1
|
Tuon FF, Dantas LR, de Souza RM, Ribeiro VST, Amato VS. Liposomal drug delivery systems for the treatment of leishmaniasis. Parasitol Res 2022; 121:3073-3082. [DOI: 10.1007/s00436-022-07659-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 09/06/2022] [Indexed: 10/14/2022]
|
2
|
Pereira LOR, Sousa CS, Ramos HCP, Torres-Santos EC, Pinheiro LS, Alves MR, Cuervo P, Romero GAS, Boité MC, Porrozzi R, Cupolillo E. Insights from Leishmania (Viannia) guyanensis in vitro behavior and intercellular communication. Parasit Vectors 2021; 14:556. [PMID: 34711290 PMCID: PMC8554959 DOI: 10.1186/s13071-021-05057-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 08/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pentavalent antimonial-based chemotherapy is the first-line approach for leishmaniasis treatment and disease control. Nevertheless antimony-resistant parasites have been reported in some endemic regions. Treatment refractoriness is complex and is associated with patient- and parasite-related variables. Although amastigotes are the parasite stage in the vertebrate host and, thus, exposed to the drug, the stress caused by trivalent antimony in promastigotes has been shown to promote significant modification in expression of several genes involved in various biological processes, which will ultimately affect parasite behavior. Leishmania (Viannia) guyanensis is one of the main etiological agents in the Amazon Basin region, with a high relapse rate (approximately 25%). METHODS Herein, we conducted several in vitro analyses with L. (V.) guyanensis strains derived from cured and refractory patients after treatment with standardized antimonial therapeutic schemes, in addition to a drug-resistant in vitro-selected strain. Drug sensitivity assessed through Sb(III) half-maximal inhibitory concentration (IC50) assays, growth patterns (with and without drug pressure) and metacyclic-like percentages were determined for all strains and compared to treatment outcomes. Finally, co-cultivation without intercellular contact was followed by parasitic density and Sb(III) IC50 measurements. RESULTS Poor treatment response was correlated with increased Sb(III) IC50 values. The decrease in drug sensitivity was associated with a reduced cell replication rate, increased in vitro growth ability, and higher metacyclic-like proportion. Additionally, in vitro co-cultivation assays demonstrated that intercellular communication enabled lower drug sensitivity and enhanced in vitro growth ability, regardless of direct cell contact. CONCLUSIONS Data concerning drug sensitivity in the Viannia subgenus are emerging, and L. (V.) guyanensis plays a pivotal epidemiological role in Latin America. Therefore, investigating the parasitic features potentially related to relapses is urgent. Altogether, the data presented here indicate that all tested strains of L. (V.) guyanensis displayed an association between treatment outcome and in vitro parameters, especially the drug sensitivity. Remarkably, sharing enhanced growth ability and decreased drug sensitivity, without intercellular communication, were demonstrated.
Collapse
Affiliation(s)
- Luiza O R Pereira
- Laboratório de Pesquisa em Leishmanioses, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil.
| | - Cíntia S Sousa
- Laboratório de Pesquisa em Leishmanioses, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Hellen C P Ramos
- Laboratório de Pesquisa em Leishmanioses, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | | | - Liliane S Pinheiro
- Laboratório de Bioquímica de Tripanossomatídeos, IOC, FIOCRUZ, Rio de Janeiro, Brazil.,Instituto de Saúde e Biotecnologia, Universidade Federal do Amazonas, Campus Coari, Amazonas, Brazil
| | - Marcelo R Alves
- Laboratório de Pesquisa Clínica em DST-AIDS, Instituto Nacional de Infectologia Evandro Chagas, FIOCRUZ, Rio de Janeiro, Brazil
| | - Patricia Cuervo
- Laboratório de Pesquisa em Leishmanioses, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | | | - Mariana C Boité
- Laboratório de Pesquisa em Leishmanioses, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Renato Porrozzi
- Laboratório de Pesquisa em Leishmanioses, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Elisa Cupolillo
- Laboratório de Pesquisa em Leishmanioses, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| |
Collapse
|
3
|
Major changes in chromosomal somy, gene expression and gene dosage driven by Sb III in Leishmania braziliensis and Leishmania panamensis. Sci Rep 2019; 9:9485. [PMID: 31263131 PMCID: PMC6603004 DOI: 10.1038/s41598-019-45538-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 06/06/2019] [Indexed: 12/17/2022] Open
Abstract
Leishmania braziliensis and Leishmania panamensis are two species clinically and epidemiologically important, among others because of their relative resistance to first-line drugs (antimonials). The precise mechanism underlying the ability of these species to survive antimony treatment remains unknown. Therefore, elucidating the pathways mediating drug resistance is essential. We herein experimentally selected resistance to trivalent antimony (SbIII) in the reference strains of L. braziliensis (MHOM/BR75/M2904) and L. panamensis (MHOM/COL/81L13) and compared whole genome and transcriptome alterations in the culture promastigote stage. The results allowed us to identify differences in somy, copy number variations in some genes related to antimony resistance and large-scale copy number variations (deletions and duplications) in chromosomes with no somy changes. We found mainly in L. braziliensis, a direct relation between the chromosomal/local copy number variation and the gene expression. We identified differentially expressed genes in the resistant lines that are involved in antimony resistance, virulence, and vital biological processes in parasites. The results of this study may be useful for characterizing the genetic mechanisms of these Leishmania species under antimonial pressure, and for clarifying why the parasites are resistant to first-line drug treatments.
Collapse
|
4
|
Sundar S, Agrawal N, Singh B. Exploiting knowledge on pharmacodynamics-pharmacokinetics for accelerated anti-leishmanial drug discovery/development. Expert Opin Drug Metab Toxicol 2019; 15:595-612. [PMID: 31174439 DOI: 10.1080/17425255.2019.1629417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Introduction: Being on the top list of neglected tropical diseases, leishmaniasis has been marked for elimination by 2020. In the light of small armamentarium of drugs and their associated drawbacks, the understanding of pharmacodynamics and/or pharmacokinetics becomes a priority to achieve and sustain disease elimination. Areas covered: The authors have looked into pharmacological aspects of existing and emerging drugs for treatment of leishmaniasis. An in-depth understanding of pharmacodynamics and pharmacokinetics (PKPD) provides a rationale for drug designing and optimizing the treatment strategies. It forms a key to prevent drug resistance and avoid drug-associated adverse effects. The authors have compiled the researches on the PKPD of different anti-leishmanial formulations that have the potential for improved and/or effective disease intervention. Expert opinion: Understanding the pharmacological aspects of drugs forms the basis for the clinical application of novel drugs. Tailoring drug dosage and individualized treatment can avoid the adverse events and bridge gap between the in vitro models and their clinical application. An integrated approach, with pragmatic use of technological advances can improve phenotypic screening and physiochemical properties of novel drugs. Concomitantly, this can serve to improve clinical efficacies, reduce the incidence of relapse and accelerate the drug discovery/development process for leishmaniasis elimination.
Collapse
Affiliation(s)
- Shyam Sundar
- a Department of Medicine , Institute of Medical Sciences, Banaras Hindu University , Varanasi , India
| | - Neha Agrawal
- b Hepatology , Temple University , Philadelphia , PA , USA
| | - Bhawana Singh
- a Department of Medicine , Institute of Medical Sciences, Banaras Hindu University , Varanasi , India.,c Department of Pathology , Wexner Medical Center, The Ohio State University , Columbus , OH , USA
| |
Collapse
|
5
|
Brahim LR, Valete-Rosalino CM, Antônio LDF, Pimentel MIF, Lyra MR, Paes LEDC, Costa ADD, Vieira IF, Dias CMG, Duque MCDO, Marzochi MCDA, Schubach ADO. Low dose systemic or intralesional meglumine antimoniate treatment for American tegumentary leishmaniasis results in low lethality, low incidence of relapse, and low late mucosal involvement in a referral centre in Rio de Janeiro, Brazil (2001-2013). Mem Inst Oswaldo Cruz 2017; 112:838-843. [PMID: 29211245 PMCID: PMC5719553 DOI: 10.1590/0074-02760160478] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 06/23/2017] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND American tegumentary leishmaniasis (ATL) is a non-lethal parasitic disease
that presents with cutaneous (CL) and mucosal (ML) clinical forms. ATL
treatment aims at healing the lesions and preventing the development of the
late mucosal form. Systemic meglumine antimoniate (MA) therapy with 10-20 mg
Sb5+/kg/day is the first choice of treatment. However,
alternative therapies using 5 mg Sb5+/kg/day or intralesional
(IL) MA are the usual regimens at the National Institute of Infectious
Diseases (NIID), Rio de Janeiro, Brazil. OBJECTIVES To evaluate lethality and the incidence of relapse and development of late ML
in CL patients treated at NIID from 2001 until 2013. METHODS Data were recovered from records of all ATL patients diagnosed during that
period. FINDINGS Out of 777 patients, 753 were treated with MA (96.9%). Of those, 89.1%
received alternative therapy of 9.9% IL and 79.2% systemic 5 mg
Sb5+/kg/day. Some patients required 1-3 additional courses of
treatment, thus making a total of 997 courses; 85.2% of them were subjected
to alternative therapies. Lethality was 0.1%, relapse incidence 5.8%, and
late ML incidence 0.25%. As a final outcome for the 777 patients, 95.9% were
cured, 0.1% died and 4.0% were not able to follow-up. MAIN CONCLUSIONS Alternative MA schedules resulted in low lethality without increase of
relapse or late ML incidence.
Collapse
Affiliation(s)
- Lucia Regina Brahim
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Rio de Janeiro, RJ, Brasil.,Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório Interdisciplinar de Vigilância Entomológica em Diptera e Hemiptera, Rio de Janeiro, RJ, Brasil
| | - Cláudia Maria Valete-Rosalino
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Rio de Janeiro, RJ, Brasil.,Universidade Federal do Rio de Janeiro, Departamento de Otorrinolaringologia e Oftalmologia, Rio de Janeiro, RJ, Brasil
| | - Liliane de Fátima Antônio
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Rio de Janeiro, RJ, Brasil
| | - Maria Inês Fernandes Pimentel
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Rio de Janeiro, RJ, Brasil.,Secretaria de Estado de Saúde do Rio de Janeiro, Vigilância Epidemiológica, Rio de Janeiro, RJ, Brasil
| | - Marcelo Rosandiski Lyra
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Rio de Janeiro, RJ, Brasil
| | - Luiz Eduardo de Carvalho Paes
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Rio de Janeiro, RJ, Brasil.,Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Pesquisas em Leishmanioses, Rio de Janeiro, RJ, Brasil
| | - Ananda Dutra da Costa
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Rio de Janeiro, RJ, Brasil
| | - Iracema Forni Vieira
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Rio de Janeiro, RJ, Brasil
| | | | - Maria Cristina de Oliveira Duque
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Rio de Janeiro, RJ, Brasil.,Secretaria Municipal de Saúde de Timóteo, Timóteo, MG, Brasil
| | - Mauro Celio de Almeida Marzochi
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Rio de Janeiro, RJ, Brasil
| | - Armando de Oliveira Schubach
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Rio de Janeiro, RJ, Brasil
| |
Collapse
|
6
|
Gagini T, de Oliveira Schubach A, de Fatima Madeira M, Maria Valete-Rosalino C, Fernandes Pimentel MI, da Silva Pacheco R. Genotypic profiles of Leishmania (Viannia) braziliensis strains from cutaneous leishmaniasis patients and their relationship with the response to meglumine antimoniate treatment: a pilot study. ACTA ACUST UNITED AC 2017; 24:34. [PMID: 28959938 PMCID: PMC5621350 DOI: 10.1051/parasite/2017035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 09/04/2017] [Indexed: 11/20/2022]
Abstract
Background: Forty-four strains isolated from a cohort of cutaneous leishmaniasis (CL) patients who did or did not respond to one course of treatment with meglumine antimoniate were investigated to explore genetic polymorphisms in parasite kinetoplast DNA minicircles. Leishmania (Viannia) braziliensis strains isolated from responder (R) and non-responder (NR) patients who acquired infection in Rio de Janeiro or in other Brazilian states were studied using low-stringency single-specific primer polymerase chain reaction (LSSP-PCR) to identify genetic polymorphisms. Results: Polymorphisms were observed in parasites recovered from patient lesions. No association was found between a specific genotype and R or NR patients. Phenetic analysis grouped the genotypes into three main clusters, with similarity indices varying from 0.72 to 1.00. Although no specific genotype association was detected, at least one group of L. (V.) braziliensis genotypes that circulates in Rio de Janeiro was discriminated in clusters I and III, showing phenotypes of good and poor responses to treatment, respectively. Cluster I comprised parasite profiles recovered from R patients from Rio de Janeiro and in cluster III, NR samples were prevalent. Cluster II comprised 24 isolates, with 21 from Rio de Janeiro and three from other states, equally distributed between R and NR patients. Additionally, we found that parasites sharing all common genetic characteristics acted differently in response to treatment. Conclusions: These results are of clinical-epidemiological importance since they demonstrate that populations of L. (V.) braziliensis that exhibit high levels of genetic similarity also display different phenotypes associated with meglumine antimoniate responses in cutaneous leishmaniasis patients.
Collapse
Affiliation(s)
- Thalita Gagini
- Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Instituto Nacional de Infectologia Evandro Chagas INI/FIOCRUZ, Manguinhos, Rio de Janeiro, Brazil
| | - Armando de Oliveira Schubach
- Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Instituto Nacional de Infectologia Evandro Chagas INI/FIOCRUZ, Manguinhos, Rio de Janeiro, Brazil
| | - Maria de Fatima Madeira
- Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Instituto Nacional de Infectologia Evandro Chagas INI/FIOCRUZ, Manguinhos, Rio de Janeiro, Brazil
| | - Cláudia Maria Valete-Rosalino
- Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Instituto Nacional de Infectologia Evandro Chagas INI/FIOCRUZ, Manguinhos, Rio de Janeiro, Brazil - Departamento de Otorrinolaringologia e Oftalmologia, Faculdade de Medicina, UFRJ, Hospital Universitário Clementino Fraga Filho, Cidade Universitária - Ilha do Fundão, Rio de Janeiro, Brazil
| | - Maria Inês Fernandes Pimentel
- Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Instituto Nacional de Infectologia Evandro Chagas INI/FIOCRUZ, Manguinhos, Rio de Janeiro, Brazil
| | - Raquel da Silva Pacheco
- Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Instituto Nacional de Infectologia Evandro Chagas INI/FIOCRUZ, Manguinhos, Rio de Janeiro, Brazil
| |
Collapse
|
7
|
de Moura TR, Santos MLB, Braz JM, Santos LFVC, Aragão MT, de Oliveira FA, Santos PL, da Silva ÂM, de Jesus AR, de Almeida RP. Cross-resistance of Leishmania infantum isolates to nitric oxide from patients refractory to antimony treatment, and greater tolerance to antileishmanial responses by macrophages. Parasitol Res 2016; 115:713-21. [PMID: 26481489 DOI: 10.1007/s00436-015-4793-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 10/12/2015] [Indexed: 11/24/2022]
Abstract
Visceral leishmaniasis is a life-threatening disease characterized by intense parasitism of the spleen, liver, and bone marrow. Antimonials have served as front-line antileishmanial therapeutics for decades, but the increasing failure rates under antimonial treatment have challenged the continued use of these drugs. Pentavalent antimonials are known to reinforce the killing mechanisms of macrophages, although the associated mechanism remains unclear. Here, for the first time, we determined whether Leishmania infantum strains isolated from patients refractory to antimony treatment (relapse cases) were cross-resistant to antimonials, liposomal amphotericin B, and/or nitric oxide, and also whether these strains modulate macrophage infection. We selected four clinical isolates from relapse cases and two clinical isolates from antimony-responsive patients (control group) for the present study. The L. infantum promastigotes from all four relapse cases were resistant to trivalent antimonial treatment and nitric oxide, while only one isolate was resistant to liposomal amphotericin B. We evaluated whether the resistant strains from relapse cases showed enhanced infectivity and amastigote survival in macrophages, or macrophage-killing mechanisms in macrophages activated by lipopolysaccharide plus interferon gamma. Infection indexes calculated using macrophages infected with isolates from relapse were higher than those observed with control strains that were stimulated independently. Macrophage infection was higher with L. infantum isolates from relapse cases and correlated with enhanced interleukin 1-β production but showed similar nitrite production. Our results demonstrate that L. infantum field isolates from relapse cases were resistant to antimonials and nitric oxide and that these parasites stimulated inflammatory cytokines and were resistant to macrophage-killing mechanisms, factors that may contribute to disease severity.
Collapse
|
8
|
Toledo Junior A, Daher AB, Amaral TA, Carvalho SFG, Romero GAS, Rabello A. Poor response to azithromycin in cutaneous leishmaniasis leading to a premature interruption of a multicentric phase III clinical trial in Brazil. Rev Soc Bras Med Trop 2015; 47:756-62. [PMID: 25626655 DOI: 10.1590/0037-8682-0266-2014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 12/08/2014] [Indexed: 11/22/2022] Open
Abstract
Introduction Parenteral antimony-based compounds are still the standard of care for cutaneous leishmaniasis (CL) treatment in many countries, despite their high toxicity. Previous studies showed that oral azithromycin could be an option for CL treatment. The aim of this study was to evaluate efficacy and safety of oral azithromycin (AZ) for CL treatment compared with injectable meglumine antimoniate (MA). Methods This was a randomized, open-label, 2-arm, non-inferiority clinical trial. Treatment-naïve patients with localized CL were treated with MA (15mg/kg/day up to 1,215mg) or AZ (500mg/day) during 20 consecutive days. The primary efficacy end point was a CL cure 90 days after treatment completion. The analysis was performed with intention-to-treat (ITT) and per protocol (PP) analyses. After an anticipated interim analysis, the study was interrupted due to the high failure rate in the azithromycin group. Results Twenty-four volunteers were included in each group. The MA group had a higher cure rate than the AZ group with the ITT and PP analyses, which were 54.2% versus 20.8% [relative risk (RR) 1.97; 95% confidence intervals (95%CI) 1.13-3.42] and 72.2% versus 23.8% (RR 3.03; 95%CI 1.34-6.87), respectively. No unexpected adverse events were observed. Conclusions Azithromycin is ineffective for CL treatment and does not seem to have a role in the therapeutic arsenal for CL.
Collapse
Affiliation(s)
- Antonio Toledo Junior
- Serviço Multiprofissional de Infectologia, Universidade José do Rosário Vellano, Belo Horizonte, MG, BRAZIL
| | - André Bastos Daher
- Plataforma de Pesquisa Clínica, Vice-Presidência de Pesquisa e Laboratórios de Referência, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
| | - Thaís Alves Amaral
- Plataforma de Pesquisa Clínica, Vice-Presidência de Pesquisa e Laboratórios de Referência, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
| | - Sílvio Fernando Guimarães Carvalho
- Departamento de Doenças Infecciosas, Hospital Universitário Clemente de Faria, Universidade Estadual de Montes Claros, Montes Claros, MG, Brasil
| | | | - Ana Rabello
- Laboratório de Pesquisa Clínica, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, MG, BRAZIL
| |
Collapse
|
9
|
Antonio LDF, Fagundes A, Oliveira RVC, Pinto PG, Bedoya-Pacheco SJ, Vasconcellos EDCFE, Valete-Rosalino MC, Lyra MR, Passos SRL, Pimentel MIF, Schubach ADO. Montenegro skin test and age of skin lesion as predictors of treatment failure in cutaneous leishmaniasis. Rev Inst Med Trop Sao Paulo 2015; 56:375-80. [PMID: 25229216 PMCID: PMC4172107 DOI: 10.1590/s0036-46652014000500002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 02/21/2014] [Indexed: 11/22/2022] Open
Abstract
A case-control study was conducted to examine the association among
the Montenegro skin test (MST), age of skin lesion and therapeutic
response in patients with cutaneous leishmaniasis (CL) treated at
Evandro Chagas National Institute of Infectious Diseases (INI),
Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil. For each
treatment failure (case), two controls showing skin lesion healing
following treatment, paired by sex and age, were randomly selected. All patients
were treated with 5 mg Sb5+/kg/day of intramuscular
meglumine antimoniate (Sb5+) for 30 successive days.
Patients with CL were approximately five times more likely to fail when lesions
were less than two months old at the first appointment. Patients with treatment
failure showed less intense MST reactions than patients progressing to clinical
cure. For each 10 mm of increase in MST response, there was a 26% reduction
in the chance of treatment failure. An early treatment - defined as a treatment
applied for skin lesions, which starts when they are less than two months old at
the first appointment -, as well as a poor cellular immune response, reflected
by lower reactivity in MST, were associated with treatment failure in cutaneous
leishmaniasis.
Collapse
Affiliation(s)
- Liliane de Fátima Antonio
- Laboratório de Vigilância em Leishmanioses (Lab VigiLeish), Instituto de Pesquisa Clínica Evandro Chagas (IPEC)/Fiocruz, Brazil
| | - Aline Fagundes
- Laboratório de Vigilância em Leishmanioses (Lab VigiLeish), Instituto de Pesquisa Clínica Evandro Chagas (IPEC)/Fiocruz, Brazil
| | | | - Priscila Garcia Pinto
- Laboratório de Vigilância em Leishmanioses (Lab VigiLeish), Instituto de Pesquisa Clínica Evandro Chagas (IPEC)/Fiocruz, Brazil
| | - Sandro Javier Bedoya-Pacheco
- Laboratório de Vigilância em Leishmanioses (Lab VigiLeish), Instituto de Pesquisa Clínica Evandro Chagas (IPEC)/Fiocruz, Brazil
| | | | - Maria Cláudia Valete-Rosalino
- Laboratório de Vigilância em Leishmanioses (Lab VigiLeish), Instituto de Pesquisa Clínica Evandro Chagas (IPEC)/Fiocruz, Brazil
| | - Marcelo Rosandiski Lyra
- Laboratório de Vigilância em Leishmanioses (Lab VigiLeish), Instituto de Pesquisa Clínica Evandro Chagas (IPEC)/Fiocruz, Brazil
| | - Sônia Regina Lambert Passos
- Laboratório de Epidemiologia Clínica (Lab. EpiClin), Instituto de Pesquisa Clínica Evandro Chagas (IPEC)/Fiocruz, Brazil
| | - Maria Inês Fernandes Pimentel
- Laboratório de Vigilância em Leishmanioses (Lab VigiLeish), Instituto de Pesquisa Clínica Evandro Chagas (IPEC)/Fiocruz, Brazil
| | - Armando de Oliveira Schubach
- Laboratório de Vigilância em Leishmanioses (Lab VigiLeish), Instituto de Pesquisa Clínica Evandro Chagas (IPEC)/Fiocruz, Brazil
| |
Collapse
|
10
|
Orellano PW, Vazquez N, Salomon OD. Cost-effectiveness of prevention strategies for American tegumentary leishmaniasis in Argentina. CAD SAUDE PUBLICA 2014; 29:2459-72. [PMID: 24356692 DOI: 10.1590/0102-311x00172512] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 07/12/2012] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to estimate the cost-effectiveness of reducing tegumentary leishmaniasis transmission using insecticide-impregnated clothing and curtains, and implementing training programs for early diagnosis. A societal perspective was adopted, with outcomes assessed in terms of costs per disability adjusted life years (DALY). Simulation was structured as a Markov model and costs were expressed in American dollars (US$). The incremental cost-effectiveness ratio of each strategy was calculated. One-way and multivariate sensitivity analyses were performed. The incremental cost-effectiveness ratio for early diagnosis strategy was estimated at US$ 156.46 per DALY averted, while that of prevention of transmission with insecticide-impregnated curtains and clothing was US$ 13,155.52 per DALY averted. Both strategies were more sensitive to the natural incidence of leishmaniasis, to the effectiveness of mucocutaneous leishmaniasis treatment and to the cost of each strategy. Prevention of vectorial transmission and early diagnosis have proved to be cost-effective measures.
Collapse
Affiliation(s)
| | - Nestor Vazquez
- Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | | |
Collapse
|
11
|
Torres DC, Ribeiro-Alves M, Romero GAS, Dávila AMR, Cupolillo E. Assessment of drug resistance related genes as candidate markers for treatment outcome prediction of cutaneous leishmaniasis in Brazil. Acta Trop 2013; 126:132-41. [PMID: 23416123 DOI: 10.1016/j.actatropica.2013.02.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 01/28/2013] [Accepted: 02/05/2013] [Indexed: 12/21/2022]
Abstract
The great public health problem posed by leishmaniasis has substantially worsened in recent years by the emergence of clinical failure. In Brazil, the poor prognosis observed for patients infected by Leishmania braziliensis (Lb) or L. guyanensis (Lg) may be related to parasite drug resistance. In the present study, 19 Lb and 29 Lg isolates were obtained from infected patients with different treatment outcomes. Translated amino acid sequence polymorphisms from four described antimony resistance related genes (AQP1, hsp70, MRPA and TRYR) were tested as candidate markers for antimonial treatment failure prediction. Possibly due to the low intraspecific variability observed in Lg samples, none of the prediction models had good prognosis values. Most strikingly, one mutation (T579A) found in hsp70 of Lb samples could predict 75% of the antimonial treatment failure clinical cases. Moreover, a multiple logistic regression model showed that the change from adenine to guanine at position 1735 of the hsp70 gene, which is responsible for the T579A mutation, significantly increased the chance of Lb clinical isolates to be associated with treatment failure (OR=7.29; CI 95%=[1.17, 45.25]; p=0.0331). The use of molecular markers to predict treatment outcome presents practical and economic advantages as it allows the development of rapid assays to monitor the emergence of drug resistant parasites that can be clinically applied to aid the prognosis of cutaneous leishmaniasis in Brazil.
Collapse
Affiliation(s)
- Davi Coe Torres
- Laboratório de Pesquisa em Leishmaniose/Coleção de Leishmania do Instituto Oswaldo Cruz (IOC) - Fiocruz, Rio de Janeiro, Brazil
| | | | | | | | | |
Collapse
|
12
|
Efficacy of glucantime for treatment of cutaneous leishmaniasis in Central Iran. J Infect Public Health 2013; 6:120-4. [DOI: 10.1016/j.jiph.2012.11.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 10/25/2012] [Accepted: 11/07/2012] [Indexed: 11/22/2022] Open
|
13
|
Torres DC, Adaui V, Ribeiro-Alves M, Romero GAS, Arévalo J, Cupolillo E, Dujardin JC. Targeted gene expression profiling in Leishmania braziliensis and Leishmania guyanensis parasites isolated from Brazilian patients with different antimonial treatment outcomes. INFECTION GENETICS AND EVOLUTION 2010; 10:727-33. [PMID: 20478409 DOI: 10.1016/j.meegid.2010.05.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Revised: 05/06/2010] [Accepted: 05/07/2010] [Indexed: 11/17/2022]
Abstract
In Brazil, cutaneous leishmaniasis represents a serious public health problem, and chemotherapy is an important element of the clinical management of this disease. However, treatment efficacy is variable, a phenomenon that might be due to host and parasite (e.g., drug resistance) factors. To better understand the possible contribution of parasite factors to this phenomenon, we characterised 12 Leishmania braziliensis (LB) and 25 Leishmania guyanensis (LG) isolates collected from patients experiencing different antimonial treatment outcomes. For each isolate, promastigote cultures were grown in duplicate and were harvested at the late-log and stationary phases of growth. The RNA expression profiles of six genes encoding proteins with roles in antimony metabolism (AQP1, MRPA, GSH1, GSH2, TRYR and TDR1) were assessed by means of real-time quantitative PCR. Molecular data were compared to the clinical phenotypes. Within LB, we did not find statistically significant differences in the expression levels of the examined genes among isolates from patients with different treatment outcomes. In LG, GSH1 (encoding gamma-glutamylcysteine synthetase, gamma-GCS) was overexpressed in therapeutic failure isolates regardless of the growth curve phase. This finding reveals the predictive potential of promastigote expression curves for the prognosis of cutaneous leishmaniasis caused by LG in Brazil.
Collapse
Affiliation(s)
- Davi Coe Torres
- Laboratório de Pesquisa em Leishmaniose, Coleção de Leishmania do Instituto Oswaldo Cruz IOC, Fiocruz, Rio de Janeiro, Brazil
| | | | | | | | | | | | | |
Collapse
|
14
|
Chagas-Junior AD, McBride AJA, Athanazio DA, Figueira CP, Medeiros MA, Reis MG, Ko AI, McBride FWC. An imprint method for detecting leptospires in the hamster model of vaccine-mediated immunity for leptospirosis. J Med Microbiol 2009; 58:1632-1637. [PMID: 19679685 PMCID: PMC2887544 DOI: 10.1099/jmm.0.014050-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Accepted: 08/10/2009] [Indexed: 11/18/2022] Open
Abstract
In determining the efficacy of new vaccine candidates for leptospirosis, the primary end point is death and an important secondary end point is sterilizing immunity. However, evaluation of this end point is often hampered by the time-consuming demands and complexity of methods such as culture isolation (CI). In this study, we evaluated the use of an imprint (or touch preparation) method (IM) in detecting the presence of leptospires in tissues of hamsters infected with Leptospira interrogans serovar Copenhageni. In a dissemination study, compared to CI, the IM led to equal or improved detection of leptospires in kidney, liver, lung and blood samples collected post-infection and overall concordance was good (kappa=0.61). Furthermore, in an evaluation of hamsters immunized with a recombinant leptospiral protein-based vaccine candidate and subsequently challenged, the agreement between the CI and IM was very good (kappa=0.84). These findings indicate that the IM is a rapid method for the direct observation of Leptospira spp. that can be readily applied to evaluating infection in experimental animals and determining sterilizing immunity when screening potential vaccine candidates.
Collapse
Affiliation(s)
- Adenizar D. Chagas-Junior
- Gonçalo Moniz Research Centre, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador, BA, Brazil
| | - Alan J. A. McBride
- Gonçalo Moniz Research Centre, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador, BA, Brazil
| | - Daniel A. Athanazio
- Gonçalo Moniz Research Centre, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador, BA, Brazil
- Department of Biointeraction, Health Sciences Institute, Federal University of Bahia, Salvador, BA, Brazil
| | - Cláudio P. Figueira
- Gonçalo Moniz Research Centre, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador, BA, Brazil
| | - Marco A. Medeiros
- Bio-Manguinhos, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Rio de Janeiro, RJ, Brazil
| | - Mitermayer G. Reis
- Gonçalo Moniz Research Centre, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador, BA, Brazil
| | - Albert I. Ko
- Gonçalo Moniz Research Centre, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador, BA, Brazil
- Division of Infectious Diseases, Weill Medical College of Cornell University, NY, USA
| | - Flávia W. C. McBride
- Gonçalo Moniz Research Centre, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador, BA, Brazil
- Department of Biointeraction, Health Sciences Institute, Federal University of Bahia, Salvador, BA, Brazil
| |
Collapse
|