Effect of secondary infection on epithelialisation and total healing of cutaneous leishmaniasis lesions

BACKGROUND Cutaneous leishmaniasis (CL) generally presents with a single or several localised cutaneous ulcers without involvement of mucous membranes. Ulcerated lesions are susceptible to secondary contamination that may slow the healing process. OBJECTIVE This study verified the influence of non-parasitic wound infection on wound closure (epithelialisation) and total healing. METHODS Twenty-five patients with a confirmed diagnosis of CL and ulcerated lesions underwent biopsy of ulcer borders. One direct microbial parameter (germ identification in cultures) and four indirect clinical parameters (secretion, pain, burning sensation, pruritus) were analysed. FINDINGS Biopsies of ten lesions showed secondary infection by one or two microorganisms (Staphylococcus aureus, Pseudomonas aeruginosa, Enterococcus faecalis, Streptococcus pyogenes and Candida parapsilosis). “Secretion” and “burning sensation” influenced epithelialisation time but not total healing time. Positive detection of germs in the ulcer border and “pain” and “pruritus” revealed no influence on wound closure. CONCLUSIONS Our borderline proof of clinical CL ulcer infection inhibiting CL wound healing supports the need to follow antimicrobial stewardship in CL ulcer management, which was recently proposed for all chronic wounds.

背景 皮肤利什曼病（Cutaneous leishmaniasis, CL）通常表现为单个或数个局限性皮肤溃疡，不累及黏膜。溃疡性病灶易继发污染，可能延缓愈合进程。目的 本研究旨在验证非寄生性伤口感染对伤口闭合（上皮形成）及完全愈合的影响。方法 25例经确诊的皮肤利什曼病且伴有溃疡性病灶的患者，对其溃疡边缘实施活检。分析1项直接微生物学参数（培养物中的病原菌鉴定）与4项间接临床参数（分泌物、疼痛、烧灼感、瘙痒）。结果 10个病灶的活检结果显示存在1~2种病原菌继发感染，包括金黄色葡萄球菌、铜绿假单胞菌、粪肠球菌、化脓性链球菌及近平滑念珠菌。“分泌物”与“烧灼感”可影响上皮形成时间，但不影响完全愈合时间。溃疡边缘病原菌检测呈阳性，以及“疼痛”与“瘙痒”，未对伤口闭合产生影响。结论 本研究针对皮肤利什曼病溃疡感染可抑制其伤口愈合的边缘性证据表明，在皮肤利什曼病溃疡的管理中需遵循抗菌药物管理原则，该原则近期已被提出适用于所有慢性伤口。