Clinical and Parasite Species Risk Factors for Pentavalent Antimonial Treatment Failure in Cutaneous Leishmaniasis in Peru

ArticleinClinical Infectious Diseases 46(2):223-31 · January 2008with16 Reads
DOI: 10.1086/524042 · Source: PubMed
Abstract
Treatment for cutaneous leishmaniasis (CL) with standard pentavalent antimonial therapy is hampered by cumbersome administration, toxicity, and potential failure. Knowledge of factors influencing treatment outcome is essential for successful management. A case-control study of incident cases was performed with patients experiencing their first CL episode. The standard treatment for CL for these patients was 20 mg/kg/day of sodium stibogluconate for 20 days. Clinical and epidemiological data were recorded, and parasite isolates were species typed. Patients were followed up for 6 months to assess treatment outcome. Clinical cure was defined as complete wound closure and re-epithelization without inflammation or infiltration; new lesions, wound reopening, or signs of activity were classified as treatment failure. Descriptive, bivariate, and logistic regression analyses were performed. One hundred twenty-seven patients were recruited; 63 (49.6%) were infected with Leishmania (Viannia) peruviana, 29 (22.8%) were infected with Leishmania (Viannia) braziliensis, 27 (21.3%) were infected with Leishmania (Viannia) guyanensis, and 8 (6.3%) were infected with other species. Only patients infected with the 3 most common species were selected for risk-factor analysis (n=119). Final failure rate at 6 months was 24.4% (95% confidence interval [CI], 16.5%-32.1%), with 96% of failures occurring within the first 3 months of follow-up assessment. Risk factors for treatment failure identified in the final multivariate model were age (per year, odds ratio [OR], 0.95; 95% CI, 0.92-0.99; P=.017), stay of <72 months in area of disease acquisition (OR, 30.45; 95% CI, 2.38-389.25; P=.009), duration of disease <5 weeks (OR, 4.39; 95% CI, 1.12-17.23; P=.034), additional lesion (per lesion, OR, 2.06; 95% CI, 1.3-3.28; P=.002), infection with L. (V.) peruviana (OR, 9.85; 95% CI, 1.01-95.65; P=.049), and infection with L. (V.) braziliensis (OR, 22.36; 95% CI, 1.89-263.96; P=.014). The identification of parasite species and clinical risk factors for antimonial treatment failure should lead to an improved management of CL in patients in Peru.
    • "In conclusion, the fact that 55% of isolates from patients under ATF showed a decrease in Glucantime susceptibility, and that most resistant isolates came from patients who had received two or more rounds of AM for ACL treatment, suggests that the practice of recommending ACL patients for a second round of AM treatment to deal with an ATF or relapse episode should be reviewed. Moreover, the finding that 95.5% of lesions in patients with ATF were associated to L. braziliensis in a region where other species have also been reported [6][7][8]is in agreement with findings from others [9,12,13] , reasserting that LCA produced by L. braziliensis is generally more difficult to cure and concurs with a higher relapse rate. This consideration implies that the therapeutic approach in ACL should be based on identification of the parasite species, and a combination treatment for LCA associated to L. braziliensis could be contemplated as a first line of treatment. "
    [Show abstract] [Hide abstract] ABSTRACT: American cutaneous leishmaniasis (ACL) is a complicated disease producing about 67.000 new cases per year. The severity of the disease depends on the parasite species; however in the vast majority of cases species confirmation is not feasible. WHO suggestion for ACL produced by Leishmania braziliensis, as first line treatment, are pentavalent antimonial derivatives (Glucantime or Sodium Stibogluconate) under systemic administration. According to different authors, pentavalent antimonial derivatives as treatment for ACL show a healing rate of about 75% and reasons for treatment failure are not well known.
    Full-text · Article · May 2016
    • "Pyrethroid-impregnated nets providing additional protection reducing biting rates by up to 64–100 % (Tayeh et al. 1997 ). Drugresistance to pentavalent antimonials was reported from many countries (Llanos-Cuentas et al. 2008). Combination therapy to prevent appearance of resistance (e.g. "
    [Show abstract] [Hide abstract] ABSTRACT: Cutaneous leishmaniasis is one the most important zoonotic diseases has different invertebrate hosts in different parts of its range, the vectors are often closely related. Leishmaniasis is a world-wide vector borne disease, affecting 88 countries: especially in the Middle East and southwestern Asia. Nesokiaindica or M. libycuserythrourus are confirmed as reservoir and Phlebotomine sand flies are proven as vectors of the disease in the south of Iran. Patients’ information collected from Firouzabad and Ghirokarzin county, Fars province in Iran during 2006–2014. Data analyzed by Chi square test using SPSS19 statistic software. 613 cases (61.91 %) lived in rural and 377 (38.08 %) lived in urban areas. All ages were grouped between 1 and ≥30 years. 479 (48.38 %) of patients being male and 511 (51.61 %) female. 39.49 % of patients were with dry lesions and 60.5 % were with wet lesions. Hand ulcers were the highest prevalence part of body (39.59 %). The common frequent size of lesions was lesser than 2 cm. Regarding the most prevalence rate (47.67 %) raised in autumn season. This study showed that cutaneous leishmaniasis was an endemic disease in Firouzabad and Ghirokarzin regions.
    Full-text · Article · Jan 2016
    • "These latter two reasons could mask any existing relationship between arsenic exposure and SSG treatment failure in VL. Although multiple studies have been carried out on the mechanisms of antimonial resistance in the Leishmania parasite [9], only a few epidemiological studies have been performed looking at the clinical and demographic risk factors associated with SSG treatment failure in the leishmaniases [22,26]. The most relevant is a prospective study in Nepal on VL patients [22] that identified patients living on the border of Bihar as having a markedly increased chance of treatment failure. "
    [Show abstract] [Hide abstract] ABSTRACT: In the late twentieth century, emergence of high rates of treatment failure with antimonial compounds (SSG) for visceral leishmaniasis (VL) caused a public health crisis in Bihar, India. We hypothesize that exposure to arsenic through drinking contaminated groundwater may be associated with SSG treatment failure due to the development of antimony-resistant parasites.A retrospective cohort design was employed, as antimony treatment is no longer in routine use. The study was performed on patients treated with SSG between 2006 and 2010. Outcomes of treatment were assessed through a field questionnaire and treatment failure used as a proxy for parasite resistance. Arsenic exposure was quantified through analysis of 5 water samples from within and surrounding the patient's home. A logistic regression model was used to evaluate the association between arsenic exposure and treatment failure. In a secondary analysis survival curves and Cox regression models were applied to assess the risk of mortality in VL patients exposed to arsenic.One hundred and ten VL patients treated with SSG were analysed. The failure rate with SSG was 59%. Patients with high mean local arsenic level had a non-statistically significant higher risk of treatment failure (OR = 1.78, 95% CI: 0.7-4.6, p = 0.23) than patients using wells with arsenic concentration
    Full-text · Article · Mar 2015
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