternative treatments for CL management is crucial.

Close monitoring of hematological parameters during treatment for cutaneous leishmaniasis (CL) is essential, particularly because sodium stibogluconate (SSG) can induce significant alterations in blood profiles among affected individuals. Patients receiving SSG may experience changes such as leukopenia, thrombocytopenia, or anemia, which can compromise their immune function and overall health. Therefore, it is imperative to incorporate supplementary medications that can help support homeostasis and bolster immune responses during the course of treatment. Furthermore, exploring alternative treatment options for CL management is crucial, as it may provide safer and more effective solutions that minimize hematological side effects. Research into newer therapies, including immunotherapies and novel pharmacological agents, is essential to improve treatment protocols and offer patients a comprehensive approach to managing this challenging condition. This highlights the complex interplay of therapeutic effects and the body's response to the disease and treatment.