Ambiguities in cutaneous leishmaniasis classification and the need for consensus: Experience from Ethiopia.

Publisher: Public Library of Science Country of Publication: United States NLM ID: 101291488 Publication Model: eCollection Cited Medium: Internet ISSN: 1935-2735 (Electronic) Linking ISSN: 19352727 NLM ISO Abbreviation: PLoS Negl Trop Dis Subsets: MEDLINE

Original Publication: San Francisco, CA : Public Library of Science

Leishmaniasis, Cutaneous*/classification ; Leishmaniasis, Cutaneous*/drug therapy ; Leishmaniasis, Cutaneous*/pathology; Humans ; Ethiopia ; Consensus ; Female ; Male ; Adult ; Antiprotozoal Agents/therapeutic use

Competing Interests: The authors have declared that no competing interests exist.
Background: Cutaneous leishmaniasis (CL) is clinically classified into localized (LCL), mucocutaneous (MCL) and diffuse (DCL) types. While conducting a treatment study on CL at two sites in Ethiopia (Boru Meda and Gondar), differences in opinion in the classification of CL became apparent. The lack of uniformly understandable classifications has made comparison and generalizability of research findings challenging. We wanted to investigate the extent of agreement in CL classification between CL experts and describe on which points there was disagreement.
Methodology/principal Findings: Thirteen CL experts in Ethiopia were provided with 26 high-quality photographs of CL lesions from patients enrolled in a clinical study on miltefosine treatment. Patients were selected for this sub study due to potential classification difficulties. The most common (majority vote) classification category was noted, and the proportion of experts which choose this (% agreement). Majority vote classification was used to reclassify patients compared to the original study classification. Among included patients, sixteen were originally classified as DCL, eight as MCL, one as LCL, and one as Leishmania recidivans. There was no unanimous consensus for any of the selected cases. The maximum agreement was 80%, which was seen for 38% (10/26) cases. Disagreements existed on whether patients had mucosal involvement, how to classify patients with singular large diffusely swollen lesions and when to classify patients with multiple lesions as DCL. According to the majority vote, 62% of selected patients would be reclassified to a different CL classification compared to the original study from which photographs were selected.
Conclusions/significance: There is no clear understanding and harmony in the classification of CL. Reproducible classification guidelines and training of healthcare providers on CL are needed to ensure consistency in further classification to allow generalizability and comparison of clinical trial findings. Simpler classifications with direct links to treatment decision-making would be valuable.
(Copyright: © 2025 van Henten et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

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0 (Antiprotozoal Agents)

Date Created: 20250822 Date Completed: 20250829 Latest Revision: 20250831

20250903

PMC12396759

10.1371/journal.pntd.0013458

40845055