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Teixeira AC, Paes MG, Guerra JDO, Prata A, Silva-Vergara ML. Failure of both azithromycin and antimony to treat cutaneous leishmaniasis in Manaus, AM, Brazil. Rev Inst Med Trop Sao Paulo 2008; 50:157-60. [DOI: 10.1590/s0036-46652008000300005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2007] [Accepted: 04/02/2008] [Indexed: 11/21/2022] Open
Abstract
A non-randomized controlled clinical trial was carried outin order to evaluate both azithromycin and antimony efficacy in cutaneous leishmaniasis in Manaus, AM, Brazil. Forty nine patients from both genders, aged 14 to 70, with cutaneous ulcers for less than three months and a positive imprint for Leishmania spp. amastigotes were recruited into two groups. Group I (26 patients) received a daily-single oral dose of 500 mg of azithromycin for 20 days and Group II (23 patients) received a daily-single intramuscular dose of 20 mg/kg of meglumine antimony, also for 20 days. Azithromycin cured three of 24 (12.5%) patients on days 60, 90 and 120 respectively whereas therapeutic failure was considered in 21 of 24 (87.5%) cases. In group II, antimony cured eight of 19 (42.1%) cases as follows: three on day 30, one each on day 60 and day 90, and three on day 120. Therapeutic failure occurred in 11 of 19 (57.9%) individuals. The efficacy of antimony for leishmaniasis was better than azithromycin but analysis for the intention-to-treat response rate did not show statistical difference between them. Although azithromycin was better tolerated, it showed a very low efficacy to treat cutaneous leishmaniasis in Manaus.
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Teixeira AC, Paes MG, Guerra JDO, Prata A, Silva-Vergara ML. Low efficacy of azithromycin to treat cutaneous leishmaniasis in Manaus, AM, Brazil. Rev Inst Med Trop Sao Paulo 2007; 49:235-8. [PMID: 17823753 DOI: 10.1590/s0036-46652007000400008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2006] [Accepted: 11/27/2006] [Indexed: 11/22/2022] Open
Abstract
An open trial to evaluate the azithromycin efficacy in cutaneous leishmaniasis patients was carried out in Manaus (AM), where Leishmania (Viannia) guyanensis is the main etiologic agent. Forty-one patients with skin lesions of less than 12 weeks duration, without specific treatment for the last three months and a positive imprint to Leishmania sp. were included. From these, 31 (75.6%) were male with median age of 30.2. All of them received a daily-single oral dose of 500 mg of azithromycin for ten days. At 25th day, 16 (39%) presented therapeutic failure and received intramuscular pentavalent antimonial, four were considered lost, 21, that had improved or were inaltered received another ten-day series of azithromycin and were monthly followed, but nine (21.9%) of them presented a poor clinical response and switched to intramuscular pentavalent antimonial on day 55. Of the 12 remaining cases evaluated on day 55, despite of clinical improvement, three asked for antimony therapy and 9 (21.9%) continued the follow-up but, only three were cured on 55th, 85th and 115th days, and six did not come back for final evaluation. The intention-treatment overall response rate was 22% and whole cure was seen in three (7.3%) of cases. Thus, azithromycin showed a low efficacy to treat cutaneous leishmaniasis in Manaus.
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Affiliation(s)
- Alan César Teixeira
- Curso de Pós-Graduação em Medicina Tropical e Infectologia, Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brasil
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Guerra JADO, Ribeiro JAS, Coelho LIDARDC, Barbosa MDGV, Paes MG. [Epidemiology of tegumentary leishmaniasis in São João, Manaus, Amazonas, Brazil]. CAD SAUDE PUBLICA 2007; 22:2319-27. [PMID: 17091169 DOI: 10.1590/s0102-311x2006001100006] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2005] [Accepted: 01/17/2006] [Indexed: 11/21/2022] Open
Abstract
In Manaus, Amazonas State, Brazil, the degree of individual exposure to leishmaniasis is related to disorganized land occupation. In order to evaluate predisposing factors for an outbreak, confirm the parasitological diagnosis, treat patients, and assess etiological agents, reservoirs, and vectors, a 12-month study was conducted in Manaus in a community located along the BR-174 federal highway. Some 451 individuals were studied, among whom 17 cases of American tegumentary leishmaniasis (ATL) were diagnosed (six women and 11 men). Age varied from one to 64 years. Eleven patients had from one to three lesions. As for reservoirs, three opossums were captured. No hemoflagellates were found in the blood tests. Lutzomyia umbratilis was the predominant vector species captured. Many ATL patients were engaged in activities that exposed them to Leishmania vectors. Some patients may have been infected in the household and peridomiciliary environments. The epidemiological profile of ATL in this community is similar that of other foci in the region. This case series characterizes ATL as an endemic local public health problem.
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Romero GAS, de la Glória Orge Orge M, de Farias Guerra MV, Paes MG, de Oliveira Macêdo V, de Carvalho EM. Antibody response in patients with cutaneous leishmaniasis infected by Leishmania (Viannia) braziliensis or Leishmania (Viannia) guyanensis in Brazil. Acta Trop 2005; 93:49-56. [PMID: 15589797 DOI: 10.1016/j.actatropica.2004.09.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2004] [Revised: 08/31/2004] [Accepted: 09/09/2004] [Indexed: 11/24/2022]
Abstract
The antibody response against Leishmania (Leishmania) amazonensis crude antigen was measured through the indirect immunofluorescent assay (IFA) and the immunoenzymatic assay (ELISA) in 114 patients with cutaneous leishmaniasis (CL) in Brazil. Fifty-four patients were infected by Leishmania (Viannia) braziliensis, and 60 patients had L. (V.) guyanensis infection. Patients were comparable by age, sex, disease duration and the Montenegro skin test diameter. L. (V.) braziliensis-infected patients showed significant lower number of ulcerated lesions, greater ulcerated area and higher proportion of lymph node enlargement. Sensitivity of IFA was 79.6% (95% CI 66.1-88.9) and 71.7% (95% CI 58.4-82.2) for L. (V.) braziliensis and L. (V.) guyanensis-infected patients, respectively (P=0.324). Sensitivity of ELISA was 98.2% (95% CI 88.8-99.9) and 85.0% (95% CI 72.9-92.5) for L. (V.) braziliensis and L. (V.) guyanensis-infected patients, respectively (P=0.018). Significant differences were observed in the magnitude of the antibody response before treatment with higher levels detected in L. (V.) braziliensis-infected patients by both serologic techniques. Eighty-four patients had serologic evaluations before and 12 weeks after treatment with meglumine antimoniate, 20 mg/kg/day for 20 days. Significant lower optic density values were observed after treatment with both species independent of cure or failure. Our data showed that L. (V.) braziliensis induces a higher antibody response against L. (L.) amazonensis antigens than L. (V.) guyanensis and that down-modulation of the antibody response occurs shortly during disease evolution after treatment. Moreover the data support the use of ELISA as a better tool for detection of antibodies in CL.
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Affiliation(s)
- Gustavo Adolfo Sierra Romero
- Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Caixa Postal 04517, Campus Universitário, Asa Norte, Brasília, Distrito Federal 70919-970, Brazil.
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Guerra JAO, Barros MLB, Fé NF, Guerra MVF, Castellon E, Paes MG, Sherlock IA. Leishmaniose visceral entre índios no Estado de Roraima, Brasil: aspectos clínicoepidemiológicos de casos observados no período de 1989 a 1993. Rev Soc Bras Med Trop 2004; 37:305-11. [PMID: 15334263 DOI: 10.1590/s0037-86822004000400004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Descreve-se o perfil epidemiológico da leishmaniose visceral entre índios no estado de Roraima, Brasil, baseado na ocorrência de casos humanos observados e nos inquéritos caninos e entomológicos realizados no período de 1989 a 1993. Foram registrados 82 casos humanos de leishmaniose visceral em seis dos oito municípios então existentes no estado; houve predomínio de 69,5% para o sexo masculino entre os casos observados. A maioria (52,4%) dos casos foi entre crianças de zero a dez anos de idade. Registrou-se o índice de 10,3% de infecção canina natural, entre 3.773 cães examinados em 74 localidades pesquisadas. A Lutzomyia longipalpis foi encontrada nas áreas de maior prevalência da doença, em 31 localidades diferentes. Os casos humanos, caninos e vetores estão concentrados em regiões onde predominam serras e lavrados, áreas características de ocorrência da leishmaniose visceral americana. A introdução e intensificação das atividades garimpeiras na região podem ter contribuído para a introdução da doença.
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Guerra JADO, Talhari S, Paes MG, Garrido M, Talhari JM. Aspectos clínicos e diagnósticos da leishmaniose tegumentar americana em militares simultaneamente expostos à infecção na Amazônia. Rev Soc Bras Med Trop 2003. [DOI: 10.1590/s0037-86822003000500008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Os treinamentos militares na selva amazônica constituem importantes fatores na incidência de leishmaniose tegumentar americana na região. Este trabalho descreve 48 casos de leishmaniose tegumentar americana em pacientes militares nos quais a doença se manifestou após operação de treinamento na Amazônia. O período de incubação médio foi de 27,6 dias. Houve predomínio de lesões nos membros superiores, face e pescoço. A maioria dos indivíduos apresentou duas lesões, sendo as úlceras as manifestações mais freqüentes. O diagnóstico foi realizado pelo exame de escarificação das lesões, sendo confirmado pela demonstração do parasito em 43 (89,6%) casos.
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Affiliation(s)
| | - Sinésio Talhari
- Fundação de Medicina Tropical do Amazonas; Universidade do Amazonas
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de Oliveira Guerra JA, Talhari S, Paes MG, Garrido M, Talhari JM. [Clinical and diagnostic aspects of American tegumentary leishmaniosis in soldiers simultaneously exposed to the infection in the Amazon Region]. Rev Soc Bras Med Trop 2003; 36:587-90. [PMID: 14576873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Abstract
Military exercises in the forest of the Amazon region constitute an important factor in the incidence of American cutaneous leishmaniasis in this region. This report describes 48 cases of American tegumentary leishmaniosis. All these patients acquired the disease after military exercises in the Amazon. The mean incubation time was 27.6 days. The lesions were predominantly in the upper extremities, face and neck. The majority of patients presented two lesions. Ulcers were the most common clinical manifestation. The diagnosis was obtained through skin smears of the lesions. A total of 43 cases (89.6 %) were found to be positive.
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Romero GAS, Ishikawa E, Cupolillo E, Toaldo CB, Guerra MVDF, Paes MG, Macêdo VDO, Shaw JJ. Identification of antigenically distinct populations of Leishmania (Viannia) guyanensis from Manaus, Brazil, using monoclonal antibodies. Acta Trop 2002; 82:25-9. [PMID: 11904100 DOI: 10.1016/s0001-706x(02)00002-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Eighty Leishmania isolates from patients who contracted cutaneous leishmaniasis in the Manaus region, Amazonas State, Brazil, were identified as Leishmania (Viannia) guyanensis by the electrophoretic profiles of six enzymes. None reacted with the species-specific monoclonal antibody B19. Two L. (V.) guyanensis subpopulations were detected with the monoclonals B2 and B12. The lack of B19 expression by the L. (V.) guyanensis strains in the present study contrasts with that of the vast majority of the strains of the same parasite from eastern Amazonia and French Guyana that express the epitope.
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Affiliation(s)
- Gustavo Adolfo Sierra Romero
- Núcleo de Medicina Tropical, Universidade de Brasília, Campus Universitário, Asa Norte. Caixa Postal 04517, DF, 70919-970, Brasilia, Brazil.
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Romero GAS, Ishikawa E, Cupolillo E, Toaldo CB, Guerra MVF, Paes MG, Macêdo VO, Shaw JJ. The rarity of infection with Leishmania (Viannia) braziliensis among patients from the Manaus region of Amazonas state, Brazil, who have cutaneous leishmaniasis. Ann Trop Med Parasitol 2002; 96:131-6. [PMID: 12080973 DOI: 10.1179/000349802125000745] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The frequency of Leishmania ( Viannia) braziliensis infection was assessed in 79 of the 138 patients with cutaneous leishmaniasis who attended a reference outpatient unit in Manaus, Amazonas state, between the August and December of 1997. The disease was characterized by one or more cutaneous ulcers, the skin lesions being frequently associated with satellite lymph-node enlargement. All parasite isolates were identified using monoclonal antibodies and enzyme electrophoresis. Only two (2.8%) of the 71 patients from whom parasites were successfully isolated were found to be infected with L. ( V.) braziliensis, the other 69 isolates being identified, from their isoenzyme profiles, as L. ( V.) guyanensis. In the Manaus region, therefore, almost all human cutaneous leishmaniasis is the result of infection with L. (V.) guyanensis, and L. ( V.) braziliensis is a relatively rare cause of the disease.
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Affiliation(s)
- G A S Romero
- Núcleo de Medicina Tropical, Universidade de Brasília, Asa Norte, Brazil.
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Romero GA, Guerra MV, Paes MG, Macêdo VO. Comparison of cutaneous leishmaniasis due to Leishmania (Viannia) braziliensis and L. (V.) guyanensis in Brazil: therapeutic response to meglumine antimoniate. Am J Trop Med Hyg 2001; 65:456-65. [PMID: 11716098 DOI: 10.4269/ajtmh.2001.65.456] [Citation(s) in RCA: 139] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We conducted a quasi-experimental study to compare the response to meglumine antimoniate in patients with localized cutaneous leishmaniasis from two endemic areas of Brazil that were infected by two Leishmania species. Sixty-one were infected by Leishmania (Viannia) braziliensis (group B) and 57 by L. (V.) guyanensis (group G). All had a parasitologically proven diagnosis and were treated with 20 mg of pentavalent antimonial (SbV)/kg/day given intravenously or intramuscularly for 20 days. Main outcomes were diagnosed using clinical criteria three months after treatment and patients were followed for six months. Intention-to-treat analysis showed a higher failure rate in group G (relative risk [RR] = 1.5, 95% confidence interval [CI] = 1.1-2.0, chi2 = 7.44, P = 0.006). The analysis using an explanatory approach including 52 patients from group B and 49 from group G, who were regularly treated and followed for six months, showed a low cure rate (50.8% in group B and 26.3% in group G) with a greater risk of failure in the latter group (RR = 1.7, 95% CI = 1.2-2.5, chi2 = 8.56, P = 0.003). The effect of the etiologic agent remained significant after adjusting for age, disease duration, and site and number of lesions that were identified as predictors of failure in a logistic regression model. We concluded that Leishmania species constitute an important factor in predicting the outcome of cutaneous leishmaniasis treated with a pentavalent antimonial.
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Affiliation(s)
- G A Romero
- Núcleo de Medicina Tropical, Universidade de Brasília, Brazil
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Romero GA, Guerra MV, Paes MG, Cupolillo E, Bentin Toaldo C, Macêdo VO, Fernandes O. Sensitivity of the polymerase chain reaction for the diagnosis of cutaneous leishmaniasis due to Leishmania (Viannia) guyanensis. Acta Trop 2001; 79:225-9. [PMID: 11412806 DOI: 10.1016/s0001-706x(01)00140-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The sensitivity of the polymerase chain reaction (PCR) in 35 consecutive outpatients with cutaneous leishmaniasis caused by Leishmania (Viannia) guyanensis was evaluated using, as gold standard, the in vitro isolation of the parasite through culture of aspirates of the cutaneous ulcers. All isolates were identified using electrophoretic enzyme analysis. Patients were mainly young males with recent onset disease without prior specific treatment. PCR was performed using DNA extracted from fresh frozen biopsies of cutaneous ulcers. The reaction used a pair of oligonucleotides that amplify the conserved region of the minicircle molecule. PCR showed 100% sensitivity (95% CI from 90.0 to 100.0). These results were similar to the visualization of amastigotes in imprint preparations of cutaneous biopsy tissue and the inoculation of biopsy material in golden hamsters. Despite the high sensitivity of the PCR, in this particular clinical setting of cutaneous leishmaniasis caused by L. (V.) guyanensis in the Brazilian Amazon, it appears that the method of choice for diagnosis should be the direct visualization of amastigotes using imprint preparations and the PCR reserved for those patients with negative imprint results.
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Affiliation(s)
- G A Romero
- Núcleo de Medicina Tropical, Universidade de Brasília, Campus Universitário, Asa Norte, P.O. Box 04517, DF. 70919-970, Brasília, Brazil.
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