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Amato VS, Franco LAM, de Souza RM, da Silva CAM, Ramundo MS, Côrtes MF, Corrêa-Castro G, Santos-Oliveira JR, Da-Cruz AM, Pagliari C, Galo LK, Tuon FF. Case Report: In Situ and Systemic Immune Response to Mucosal Leishmaniasis in an HIV-Infected Patient. Am J Trop Med Hyg 2024; 110:228-233. [PMID: 38109765 PMCID: PMC10859819 DOI: 10.4269/ajtmh.23-0287] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/11/2023] [Indexed: 12/20/2023] Open
Abstract
In situ and systemic evaluations of the immune responses of HIV-infected patients to mucosal leishmaniasis have been poorly described. We describe a recently diagnosed HIV-infected patient with mucosal leishmaniasis who was characterized by a CD4 count of 85 cells/mm3 and nasal septum destruction resulting from pruritic and ulcerated nasal mucosa with crust formation and progression over 2 years. In situ and systemic immune evaluations of T cell activation, memory, and exhaustion were conducted using cytofluorometric assays, and sequencing of the Leishmania species was performed. The immune profile of HIV-infected patient with mucosal leishmaniasis shows a mixed Th1/Th2 pattern and an activated and exhausted status.
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Affiliation(s)
- Valdir Sabbaga Amato
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical, Laboratório de Parasitologia, São Paulo, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Doenças e Moléstias Infecciosas, São Paulo, Brazil
| | - Lucas Augusto Moyses Franco
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical, Laboratório de Parasitologia, São Paulo, Brazil
| | - Regina Maia de Souza
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical, Laboratório de Parasitologia, São Paulo, Brazil
| | - Camila Alves Maia da Silva
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical, Laboratório de Parasitologia, São Paulo, Brazil
| | - Mariana Severo Ramundo
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical, Laboratório de Parasitologia, São Paulo, Brazil
| | - Marina Farrel Côrtes
- Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, Laboratório de Bacteriologia e Resistência Antimicrobiana, São Paulo, Brazil
| | - Gabriela Corrêa-Castro
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
- Núcleo de Ciências Biomédicas Aplicadas, Instituto Federal de Educação, Ciência e Tecnologia – IFRJ, Rio de Janeiro, Brazil
| | - Joanna Reis Santos-Oliveira
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
- Núcleo de Ciências Biomédicas Aplicadas, Instituto Federal de Educação, Ciência e Tecnologia – IFRJ, Rio de Janeiro, Brazil
| | - Alda M. Da-Cruz
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Carla Pagliari
- Departamento de Patologia, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Luciane Kanashiro Galo
- Departamento de Patologia, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Felipe Francisco Tuon
- Pontifícia Universidade Católica do Paraná, Laboratório de Doenças Infecciosas e Emergentes, Curitiba, Brazil
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Thizy G, Caumes E, Molher J, Ariey F, Lortholary O, Buffet P, Melenotte C. Disseminated mucocutaneous leishmaniasis in a traveller with idiopathic CD4 lymphocytopenia. J Travel Med 2023; 30:taad063. [PMID: 37154581 DOI: 10.1093/jtm/taad063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/20/2023] [Accepted: 05/02/2023] [Indexed: 05/10/2023]
Affiliation(s)
- Guillaume Thizy
- Université Paris Cité, Centre d'Infectiologie Necker-Pasteur, Service de Maladies Infectieuses et Tropicales, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux Paris, Paris, France
| | - Eric Caumes
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
- Centre de diagnostic, Hôpital de l'Hôtel-Dieu, Paris 750004, France
| | - Joffrey Molher
- Service de chirurgie ORL, cervico-faciale et de la base du crâne, Hôpital Lariboisière, Paris France
| | - Frederic Ariey
- Université de Paris, INSERM 1016, Institut Cochin, Service de Parasitologie-Mycologie Hôpital Cochin, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Olivier Lortholary
- Université Paris Cité, Centre d'Infectiologie Necker-Pasteur, Service de Maladies Infectieuses et Tropicales, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux Paris, Paris, France
- IHU Imagine, Paris, France
- Université Paris Cité, Biologie Intégrée du Globule Rouge, UMR_S1134, BIGR, INSERM, Paris, France
- Laboratoire d'Excellence GR-Ex, Paris, France
- Institut National de la Transfusion Sanguine, Paris, France
- Institut Pasteur, Paris, France
| | - Pierre Buffet
- Université Paris Cité, Centre d'Infectiologie Necker-Pasteur, Service de Maladies Infectieuses et Tropicales, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux Paris, Paris, France
- Université Paris Cité, Biologie Intégrée du Globule Rouge, UMR_S1134, BIGR, INSERM, Paris, France
- Laboratoire d'Excellence GR-Ex, Paris, France
- Institut National de la Transfusion Sanguine, Paris, France
- Université Paris Cité and Université des Antilles, Inserm, BIGR, Paris F-75015, France
| | - Cléa Melenotte
- Université Paris Cité, Centre d'Infectiologie Necker-Pasteur, Service de Maladies Infectieuses et Tropicales, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux Paris, Paris, France
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Poloni A, Giacomelli A, Corbellino M, Grande R, Nebuloni M, Rizzardini G, Ridolfo AL, Antinori S. Delayed diagnosis among patients with cutaneous and mucocutaneous leishmaniasis. Travel Med Infect Dis 2023; 55:102637. [PMID: 37634674 DOI: 10.1016/j.tmaid.2023.102637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 08/29/2023]
Affiliation(s)
- Andrea Poloni
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy; Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Italy
| | - Andrea Giacomelli
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Mario Corbellino
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | | | - Manuela Nebuloni
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Italy; Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Giuliano Rizzardini
- I Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Anna Lisa Ridolfo
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Spinello Antinori
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Italy; III Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy.
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de Arruda JAA, Tomo S, Cunha JLS, Guevara JR, Martínez I, Reyes O, Bracho V, Sanchez C, de Andrade BAB, Villarroel-Dorrego M. Mucosal Leishmaniasis of the lip: Report of an Exuberant case in a Young man. Head Neck Pathol 2023; 17:540-545. [PMID: 36346574 PMCID: PMC10293522 DOI: 10.1007/s12105-022-01497-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/16/2022] [Accepted: 09/17/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Leishmaniasis is a tropical disease caused by protozoan parasites of the genus Leishmania. Mucosal leishmaniasis has been described as secondary to the cutaneous form; however, isolated mucosal involvement can also occur. Specifically, mucosal leishmaniasis of the lip is poorly described and its diagnosis challenges clinicians. METHODS We herein report a case of mucosal leishmaniasis affecting the lower lip without cutaneous involvement in a 20-year-old Venezuelan man. The patient had no relevant past medical history. Clinically, a mass-like lesion with ulcerations and crusts was observed. RESULTS Microscopically, the lesion was composed of granulomatous inflammation along with macrophages containing intracytoplasmic inclusions similar to round-shaped Leishmania. The species Leishmania (Viannia) braziliensis was confirmed. Treatment with meglumine antimonate was effective. The lesion healed satisfactorily, and no side effects or recurrences were observed. CONCLUSION Clinicians should be aware of isolated forms of mucosal leishmaniasis of the lip, even in cases where the cutaneous lesion is undetected or clinically manifests as self-limiting. Knowing the endemic areas in the scenario of the dynamics of the ecoepidemiology of leishmaniasis is also essential for surveillance and counselling of the population.
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Affiliation(s)
- José Alcides Almeida de Arruda
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Saygo Tomo
- Department of Stomatology, A.C.Camargo Cancer Center, São Paulo, Brazil
| | - John Lennon Silva Cunha
- Department of Oral Diagnosis, Piracicaba Dental School, Universidade Estadual de Campinas, Piracicaba, Brazil
| | - José Ramón Guevara
- National Programme of Leishmaniasis, Biomedicine Institute “Dr. Jacinto Convit”, Caracas, Venezuela
| | - Idalina Martínez
- National Programme of Leishmaniasis, Biomedicine Institute “Dr. Jacinto Convit”, Caracas, Venezuela
| | - Oscar Reyes
- National Programme of Leishmaniasis, Biomedicine Institute “Dr. Jacinto Convit”, Caracas, Venezuela
| | - Verónica Bracho
- National Programme of Leishmaniasis, Biomedicine Institute “Dr. Jacinto Convit”, Caracas, Venezuela
| | - Carlos Sanchez
- Oral Medicine, Dental School, Universidad Central de Venezuela, Caracas, Venezuela
| | - Bruno Augusto Benevenuto de Andrade
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, R. Rodolpho Paulo Rocco, n. 325, 1st floor, Cidade Universitária, Rio de Janeiro, RJ Brazil
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Carvalho JDP, Silva SN, Freire ML, Alves LL, de Souza CSA, Cota G. The cure rate after different treatments for mucosal leishmaniasis in the Americas: A systematic review. PLoS Negl Trop Dis 2022; 16:e0010931. [PMID: 36395328 PMCID: PMC9714886 DOI: 10.1371/journal.pntd.0010931] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 12/01/2022] [Accepted: 11/02/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Mucosal or mucocutaneous leishmaniasis is the most severe form of tegumentary leishmaniasis due to its destructive character and potential damage to respiratory and digestive tracts. The current treatment recommendations are based on low or very low-quality evidence, and pentavalent antimonial derivatives remain strongly recommended. The aim of this review was to update the evidence and estimate the cure rate and safety profile of the therapeutic options available for mucosal leishmaniasis (ML) in the Americas. METHODOLOGY A systematic review was conducted in four different databases and by different reviewers, independently, to evaluate the therapeutic efficacy and toxicity associated with different treatments for ML. All original studies reporting cure rates in more than 10 patients from American regions were included, without restriction of design, language, or publication date. The risk of bias was assessed by two reviewers, using different tools according to the study design. The pooled cure rate based on the latest cure assessment reported in the original studies was calculated grouping all study arms addressing the same intervention. The protocol for this review was registered at the International Prospective Register of Systematic Reviews, PROSPERO: CRD42019130708. PRINCIPAL FINDINGS Twenty-seven original studies from four databases fulfilled the selection criteria. A total of 1,666 patients with ML were treated predominantly with pentavalent antimonials in Brazil. Other interventions, such as pentamidine, miltefosine, imidazoles, aminosidine sulfate, deoxycholate and lipidic formulations of amphotericin B (liposomal, lipid complex, colloidal dispersion), in addition to combinations with pentoxifylline, allopurinol or sulfa were also considered. In general, at least one domain with a high risk of bias was identified in the included studies, suggesting low methodological quality. The pooled cure rate based on the latest cure assessment reported in the original studies was calculated grouping all study arms addressing the same intervention. It was confirmed that antimony is still the most used treatment for ML, with only moderate efficacy (possibly increased by combining with pentoxifylline). There is already evidence for the use of miltefosine for ML, with a cure rate similar to antimony, as observed in the only direct meta-analysis including 57 patients (OR: 1.2; 0.43-3.49, I2 = 0). It was possible to gather all descriptions available about adverse events reported during ML treatment, and the toxicity reflected the pattern informed in the manufacturers' technical information. CONCLUSIONS This study provides an overview of the clinical experience in the Americas related to ML treatment and points out interventions and possible combinations that are eligible to be explored in future well-designed studies.
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Affiliation(s)
- Janaína de Pina Carvalho
- Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Sarah Nascimento Silva
- Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Mariana Lourenço Freire
- Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Líndicy Leidicy Alves
- Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Carolina Senra Alves de Souza
- Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
- Coordenação Estadual de Laboratórios e Pesquisa em Vigilância da Subsecretaria de Vigilância em Saúde da Secretaria do Estado da Saúde de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Gláucia Cota
- Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
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Soto J, Gutiérrez P, Soto P, Paz D, Cayhuara E, Molina C, Sánchez M, Berman J. Treatment of Bolivian Leishmania braziliensis Cutaneous and Mucosal Leishmaniasis. Am J Trop Med Hyg 2022; 106:1182-1190. [PMID: 35385826 PMCID: PMC8991326 DOI: 10.4269/ajtmh.21-0928] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/08/2021] [Indexed: 11/07/2022] Open
Abstract
Although infection with Leishmania braziliensis is perhaps the key reason to treat New World cutaneous leishmaniasis (CL) and mucosal leishmaniasis (ML), the total literature contains relatively few reported cases. With the aim of supplementing the meager clinical information available, we searched the records of Jorochito (Dermatology) Hospital, Bolivia, for the years 1999-2020 and identified treatment records for 1,696 naive CL patients and 355 naive ML patients. Because follow-up was poor for this real-world treatment experience in the developing world, only 255 CL patients (15%) and 114 ML patients (32%) attended follow-up at Hospital. We therefore engaged in an Active Search for "lost" patients, located a further 542 CL patients (32%) and 142 ML patients (44%), thus eventually accomplished follow up on 697 CL patients (41%) and 256 ML patients (72%). Granular adverse event data derived from hospital records is listed for the 902 CL and 86 ML patients administered Glucantime intramuscularly, the 401 CL and 202 ML patients administered Glucantime intravenously, and the 163 CL and 89 ML patients administered miltefosine orally. Efficacy was obtained from hospital records for patients seen at hospital and from patient recall communicated by telephone for the patients found in the Active Search. The overall CL cure rate was 508 of 697 CL patients (73%) with follow-up: intramuscular Glucantime-196/293 (67%); intravenous Glucantime-90/126 (71%); intralesional Glucantime-34/54 (63%); oral miltefosine-52/69 (75%). The overall ML cure rate was 161 of 256 ML patients (63%) with follow-up: intramuscular Glucantime-26/48 (54%); intravenous Glucantime-66/104 (63%); intravenous amphotericin B deoxycholate-19/35 (54%); oral miltefosine-50/71 (70%). We offer this extensive adverse event and efficacy experience as useful guides for clinicians presented with a L. braziliensis infection. The cure rates also illustrate the quandary of New World CL and ML chemotherapy: sufficiently high to be useful but nevertheless needing augmentation with new agents.
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Affiliation(s)
- Jaime Soto
- FUNDERMA (Fundación Nacional de Dermatología) and Hospital Dermatológico de Jorochito, Santa Cruz, Bolivia
| | - Patricia Gutiérrez
- FUNDERMA (Fundación Nacional de Dermatología) and Hospital Dermatológico de Jorochito, Santa Cruz, Bolivia
| | - Paula Soto
- FUNDERMA (Fundación Nacional de Dermatología), Santa Cruz, Bolivia
| | - David Paz
- Hospital Dermatológico de Jorochito, Santa Cruz, Bolivia
| | - Eduardo Cayhuara
- Programa Nacional de Leishmaniasis, Ministerio de Salud del Estado Plurinacional de, La Paz, Bolivia
| | - Carmen Molina
- Programa Nacional de Leishmaniasis, Ministerio de Salud del Estado Plurinacional de, La Paz, Bolivia
| | - Mia Sánchez
- FUNDERMA (Fundación Nacional de Dermatología), Santa Cruz, Bolivia
| | - Jonathan Berman
- AB Foundation, North Bethesda, Maryland
- Fast-Track Drugs, Potomac, Maryland
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Botelho MCB, Ferreira LL, Fikaris S, Prado-Ribeiro AC, Soubhia AMP, Biasoli ER, Miyahara GI, Bernabé DG. Tongue Nodule as Primary Manifestation of American Cutaneous Leishmaniasis in an Immunocompetent Patient. Head Neck Pathol 2021; 15:1069-1073. [PMID: 33372239 PMCID: PMC8384968 DOI: 10.1007/s12105-020-01253-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 11/17/2020] [Indexed: 01/01/2023]
Abstract
Leishmaniasis is a parasitic disease considered an endemic public health problem in developing countries, where it is a reportable disease. Isolated oral manifestation is rare, and its clinical manifestations are variable. In this paper we describe an unusual case of an immunocompetent patient, 57-year-old man with a painless reddish submucosal nodule located on the tongue dorsum. Microscopical analysis showed chronic inflammatory infiltrate with macrophages containing leishmania in cytoplasmic vacuoles. PCR assays confirmed the diagnosis and patient was treated with meglumine antimoniate for 30 days. Absence of the parasite was confirmed by PCR. Thirteen years after treatment, a scar fibrosis persisted on the tongue dorsum. The case reported reveals that leishmaniasis should be considered in the diagnosis of tongue nodules in immunocompetent patients.
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Affiliation(s)
- Maria Clara Bertolini Botelho
- Oral Oncology Center, School of Dentistry, São Paulo State University (Unesp), 1193 José Bonifácio St, Araçatuba, São Paulo, 15050-015, Brazil
| | - Lígia Lavezo Ferreira
- Oral Oncology Center, School of Dentistry, São Paulo State University (Unesp), 1193 José Bonifácio St, Araçatuba, São Paulo, 15050-015, Brazil
| | - Stelios Fikaris
- Oral Oncology Center, School of Dentistry, São Paulo State University (Unesp), 1193 José Bonifácio St, Araçatuba, São Paulo, 15050-015, Brazil
| | - Ana Carolina Prado-Ribeiro
- Dental Oncology Service, São Paulo State Cancer Institute (ICESP-FMUSP), University of São Paulo Medical School, São Paulo, São Paulo, Brazil
| | - Ana Maria Pires Soubhia
- Department of Diagnosis and Surgery, São Paulo State University (Unesp), School of Dentistry, 1193 José Bonifácio St, Araçatuba, São Paulo, 15050-015, Brazil
| | - Eder Ricardo Biasoli
- Oral Oncology Center, School of Dentistry, São Paulo State University (Unesp), 1193 José Bonifácio St, Araçatuba, São Paulo, 15050-015, Brazil
- Department of Diagnosis and Surgery, São Paulo State University (Unesp), School of Dentistry, 1193 José Bonifácio St, Araçatuba, São Paulo, 15050-015, Brazil
| | - Glauco Issamu Miyahara
- Oral Oncology Center, School of Dentistry, São Paulo State University (Unesp), 1193 José Bonifácio St, Araçatuba, São Paulo, 15050-015, Brazil
- Department of Diagnosis and Surgery, São Paulo State University (Unesp), School of Dentistry, 1193 José Bonifácio St, Araçatuba, São Paulo, 15050-015, Brazil
| | - Daniel Galera Bernabé
- Oral Oncology Center, School of Dentistry, São Paulo State University (Unesp), 1193 José Bonifácio St, Araçatuba, São Paulo, 15050-015, Brazil.
- Department of Diagnosis and Surgery, São Paulo State University (Unesp), School of Dentistry, 1193 José Bonifácio St, Araçatuba, São Paulo, 15050-015, Brazil.
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Bezemer JM, van der Ende J, Limpens J, de Vries HJC, Schallig HDFH. Safety and efficacy of allylamines in the treatment of cutaneous and mucocutaneous leishmaniasis: A systematic review. PLoS One 2021; 16:e0249628. [PMID: 33826660 PMCID: PMC8026199 DOI: 10.1371/journal.pone.0249628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 03/22/2021] [Indexed: 12/28/2022] Open
Abstract
Cutaneous and mucocutaneous leishmaniasis affect a million people yearly, leading to skin lesions and potentially disfiguring mucosal disease. Current treatments can have severe side effects. Allylamine drugs, like terbinafine, are safe, including during pregnancy. This review assesses efficacy and safety of allylamines for the treatment of cutaneous and mucocutaneous leishmaniasis. It followed the PRISMA statement for reporting and was preregistered in PROSPERO(CRD4201809068). MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Global Health Library, Web of Science, Google Scholar, and clinical trial registers were searched from their creation to May 24th, 2020. All original human, animal, and in vitro studies concerning allylamines and cutaneous or mucocutaneous leishmaniasis were eligible for inclusion. Comparators—if any—included both placebo or alternative cutaneous or mucocutaneous leishmaniasis treatments. Complete cure, growth inhibition, or adverse events served as outcomes. The search identified 312 publications, of which 22 were included in this systematic review. There were one uncontrolled and two randomised controlled trials. The only well-designed randomised controlled trial that compared the treatment efficacy of oral terbinafine versus intramuscular meglumine antimoniate in 80 Leismania tropica infected patients showed a non-significant lower cure rate for terbinafine vs meglumine antimoniate (38% vs 53%). A meta-analysis could not be performed due to the small number of studies, their heterogeneity, and low quality. This systematic review shows that there is no evidence of efficacy of allylamine monotherapy against cutaneous and mucocutaneous leishmaniasis. Further trials of allylamines should be carefully considered as the outcomes of an adequately designed trial were disappointing and in vitro studies indicate minimal effective concentrations that are not achieved in the skin during standard doses. However, the in vitro synergistic effects of allylamines combined with triazole drugs warrant further exploration.
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Affiliation(s)
- Jacob M. Bezemer
- Experimental Parasitology Unit, Department of Medical Microbiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Fundación Misión Cristiana de Salud, Shell, Pastaza, Ecuador
- * E-mail:
| | - Jacob van der Ende
- Fundación Quina Care Ecuador, Puerto el Carmen de Putumayo, Sucumbíos, Ecuador
| | - Jacqueline Limpens
- Medical Library, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Henry J. C. de Vries
- Department of Dermatology, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Henk D. F. H. Schallig
- Experimental Parasitology Unit, Department of Medical Microbiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Carvalho JDP, de Assis TM, Simões TC, Cota G. Estimating direct costs of the treatment for mucosal leishmaniasis in Brazil. Rev Soc Bras Med Trop 2021; 54:e04542020. [PMID: 33533816 PMCID: PMC7849328 DOI: 10.1590/0037-8682-0454-2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 12/15/2020] [Indexed: 04/01/2024] Open
Abstract
INTRODUCTION The objective of this study was to estimate the direct medical costs of the treatment for mucosal leishmaniasis (ML) using three therapeutic approaches in the Brazilian context. METHODS We performed this economic assessment from the perspective of the Brazilian public healthcare system. The following therapeutic approaches were evaluated: meglumine antimoniate, liposomal amphotericin B, and miltefosine. Direct medical costs were estimated considering four treatment components: a) drug, b) combined medical products, c) procedures, and d) complementary tests. RESULTS Treatment with meglumine antimoniate had the lowest average cost per patient (US$ 167.66), followed by miltefosine (US$ 259.92) in the outpatient treatment regimen. The average cost of treatment with liposomal amphotericin B was US$ 715.35 both in inpatient regimen. In all estimates, the drugs accounted for more than 60% of the total cost for each treatment approach. CONCLUSIONS These results demonstrate the marked differences in costs between the therapeutic alternatives for ML. In addition to efficacy rates and costs related to adverse events, our data have the potential to support a complete cost-effectiveness study in the future. Complete analyses comparing costs and benefits for interventions will assist health managers in choosing drugs for ML treatment in Brazil as well as in establishing effective public health policies.
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Affiliation(s)
- Janaína de Pina Carvalho
- Fundação Oswaldo Cruz, Instituto René Rachou, Grupo de Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias, Belo Horizonte, MG, Brasil
| | - Tália Machado de Assis
- Fundação Oswaldo Cruz, Instituto René Rachou, Grupo de Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias, Belo Horizonte, MG, Brasil
- Centro Federal de Educação Tecnológica de Minas Gerais, Campus Contagem, Contagem, MG, Brasil
| | - Taynãna César Simões
- Fundação Oswaldo Cruz, Instituto René Rachou, Grupo de Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias, Belo Horizonte, MG, Brasil
| | - Gláucia Cota
- Fundação Oswaldo Cruz, Instituto René Rachou, Grupo de Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias, Belo Horizonte, MG, Brasil
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Zanelli G, Rossetti B, Gagliardini R, Paglicci L, Tordini G, Miracco C, Aversa S, Zammarchi L, Di Muccio T, Gramiccia M, Montagnani F. Use of miltefosine in a patient with mucosal leishmaniasis and HIV-coinfection: a challenge in long-term management. Infez Med 2019; 27:452-455. [PMID: 31846999] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The management of mucosal leishmaniasis in immunocompromised patients is not standardized and limited data are available on the use of miltefosine for treatment and secondary prophylaxis. We describe a case of mucosal leishmaniasis in an HIV-coinfected patient treated with miltefosine due to a severe allergic reaction to liposomal amphotericin B.
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Affiliation(s)
- Giacomo Zanelli
- Hospital Department of Specialized and Internal Medicine, Infectious Diseases Unit, University Hospital of Siena, Siena, Italy; Department of Medical Biotechnologies, University of Siena, Italy
| | - Barbara Rossetti
- Hospital Department of Specialized and Internal Medicine, Infectious Diseases Unit, University Hospital of Siena, Siena, Italy
| | - Roberta Gagliardini
- Hospital Department of Specialized and Internal Medicine, Infectious Diseases Unit, University Hospital of Siena, Siena, Italy; INMI L.Spallanzani IRCCS, Rome, Italy
| | - Lorenzo Paglicci
- Hospital Department of Specialized and Internal Medicine, Infectious Diseases Unit, University Hospital of Siena, Siena, Italy; Department of Medical Biotechnologies, University of Siena, Italy 3INMI L.Spallanzani IRCCS, Rome, Italy
| | - Giacinta Tordini
- Hospital Department of Specialized and Internal Medicine, Infectious Diseases Unit, University Hospital of Siena, Siena, Italy; Department of Medical Biotechnologies, University of Siena, Italy 3INMI L.Spallanzani IRCCS, Rome, Italy
| | - Clelia Miracco
- Pathological Anatomy Division, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Sara Aversa
- Pathological Anatomy Division, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Infectious and Tropical Diseases Unit, Careggi University and Hospital, Florence, Italy; Referral Center for Tropical Diseases of Tuscany, Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Trentina Di Muccio
- Department of Infectious Diseases, Unit of Vector-borne Diseases, Italian National Institute of Health, Rome, Italy
| | - Marina Gramiccia
- Department of Infectious Diseases, Unit of Vector-borne Diseases, Italian National Institute of Health, Rome, Italy
| | - Francesca Montagnani
- Hospital Department of Specialized and Internal Medicine, Infectious Diseases Unit, University Hospital of Siena, Siena, Italy; Department of Medical Biotechnologies, University of Siena, Italy
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Santos CR, Tuon FF, Cieslinski J, de Souza RM, Imamura R, Amato VS. Comparative study on liposomal amphotericin B and other therapies in the treatment of mucosal leishmaniasis: A 15-year retrospective cohort study. PLoS One 2019; 14:e0218786. [PMID: 31242231 PMCID: PMC6594680 DOI: 10.1371/journal.pone.0218786] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 06/11/2019] [Indexed: 11/19/2022] Open
Abstract
Background Liposomal amphotericin B (L-AMB) has been used for mucosal leishmaniasis (ML), but comparative studies on L-AMB and other drugs used for the treatment of ML have not been conducted. The present study aimed to evaluate the outcome of patients with ML who were treated with L-AMB. Methods This is a 15-year retrospective study of Brazilian patients with a confirmed diagnosis of ML. The therapeutic options for the treatment of ML consisted of L-AMB, amphotericin B lipid complex (ABLC), deoxycholate amphotericin B (d-AMB), itraconazole, antimonial pentavalent, or pentamidine. Healing, cure rate and adverse effects (AEs) associated with the drugs used to treat this condition were analyzed. Results In 71 patients, a total of 105 treatments were evaluated. The outcome of the treatment with each drug was compared, and results showed that L-AMB was superior to other therapeutic regimens (P = 0.001; odds ratio [OR] = 4.84; 95% confidence interval [CI] = 1.78–13.17). d-AMB had worse AEs than other treatment regimens (P = 0.001, OR = 0.09; 95% CI = 0.09–0.43). Approximately 66% of the patients presented with AEs during ML treatment. Although L-AMB was less nephrotoxic than d-AMB, it was associated with acute kidney injury compared with other drugs (P <0.05). Conclusion L-AMB was more effective than other therapies for the treatment of ML. However, a high incidence of toxicity was associated with its use. Therapeutic choices should be reassessed, and the development of new drugs is necessary for the treatment of ML.
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Affiliation(s)
- Carolina Rocio Santos
- Departamento de Molestias Infecciosas e Parasitarias, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, São Paulo, Brasil
| | - Felipe Francisco Tuon
- School of Medicine, Pontificia Universidade Catolica do Parana, Curitiba, Parana, Brasil
| | - Juliette Cieslinski
- School of Medicine, Pontificia Universidade Catolica do Parana, Curitiba, Parana, Brasil
| | - Regina Maia de Souza
- Laboratório de Parasitologia LIM-46, Instituto de Medicina Tropical, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brasil
| | - Rui Imamura
- Departamento de Otorrinolaringologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, São Paulo, Brasil
| | - Valdir Sabbaga Amato
- Departamento de Molestias Infecciosas e Parasitarias, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, São Paulo, Brasil
- * E-mail:
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Møller M, Engsig FN, Barfod TS, Friis-Møller N. [Atypical mycocutaneous manifestation of Leishmania tropica in a refugee]. Ugeskr Laeger 2018; 180:V12170922. [PMID: 30152325] [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: 06/08/2023]
Abstract
In this case report a male 19-year-old Syrian refugee presented with a sore throat. A biopsy from larynx detected Leishmania tropica compatible with leishmaniasis, although L. tropica does not normally cause mucosal leishmaniasis (CL). An immunodeficiency was detected, and the patient was treated for hypogammaglobulinaemia and CL three times, before the symptoms disappeared. Leishmaniasis is a disease, which should be taken into consideration, when refugees present with atypical clinical manifestations, especially in immunosuppressed patients.
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Rojas-Jaimes J, Frischtak HL, Arenas J, Lescano AG. Case Report: Mucosal Leishmaniasis Presenting with Nasal Septum Perforation after Almost Thirty Years. Am J Trop Med Hyg 2018; 99:327-330. [PMID: 29869609 PMCID: PMC6090329 DOI: 10.4269/ajtmh.17-0831] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 04/13/2018] [Indexed: 01/09/2023] Open
Abstract
Mucosal leishmaniasis (ML) is associated with progressive tissue destruction and granuloma formation, often after a considerable period of latency from an initial cutaneous infection. We report a case of recurrent epistaxis of 3 years duration and nasopharyngeal obstruction in a woman with treated cutaneous leishmaniasis nearly 30 years before and with no further exposure to Leishmania. Computed tomography revealed nasal septal perforation and histopathology demonstrated chronic inflammation. Microscopy was negative for amastigotes, but molecular testing of nasal mucosa biopsy detected Leishmania (Viannia) braziliensis. The patient underwent 28 days of treatment with IV sodium stibogluconate and her symptoms improved significantly. Sixteen months after treatment, she continues to have episodic epistaxis and detectable parasite load in her nasal lesion. Although ML is known to take years to decades to develop, there are few reported cases in the literature of such a long latency period. This report highlights the importance of considering ML in the differential diagnosis of chronic epistaxis in countries where leishmaniasis is endemic or in immigrants from these countries, even when presentation occurs decades after leaving an endemic region.
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Affiliation(s)
- Jesùs Rojas-Jaimes
- Department of Medicine, Universidad Cientifica del Sur, Lima, Peru
- Department of Sciences, Universidad Continental, Lima, Peru
| | | | - Jose Arenas
- Hospital Nacional Guillermo Almenara Irigoyen ESSalud, Lima, Peru
| | - Andres G. Lescano
- Emerge, Emerging Diseases and Climate Change Research Unit, School of Public Health and Administration, Universidad Cayetano Heredia, Lima, Peru
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Franco-Muñoz C, Manjarrés-Estremor M, Ovalle-Bracho C. Intraspecies differences in natural susceptibility to amphotericine B of clinical isolates of Leishmania subgenus Viannia. PLoS One 2018; 13:e0196247. [PMID: 29698432 PMCID: PMC5919572 DOI: 10.1371/journal.pone.0196247] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 03/08/2018] [Indexed: 12/18/2022] Open
Abstract
Amphotericin B (AmB) is a recommended medication for the treatment of cutaneous and mucosal leishmaniasis in cases of therapeutic failure with first-line medications; however, little is known about the in vitro susceptibility to AmB of clinical isolates of the subgenus Viannia, which is most prevalent in South America. This work aimed to determine the in vitro susceptibility profiles to AmB of clinical isolates of the species L. (V.) panamensis, L. (V.) guyanensis and L. (V.) braziliensis. In vitro susceptibility to AmB was evaluated for 65 isolates. Macrophages derived from the U937 cell line were infected with promastigotes and exposed to different AmB concentrations. After 96 hours, the number of intracellular amastigotes was quantified by qPCR, and median effective concentration (EC50) was determined using the PROBIT model. The controls included sensitive strains and experimentally derived less sensitive strains generated in vitro, which presented EC50 values up to 7.57-fold higher than the values of the sensitive strains. The isolates were classified into groups according to their in vitro susceptibility profiles using Ward’s hierarchical method. The susceptibility to AmB differed in an intraspecies-specific manner as follows: 28.21% (11/39) of L. (V.) panamensis strains, 50% (3/6) of L. (V.) guyanensis strains and 34.61% (9/26) of L. (V.) braziliensis strains were classified as less sensitive. The latter subset featured three susceptibility groups. We identified Colombian isolates with different AmB susceptibility profiles. In addition, the capacity of species of subgenus Viannia to develop lower susceptibility to AmB was demonstrated in vitro. These new findings should be considered in the pharmacovigilance of AmB in Colombia and South America.
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Affiliation(s)
- Carlos Franco-Muñoz
- Hospital Universitario Centro Dermatológico Federico Lleras Acosta E.S.E., Bogotá D.C., Colombia
| | - Merab Manjarrés-Estremor
- Hospital Universitario Centro Dermatológico Federico Lleras Acosta E.S.E., Bogotá D.C., Colombia
| | - Clemencia Ovalle-Bracho
- Hospital Universitario Centro Dermatológico Federico Lleras Acosta E.S.E., Bogotá D.C., Colombia
- * E-mail:
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Guery R, Henry B, Martin-Blondel G, Rouzaud C, Cordoliani F, Harms G, Gangneux JP, Foulet F, Bourrat E, Baccard M, Morizot G, Consigny PH, Berry A, Blum J, Lortholary O, Buffet P. Liposomal amphotericin B in travelers with cutaneous and muco-cutaneous leishmaniasis: Not a panacea. PLoS Negl Trop Dis 2017; 11:e0006094. [PMID: 29155816 PMCID: PMC5714383 DOI: 10.1371/journal.pntd.0006094] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 12/04/2017] [Accepted: 11/02/2017] [Indexed: 11/18/2022] Open
Abstract
Background Complex cutaneous and muco-cutaneous leishmaniasis (CL and MCL) often requires systemic therapy. Liposomal amphotericin B (L-AmB) has a strong potential for a solid clinical benefit in this indication. Methods We conducted a retrospective analysis of data from a French centralized referral treatment program and from the “LeishMan” European consortium database. All patients with parasitologically proven CL or MCL who received at least one dose of L-AmB were included. Positive outcome was based on ulcer closure as per recent WHO workshop guidelines. Results From 2008 through 2016, 43 travelers returning from 18 countries (Old World n = 28; New World n = 15) were analyzed with a median follow-up duration of 79 days [range 28–803]. Main clinical forms were: localized CL with one or multiple lesions (n = 32; 74%) and MCL (n = 8; 19%). As per published criteria 19 of 41 patients (46%) were cured 90 days after one course of L-AmB. When the following items -improvement before day 90 but no subsequent follow-up, delayed healing (>3 months) and healing after a second course of L-AmB- were included in the definition of cure, 27 of 43 patients (63%) had a positive outcome. Five patients (MCL = 1; CL = 4) experienced a relapse after a median duration of 6 months [range 3–27] post treatment and 53% of patients (23/43) experienced at least one adverse event including severe hypokalaemia and acute cardiac failure (one patient each). In multivariate analysis, tegumentary infection with L. infantum was associated with complete healing after L-AmB therapy (OR 5.8 IC 95% [1.03–32]) while infection with other species had no impact on outcome. Conclusion In conditions close to current medical practice, the therapeutic window of L-AmB was narrow in travellers with CL or MCL, with the possible exception of those infected with L. infantum. Strict follow-up is warranted when using L-AmB in patients with mild disease. Cutaneous and muco-cutaneous leishmaniasis (CL/MCL) are disfiguring diseases caused by a worldwide distributed parasite called Leishmania and its 20 species. Clinical manifestations span a wide continuum from single nodular lesion to disseminated form with mucosal involvement. Though local treatment with cryotherapy and intralesionnal antimony or topical formulations of paromomycin is generally adequate in most of situations, some patients with complex CL/MCL require systemic therapy. No convenient regimen has been proved to be safe and effective for all infecting species, all clinical forms and all patients (e.g. children, pregnant women, adults with comorbidities or immunosuppression). In this study, the authors examined in returning travelers with CL/MCL the effectiveness of an antifungal agent “liposomal amphotericin B” (L-AmB), which is highly effective in visceral leishmaniasis. Surprisingly, rates of healing were lower than in previous reports in this unselected population that reflects clinical practice in non-endemic countries. The observations also suggest that some Leishmania species (namely, L. infantum) may be more susceptible to L-AmB than others. Occurrence of adverse events should raises the question of the benefit-risk balance of L-AmB in CL/MCL. Careful attention to comorbidities and adoption of strict protocols for administration are pre-requisites for the use of L-AmB in patients with CL/MCL.
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Affiliation(s)
- Romain Guery
- Service de Maladies Infectieuses et Tropicales, Centre d’Infectiologie Necker-Pasteur, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants Malades, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- * E-mail: (PB); (RG)
| | - Benoit Henry
- Service de Maladies Infectieuses et Tropicales, Centre d’Infectiologie Necker-Pasteur, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants Malades, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Guillaume Martin-Blondel
- Service des Maladies Infectieuses et Tropicales, CHU de Toulouse, INSERM U1043—CNRS UMR 5282, Centre de Physiopathologie Toulouse-Purpan, Toulouse, France
| | - Claire Rouzaud
- Service de Maladies Infectieuses et Tropicales, Centre d’Infectiologie Necker-Pasteur, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants Malades, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Florence Cordoliani
- Service de Dermatologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot-Paris VII, Paris, France
| | - Gundel Harms
- Institute of Tropical Medicine and International Health, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Jean-Pierre Gangneux
- Service de Parasitologie-Mycologie, CHU de Rennes, INSERM U1085, Université Rennes 1, Rennes, France
| | - Françoise Foulet
- Unité de Mycologie, Département de Biologie-Pathologie, CHU Henri Mondor, DHU VIC, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Emmanuelle Bourrat
- Service de Pédiatrie Général, Hôpital Robert Debré, Service de Dermatologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot-Paris VII, Paris, France
| | - Michel Baccard
- Service de Dermatologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot-Paris VII, Paris, France
| | | | - Paul-Henri Consigny
- Centre Médical de l'Institut Pasteur, Consultation de Maladies Infectieuses, Tropicales et de Médecine des Voyages, Centre d'Infectiologie Necker-Pasteur, Institut Pasteur, Paris, France
| | - Antoine Berry
- Service de Parasitologie-Mycologie, CHU de Toulouse, INSERM U1043—CNRS UMR 5282, Centre de Physiopathologie Toulouse-Purpan, Toulouse, France
| | - Johannes Blum
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | - Olivier Lortholary
- Service de Maladies Infectieuses et Tropicales, Centre d’Infectiologie Necker-Pasteur, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants Malades, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Pierre Buffet
- INTS, Unité Biologie Intégrée du Globule Rouge, Laboratoire d'Excellence GR-Ex, Centre d'Infectiologie Necker-Pasteur, Institut Pasteur, Paris, France
- * E-mail: (PB); (RG)
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Galvão EL, Rabello A, Cota GF. Efficacy of azole therapy for tegumentary leishmaniasis: A systematic review and meta-analysis. PLoS One 2017; 12:e0186117. [PMID: 29016694 PMCID: PMC5633178 DOI: 10.1371/journal.pone.0186117] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 09/25/2017] [Indexed: 11/18/2022] Open
Abstract
Background Several controlled and uncontrolled studies addressing azole antifungal drugs for cutaneous and mucosal leishmaniasis have been published with inconclusive results. We conducted a systematic literature review of studies evaluating the efficacy and toxicity associated with azole therapy for tegumentary leishmaniasis. Methodology PRISMA guidelines for systematic reviews and the Cochrane manual were followed, and the review methodology was registered (PROSPERO; CRD42016048668). Sources included the EMBASE, Web of Science, MEDLINE, LILACS, and IBECS databases along with a manual search of references from evaluated studies. Additional resources such as Google Scholar and clinicaltrials.gov were also searched. We included all studies reporting cure rate after cutaneous or mucosal leishmaniasis treatment with systemic azole drugs, regardless of their design. R software was used to estimate global rates of success and adverse events with each drug. The main outcome of interest was clinical cure, defined as complete re-epithelialization of all lesions. Results A total of 37 studies involving 1259 patients that reported outcomes after fluconazole (9), ketoconazole (14) and itraconazole (15) treatments were included. Only 14 (38%) were randomized controlled trials (RCT). The pooled azole final efficacy rate was 64% (CI95%: 57–70%) for all studies and 60% (CI95%: 50–70%) (p = 0.41) if only RCTs studies were considered. Twenty-four studies were conducted in the Old World and 13 studies in the Americas. The final efficacy rate according to New and Old World were 62% (CI95%: 43–77%) and 66% (CI95%: 58–73%), respectively. The final efficacy rate of azoles according to species were 89% (CI95%: 50–98%) for L. mexicana; 88% for L. infantum (CI95%: 27–99%); 80% for L. donovani; 53% (CI95%: 29–76%) for L. major; 49% for L. braziliensis (CI95%: 21–78%); and 15% (CI95%: 1–84%) for L. tropica. The cure rates were similar among the fluconazole, ketoconazole and itraconazole group arms (p = 0.89), specifically 61% (CI95%: 48–72%), 64% (CI95%: 44–80%) 65% (CI95%: 56–72%), respectively. Adverse events during fluconazole, itraconazole and ketoconazole therapy were reported in 7% (CI95%: 3–14%), 12% (CI95% 8–19%) and 13% (CI95%: 6–29%) of treated patients, respectively, without difference among them (p = 0.35). This systematic review included studies with small samples and both non-comparative and non-randomized studies and the main limitation was the low quality of the available studies. Conclusions Available evidence suggests that fluconazole, ketoconazole and itraconazole have similar and modest efficacy rates for tegumentary leishmaniasis treatment. There is insufficient evidence to support the exclusive use of azole therapy as a single agent for leishmaniasis treatment.
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Affiliation(s)
- Endi Lanza Galvão
- Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias–Centro de Pesquisas René Rachou—Fundação Oswaldo Cruz, Fiocruz, Belo Horizonte, Minas Gerais, Brazil
- * E-mail:
| | - Ana Rabello
- Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias–Centro de Pesquisas René Rachou—Fundação Oswaldo Cruz, Fiocruz, Belo Horizonte, Minas Gerais, Brazil
| | - Gláucia Fernandes Cota
- Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias–Centro de Pesquisas René Rachou—Fundação Oswaldo Cruz, Fiocruz, Belo Horizonte, Minas Gerais, Brazil
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Nicodemo AC, Duailibi DF, Feriani D, Duarte MIS, Amato VS. Mucosal leishmaniasis mimicking T-cell lymphoma in a patient receiving monoclonal antibody against TNFα. PLoS Negl Trop Dis 2017; 11:e0005807. [PMID: 28934199 PMCID: PMC5608166 DOI: 10.1371/journal.pntd.0005807] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Antonio Carlos Nicodemo
- Department of Infectious Diseases, University of São Paulo Medical School, Sao Paulo, Brazil
- * E-mail:
| | - Daniel Fernandes Duailibi
- Department of Infectious and Parasitic Diseases, Clinical Hospital, University of São Paulo Medical School, Sao Paulo, Brazil
| | - Diego Feriani
- Department of Infectious and Parasitic Diseases, Clinical Hospital, University of São Paulo Medical School, Sao Paulo, Brazil
| | | | - Valdir Sabbaga Amato
- Department of Infectious Diseases, University of São Paulo Medical School, Sao Paulo, Brazil
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Mohammadpour I, Motazedian MH, Handjani F, Hatam GR. Lip leishmaniasis: a case series with molecular identification and literature review. BMC Infect Dis 2017; 17:96. [PMID: 28122496 PMCID: PMC5264488 DOI: 10.1186/s12879-016-2178-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 12/28/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mucocutaneous leishmaniasis (MCL), a protozoan infectious disease, is very rare in Iran despite the endemicity of both cutaneous and visceral forms. It is transmitted by the Phlebotomus sand fly. The lip is considered one of the extraordinary sites. Lesions usually initiate with erythematous papules, slowly enlarges and then it ulcerates. The diagnosis of MCL encompasses epidemiological, clinical and laboratory aspects. Usually, the combination of some of these elements is necessary for the final diagnosis. So, lip leishmaniasis lesions can be challenging to diagnose. CASE PRESENTATION We presented seven rare cases of lip leishmaniasis. Tissue impression smear, culture, PCR and phylogenetic analysis were carried out for explicit diagnosis. Skin scraping investigation showed several Leishmania spp. amastigotes in the cytoplasm of macrophages. Culture examination was positive for Leishmania spp. PCR was positive for L. major, L. tropica, and L. infantum. Differential diagnosis includes orofacial granulomatosis, basal cell carcinoma, squamous cell carcinoma, and mesenchymal tumors. The cases were treated with systemic meglumine antimoniate (Glucantime®). No relapses were observed during 1 year of follow-up. Early detection of the infection are necessary in order to start effective treatment and prevent more serious complications. CONCLUSIONS In this paper, we reported seven rare cases of lip leishmaniasis in Iran, emphasized the importance of clinical and diagnostic features of lesions, characterized the phylogenetic kinship of isolated parasites, and reviewed the literature on lip leishmaniasis.
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Affiliation(s)
- Iraj Mohammadpour
- Department of Medical Parasitology & Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hossein Motazedian
- Basic Sciences in Infectious Diseases Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farhad Handjani
- Department of Dermatology, Molecular Dermatology Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Gholam Reza Hatam
- Department of Medical Parasitology & Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Affiliation(s)
- Gina R Virgilio
- Naval Special Warfare Center Division, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, USA.
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Bustos MFG, Barrio A, Basombrío MÁ. [More about miltefosine in the treatment of mucosal leishmaniasis]. Medicina (B Aires) 2015; 75:131. [PMID: 25919882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
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Menten K, Soentjens P, Caenepeel P, Lemkens P. Mucocutaneous leishmaniasis of the nose: a case report. B-ENT 2015; 11:77-80. [PMID: 26513953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
Mucocutaneous leishmaniasis of the nose: a case report. Leishmaniasis is a parasitic infection that is rarely seen in Belgium. The majority of new diagnoses are seen in patients living in or visiting endemic regions, which are mostly developing countries. Here we describe the case of a 60-year-old male patient who was referred to an ENT specialist because of an erythematous swelling of the left side of the nose tip, which had persisted for 3 months. Biopsies showed the presence of leishmaniasis. This case report alerts ENT physicians that leishmaniasis is part of the differential diagnosis in patients who present with an uncommon persistent lesion in the head and neck region and who have travelled to endemic regions or are immunodeficient.
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Joob B, Wiwanitkit V. [Miltefosine or meglumine antimoniate in leishmaniasis]. Medicina (B Aires) 2015; 75:130-131. [PMID: 25919881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Affiliation(s)
- Beuy Joob
- Sanitation Medical Center, Bangkok Thailand
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da Costa DCS, Palmeiro MR, Moreira JS, Martins ACDC, da Silva AF, de Fátima Madeira M, Quintella LP, Confort EM, de Oliveira Schubach A, da Conceição Silva F, Valete-Rosalino CM. Oral manifestations in the American tegumentary leishmaniasis. PLoS One 2014; 9:e109790. [PMID: 25386857 PMCID: PMC4227643 DOI: 10.1371/journal.pone.0109790] [Citation(s) in RCA: 13] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 09/10/2014] [Indexed: 11/27/2022] Open
Abstract
Introduction American tegumentary leishmaniasis (ATL) can affect the skin or mucosa (mucocutaneous leishmaniasis – MCL) including the oral cavity. MCL oral lesions are often confused with other oral diseases, delaying diagnosis and specific treatment, and increasing the likelihood of sequelae. Thus, increasing the knowledge of the evolution of ATL oral lesions can facilitate its early diagnosis improving the prognosis of healing. Objectives Evaluate the frequency of ATL oral lesion and describe its clinical, laboratory and therapeutic peculiarities. Methods A descriptive transversal study was carried out, using data from medical records of 206 patients with MCL examined at the outpatient clinics-IPEC-Fiocruz between 1989 and 2013. Proportions were calculated for the categorical variables and the association among them was assessed by the Pearson's chi-square test. Measures of central tendency and dispersion were used for the continuous variables and their differences were assessed by both parametric (t test) and non parametric (Mann-Whitney) tests. P-values <0.05 were considered as significant. Results The most affected site was the nose, followed by the mouth, pharynx and larynx. Seventy eight (37.9%) have oral lesions and the disease presented a lower median of the evolution time than in other mucous sites as well as an increased time to heal. The presence of oral lesion was associated with: the presence of lesions in the other three mucosal sites; a smaller median of the leishmanin skin test values; a longer healing time of the mucosal lesions; a higher recurrence frequency; and a smaller frequency of treatment finishing and healing. When the oral lesion was isolated, it was associated with an age 20 years lower than when the oral lesion was associated with other mucosal sites. Conclusion Considering the worst therapy results associated with the presence of oral lesions, we suggest that lesions in this location represent a factor of worse prognosis for MCL.
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Affiliation(s)
- Daniel Cesar Silva da Costa
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro-RJ, Brazil
| | - Mariana Reuter Palmeiro
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro-RJ, Brazil
| | - João Soares Moreira
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro-RJ, Brazil
| | | | - Aline Fagundes da Silva
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro-RJ, Brazil
| | - Maria de Fátima Madeira
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro-RJ, Brazil
| | - Leonardo Pereira Quintella
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro-RJ, Brazil
| | - Eliame Mouta Confort
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro-RJ, Brazil
| | | | - Fátima da Conceição Silva
- Laboratory of Immunoparasitology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro-RJ, Brazil
- * E-mail: (CMVR); (FCS)
| | - Cláudia Maria Valete-Rosalino
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro-RJ, Brazil
- Department of Otorhinolaryngology and Ophthalmology, Federal University of Rio de Janeiro, Rio de Janeiro-RJ, Brazil
- * E-mail: (CMVR); (FCS)
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Affiliation(s)
| | - Laila Woc-Colburn
- National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | - Stephen K Tyring
- Center for Clinical Studies, Houston, Texas3Department of Dermatology, University of Texas Health Science Center at Houston
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de Camargo RA, Nicodemo AC, Sumi DV, Gebrim EMMS, Tuon FF, de Camargo LM, Imamura R, Amato VS. Facial structure alterations and abnormalities of the paranasal sinuses on multidetector computed tomography scans of patients with treated mucosal leishmaniasis. PLoS Negl Trop Dis 2014; 8:e3001. [PMID: 25080261 PMCID: PMC4117457 DOI: 10.1371/journal.pntd.0003001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 05/31/2014] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND/OBJECTIVES Mucosal leishmaniasis (ML) is a progressive disease that affects cartilage and bone structures of the nose and other upper respiratory tract structures. Complications associated with ML have been described, but there is a lack of studies that evaluate the structural changes of the nose and paranasal sinuses in ML using radiological methods. In this study, we aimed to assess the opacification of the paranasal sinuses in patients with treated ML and any anatomical changes in the face associated with ML using multidetector computed tomography scans (MDCT) of the sinuses. We compared the findings with a control group. METHODOLOGY/PRINCIPAL FINDINGS We evaluated 54 patients with treated ML who underwent CT scans of the sinuses and compared them with a control group of 40 patients who underwent orbital CT scans. The degree of sinus disease was assessed according to the Lund-Mackay criteria. Forty of the 54 patients with a history of ML (74.1%) had a tomographic score compatible with chronic sinusitis (Lund-Mackay ≥4). CT scans in the leishmaniasis and control groups demonstrated significant differences in terms of facial structure alterations. Patients from the ML group showed more severe levels of partial opacification and pansinus mucosal thickening (42.6%) and a greater severity of total opacification. Patients from the ML group with a Lund-Mackay score ≥4 presented longer durations of disease before treatment and more severe presentations of the disease at diagnosis. CONCLUSION/SIGNIFICANCE CT scans of the sinuses of patients with ML presented several structural alterations, revealing a prominent destructive feature of the disease. The higher prevalence in this study of chronic rhinosinusitis observed in CT scans of patients with treated ML than in those of the control group suggests that ML can be considered a risk factor for chronic rhinosinusitis in this population (p<0.05).
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Affiliation(s)
- Raphael Abegão de Camargo
- Department of Infectious Diseases, University of São Paulo Medical School, São Paulo, São Paulo, Brazil
| | - Antonio C. Nicodemo
- Department of Infectious Diseases, University of São Paulo Medical School, São Paulo, São Paulo, Brazil
| | - Daniel Vaccaro Sumi
- Institute of Radiology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, São Paulo, Brazil
| | | | - Felipe Francisco Tuon
- Division of Infectious Diseases, Federal University of Paraná, Curitiba, Paraná, Brazil
- Division of Infectious and Parasitic Diseases, Hospital Universitário Evangélico de Curitiba, Curitiba, Paraná, Brazil
| | | | - Rui Imamura
- Department of Otorhinolaryngology and Ophthalmology, University of São Paulo Medical School, São Paulo, São Paulo, Brazil
| | - Valdir Sabbaga Amato
- Department of Infectious Diseases, University of São Paulo Medical School, São Paulo, São Paulo, Brazil
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Gökmen TG, Haytoglu S, Güran M, Kusçu F, Köksal F. A multidisciplinary approach to an uncommon case of laryngeal leishmaniasis in Turkey. J Vector Borne Dis 2014; 51:140-143. [PMID: 24947223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Affiliation(s)
| | | | - Mümtaz Güran
- Department of Medical Microbiology, Faculty of Medicine, Eastern Mediterranean University, Mersin, Turkey
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Blum J, Buffet P, Visser L, Harms G, Bailey MS, Caumes E, Clerinx J, van Thiel PPAM, Morizot G, Hatz C, Dorlo TPC, Lockwood DNJ. LeishMan recommendations for treatment of cutaneous and mucosal leishmaniasis in travelers, 2014. J Travel Med 2014; 21:116-29. [PMID: 24745041 DOI: 10.1111/jtm.12089] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Treatment of cutaneous leishmaniasis (CL) and mucosal leishmaniasis (ML) in travelers is still controversial. Over the last decade, national and international consortia have published recommendations for treating CL in travelers. These guidelines harmonize many issues, but there are some discrepancies. METHODS Leishmania parasites causing CL can now be genotyped by polymerase chain reaction techniques for detecting Leishmania DNA. Therefore, treatment recommendations can now be species based rather than based on geographical exposure. To review the evidence on which the recommendations were based, "LeishMan" (Leishmaniasis Management), a group of experts from 13 institutions in eight European countries, performed a PubMed MEDLINE) literature search and considered unpublished evidence and the experts' own personal experiences. The Oxford evidence grading system was used to evaluate the information. RESULTS AND CONCLUSION In this article, the authors provide practical treatment recommendations for imported CL and ML in Europe, drawn up from the review by the European experts.
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Gogol-Tagliaferro A, Swender D, Chernin L, Tcheurekdjian H, Meyerson H, Hostoffer R. A prolonged incubation period in zosteriform Leishmania panamensis. Cutis 2014; 93:E5-E6. [PMID: 24605357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Amanda Gogol-Tagliaferro
- University Hospitals Rainbow Babies & Children's Hospital, 11100 Euclid Ave, Cleveland, OH 44106, USA.
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Garcia Bustos MF, Barrio A, Parodi C, Beckar J, Moreno S, Basombrio MA. [Miltefosine versus meglumine antimoniate in the treatment of mucosal leishmaniasis]. Medicina (B Aires) 2014; 74:371-377. [PMID: 25347898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
The conventional treatment for tegumentary leishmaniasis is meglumine antimoniate, which needs parenteral administration, has increased therapeutic failure, and produces serious adverse effects, justifying the search for therapeutic alternatives. We report here the preliminary results of a phase II clinical trial in patients with mucosal leishmaniasis, in which the efficacy of oral miltefosine versus the antimonial compound was assessed. The evaluation of response to the treatment was performed by monitoring with nasopharyngeal video-fibroscopy, using a score of mucosal injury severity for patients at each follow-up point. We found no significant differences so far between the number of patients cured with miltefosine or conventional chemotherapy. The favorable results of this study suggest that miltefosine could be an effective and safe oral therapeutic alternative in the region.
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Affiliation(s)
- Maria F Garcia Bustos
- 1Instituto de Patología Experimental,Unidad Ejecutora CONICET, CCT Salta, Argentina. E-mail:
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Bermúdez H, Rojas E, Garcia L, Desjeux P, Dujardin JC, Boelaert M, Chappuis F. Generic sodium stibogluconate is as safe and effective as branded meglumine antimoniate, for the treatment of tegumentary leishmaniasis in Isiboro Secure Park, Bolivia. Annals of Tropical Medicine & Parasitology 2013; 100:591-600. [PMID: 16989685 DOI: 10.1179/136485906x118495] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [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
Human cutaneous leishmaniasis (CL) and mucous leishmaniasis (ML) are highly endemic in Isiboro Secure Park, which lies in the Bolivian department of Cochabamba--an area where branded meglumine antimoniate (Glucantime) is expensive and poorly distributed. The safety and efficacy of generic sodium stibogluconate (SSG), from Albert David Ltd, was therefore explored, in CL and ML cases from the park, who were treated with 20 mg/kg.day for 20 and 30 days, respectively. A questionnaire recording adverse effects was completed by a physician in each treatment centre. Efficacy of treatment was assessed at the end of treatment and at follow-ups 1 month and 3, 6 and 12 months later. Overall, 146 patients completed treatment with SSG in 2003-2004. No fatalities or severe adverse effects were reported but mild to moderate adverse effects were noted in 41 (28%) of the patients. The incidence of adverse effects was significantly higher among the cases of ML than among the cases of CL. Of the 86 patients with CL who completed 6 months of follow-up, 81 (94.2%) were considered to have been clinically cured; a comparable cohort of 69 CL cases who had been treated with Glucantime in 2001-2002 showed a similar frequency of clinical cure (90%). Generic SSG was shown to be safe and efficacious for the treatment of tegumentary leishmaniasis in Bolivia. Being several times cheaper than Glucantime, it could contribute to improving the access of CL and ML patients to treatment, not only in Bolivia but also in other countries of Latin America.
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MESH Headings
- Adult
- Antimony Sodium Gluconate/administration & dosage
- Antimony Sodium Gluconate/adverse effects
- Antiprotozoal Agents/administration & dosage
- Antiprotozoal Agents/adverse effects
- Bolivia/epidemiology
- Drugs, Generic/administration & dosage
- Drugs, Generic/adverse effects
- Female
- Humans
- Injections, Intramuscular
- Injections, Intravenous
- Leishmaniasis, Cutaneous/drug therapy
- Leishmaniasis, Cutaneous/epidemiology
- Leishmaniasis, Cutaneous/parasitology
- Leishmaniasis, Mucocutaneous/drug therapy
- Leishmaniasis, Mucocutaneous/epidemiology
- Leishmaniasis, Mucocutaneous/parasitology
- Male
- Meglumine/administration & dosage
- Meglumine/adverse effects
- Meglumine Antimoniate
- Organometallic Compounds/administration & dosage
- Organometallic Compounds/adverse effects
- Treatment Outcome
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Affiliation(s)
- H Bermúdez
- Faculty of Medicine, Universidad Mayor San Simon, P.O. Box 4866, Cochabamba, Bolivia
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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Affiliation(s)
- Davi Coe Torres
- Laboratório de Pesquisa em Leishmaniose/Coleção de Leishmania do Instituto Oswaldo Cruz (IOC) - Fiocruz, Rio de Janeiro, Brazil
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Dassoni F, Abebe Z, Naafs B, Morrone A. Cutaneous and mucocutaneous leishmaniasis resembling borderline-tuberculoid leprosy: a new clinical presentation? Acta Derm Venereol 2013; 93:74-7. [PMID: 22434112 DOI: 10.2340/00015555-1338] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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: 11/16/2022] Open
Abstract
Both cutaneous and mucocutaneous leishmaniasis are endemic in Northern Ethiopia. The different clinical presentations depend on the responsible organism and the host's immune response. Localized cutaneous leishmaniasis is the type most frequently seen. Diffuse cutaneous leishmaniasis is relatively rare and usually associated with mucous membrane involvement. Diffuse cutaneous leishmaniasis presents with multiple lesions, can be difficult to diagnose and responds less favourably to treatment. We report here 2 patients with unusual presentations of diffuse cutaneous leishmaniasis presenting with large hypopigmented skin lesions mimicking borderline-tuberculoid leprosy. To our knowledge this presentation has not been described before and may present difficulties in making a definite diagnosis in regions where both leprosy and cutaneous leishmaniasis are endemic. Lepromatous leprosy and diffuse cutaneous leishmaniasis are regularly confused, particularly when no skin smears for acid-fast bacillus or Leishman-Donovan bodies are performed.
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Affiliation(s)
- Federica Dassoni
- Department of Dermatology, National Institute for Health, Migration and Poverty, IT-00153 Rome, Italy.
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Abstract
OBJECTIVE To assess the quantity and distribution of evidence from randomised controlled trials for the treatment of the major neglected tropical diseases and to identify gaps in the evidence with network analysis. DESIGN Systematic review and network analysis. DATA SOURCES Cochrane Central Register of Controlled Trials and PubMed from inception to 31 August 2011. STUDY SELECTION Randomised controlled trials that examined treatment of 16 neglected tropical diseases or complications thereof published in English, French, Spanish, Portuguese, German, or Dutch. RESULTS We identified 971 eligible randomised trials. Leishmaniasis (184 trials, 23,039 participants) and geohelminth infections; 160 trials, 46,887 participants) were the most studied, while dracunculiasis (nine trials, 798 participants) and Buruli ulcer (five trials, 337 participants) were least studied. Relative to its global burden of disease, lymphatic filariasis had the fewest trials and participants. Only 11% of trials were industry funded. Either a single trial or trials with fewer than 100 participants comprised the randomised evidence for first or second line treatments for Buruli ulcer, human African trypanosomiasis, American trypanosomiasis, cysticercosis, rabies, echinococcosis, New World cutaneous leishmaniasis, and each of the foodborne trematode infections. Among the 10 disease categories with more than 40 trials, five lacked sufficient head to head comparisons between first or second line treatments. CONCLUSIONS There is considerable variation in the amount of evidence from randomised controlled trials for each of the 16 major neglected tropical diseases. Even in diseases with substantial evidence, such as leishmaniasis and geohelminth infections, some recommended treatments have limited supporting data and lack head to head comparisons.
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Affiliation(s)
- Shanthi Kappagoda
- Center for Primary Care and Outcomes Research and Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Hu RVPF, Kent AD, Adams ER, van der Veer C, Sabajo LOA, Mans DRA, de Vries HJC, Schallig HDFH, Lai A Fat RFM. First case of cutaneous leishmaniasis caused by Leishmania (Viannia) braziliensis in Suriname. Am J Trop Med Hyg 2012; 86:825-7. [PMID: 22556081 PMCID: PMC3335687 DOI: 10.4269/ajtmh.2012.11-0728] [Citation(s) in RCA: 15] [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] [Received: 11/23/2011] [Accepted: 02/06/2012] [Indexed: 11/07/2022] Open
Abstract
The main causative agent of cutaneous leishmaniasis (CL) in Suriname is Leishmania (Viannia) guyanensis. This case report presents a patient infected with Leishmania (Viannia) braziliensis, a species never reported before in Suriname. This finding has clinical implications, because L. braziliensis has a distinct clinical phenotype characterized by mucocutaneous leishmaniasis, a more extensive and destructive form of CL that requires different treatment. Clinicians should be aware that chronic cutaneous ulcers in patients from the Guyana region could be caused by L. braziliensis.
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Pulimood SA, Rupali P, Ajjampur SSR, Thomas M, Mehrotra S, Sundar S. Atypical mucocutaneous involvement with Leishmania donovani. Natl Med J India 2012; 25:148-150. [PMID: 22963292] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Mucocutaneous leishmaniasis has rarely been reported from India. The usual causative organisms of this infection are Leishmania braziliensis and L. tropica. Another species, L. donovani, which usually causes visceral leishmaniasis, has recently been reported to cause mucocutaneous disease in a few patients from Sri Lanka. We report two patients who had undiagnosed chronic skin lesions for several years. Skin biopsies revealed Leishmania and the species was characterized as L. donovani in both patients. There was considerable improvement in the skin lesions following treatment with liposomal amphotericin B.
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Affiliation(s)
- S A Pulimood
- Department of Dermatology and Venereology, Christian Medical College, Vellore, Tamil Nadu, India.
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Recalcati S, Vezzoli P, Girgenti V, Venegoni L, Veraldi S, Berti E. Cutaneous lymphoid hyperplasia associated with Leishmania panamensis infection. Acta Derm Venereol 2010; 90:418-9. [PMID: 20574614 DOI: 10.2340/00015555-0893] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Soto J, Rea J, Valderrama M, Toledo J, Valda L, Ardiles J, Berman J. Efficacy of extended (six weeks) treatment with miltefosine for mucosal leishmaniasis in Bolivia. Am J Trop Med Hyg 2009; 81:387-389. [PMID: 19706901] [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: 05/28/2023] Open
Abstract
We investigated whether increasing the period of follow-up or increasing the duration of therapy would markedly alter the 71% cure rate of mucosal leishmaniasis in Bolivia consequent to treatment with miltefosine for 4 weeks. Increasing the follow-up from 12 months to 24 months demonstrated additional relapse in only 2 of 41 patients. Increasing the period of therapy from 4 weeks to 6 weeks only increased the cure rate to 75%. The cure rate of mucosal leishmaniasis in Bolivia, whether 4 or 6 weeks of therapy is used and whether 12 month or 24 months follow up is conducted, is approximately 70%.
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Affiliation(s)
- Jaime Soto
- Centro de Investigaciones Bioclínicas de la Fundación FADER, Bogotá, Colombia.
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Jeddi F, Caumes E, Thellier M, Jauréguiberry S, Mazier D, Buffet PA. Drug hypersensitivity syndrome induced by meglumine antimoniate. Am J Trop Med Hyg 2009; 80:939-940. [PMID: 19478253] [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: 05/27/2023] Open
Abstract
We report a case of drug hypersensitivity syndrome (drug reaction with eosinophilia and systemic symptoms [DRESS]) induced by parenteral meglumine antimoniate (Glucantime) in a 40-year-old man who traveled to Bolivia and was treated for mucocutaneous leishmaniasis. Two weeks after starting therapy, the patient had fever, joint pain, a cutaneous eruption, and hypereosinophilia (1,358 cells/mm(3)). These symptoms resolved after drug withdrawal but reappeared upon reintroduction of the drug. Pentavalent antimonials should be definitively withdrawn in patients with hypereosinophilia > 1,000 cells/mm(3) accompanied by systemic manifestations consistent with DRESS.
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Affiliation(s)
- Fakhri Jeddi
- Service de Parasitologie-Mycologie, et Service de Maladies Infectieuses et Tropicales, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
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40
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Zea DF, Prager M, Figueroa RA, Miranda MC. [Mucosal complication of cutaneous leishmaniasis]. Biomedica 2009; 29:9-11. [PMID: 19753833] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A 74-year-old man from the rural area of Caicedonia, Valle del Cauca Province, was diagnosed with uncontrolled hypertension, stage IV chronic renal failure and severe anemia. Fifteen years earlier, while living in Guaviare Province, he was diagnosed with leishmaniasis-with lesions located on the right upper and lower eyelids, left auricle and limbs. At that time, he received an incomplete treatment with antimonials. The patient had experienced 8 years of progressive mucosal lesions located in the upper lip, nasal mucosa and right upper and lower eyelids (figure 1). A histopathological diagnosis of leishmaniasis was made and confirmed by polymerase chain reaction (figure 2). Treatment with antimonials (Glucantime) was contraindicated due to the patient's comorbidities. Inpatient supervised treatment with miltefosine (Impavido 50 mg capsules) was initiated according to the national guidelines of 1.8 mg/kg/day for 28 days. Clinical follow up and routine laboratory tests (creatinine, BUN, liver function tests and complete blood counts) were done during and after treatment; no complications were reported. Medical follow up was continued until the Internal medicine, ophthalmology, and plastic surgery consultations were provided for subsequent management of the pathology. Mucocutaneous leishmaniasis is a serious preventable complication of cutaneous leishmaniasis. This case illustrated a failure in opportune diagnosis and treatment of this disease as a consequence of an inadequate leishmaniasis control program. The case indicated the effectiveness of miltefosine as a therapeutic option in patients for whom antimonial treatment is contraindicated.
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Affiliation(s)
- Diego Fernando Zea
- Unidad Clínica, Centro Internacional de Entrenamiento e Investigaciones Médicas-CIDEIM, Call, Colombia.
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El Fékih N, Sliti N, Kharfi M, Trabelsi S, Khaled S, Fazaa B, Kamoun MR. [Mucosal leishmaniasis by contiguity with a skin lesion: another case report from Tunisia]. Med Trop (Mars) 2008; 68:634-636. [PMID: 19639835] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Three clinical forms of cutaneous leishmaniasis can be found in Tunisia, i.e. the sporadic form due to Leishmania infantum in the North, the zoonotic epidemic form due to Leishmania major in the center and Southwest, and the chronic cutaneous form due to Leishmania tropica in the South. Unlike cutaneous forms, mucosal involvement is uncommon. The purpose of this report is to describe another case of mucosal leishmaniasis due to contiguity with a skin lesion in a 54-years-old woman. The patient responded well to treatment with meglumine antimoniate.
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Affiliation(s)
- N El Fékih
- Service de dermatologie, Hôpital Charles Nicolle, Tunis, Tunisie.
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Amato VS, Tuon FF, Bacha HA, Neto VA, Nicodemo AC. Mucosal leishmaniasis . Current scenario and prospects for treatment. Acta Trop 2008; 105:1-9. [PMID: 17884002 DOI: 10.1016/j.actatropica.2007.08.003] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.2] [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: 02/27/2007] [Revised: 08/14/2007] [Accepted: 08/14/2007] [Indexed: 11/27/2022]
Abstract
Leishmaniasis causes significant morbidity and mortality and thus constitutes a serious public health problem. Even though it has long been endemic in developing countries, in recent years the economic globalization and the increased volume of international travel have extended its prevalence in developed countries. In addition, native populations may be exposed to the infection through blood transfusion and the use of blood products produced from infected asymptomatic individuals. Mucosal leishmaniasis (ML) is a chronic form of this infection, which attacks the mucosa. In most cases this form of leishmaniasis results from the metastatic spread of Leishmania (Viannia) braziliensis from cutaneous lesions. It is a healthcare issue because of its wide demographic distribution, its association with significant morbidity levels, and because of the pressing concern that tourists who travel to endemic areas might present the disease even years later. The treatment currently available for ML is based on drugs such as pentavalent antimony-containing compounds, amphotericin B deoxycholate and pentamidine and often guarantees a satisfactory clinical response. Nevertheless, it also frequently provokes serious side effects. This review offers a critical analysis of the drugs now available for the treatment of ML as also of the future prospects for the treatment of the disease.
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Affiliation(s)
- Valdir Sabbaga Amato
- Infectious and Parasitic Diseases Clinic, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, 05403-010, São Paulo, Brazil.
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Amato VS, Tuon FF, Siqueira AM, Nicodemo AC, Neto VA. Treatment of mucosal leishmaniasis in Latin America: systematic review. Am J Trop Med Hyg 2007; 77:266-74. [PMID: 17690398] [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: 05/16/2023] Open
Abstract
Mucosal leishmaniasis (ML) is an important endemic disease and public-health problem in underdeveloped countries because of its significant morbidity and mortality. Increases in ecological tourism have extended this problem to developed countries. This form of leishmaniasis, caused by reactivation after primary cutaneous lesion, has a natural history of progressive destruction of the nasal septa and soft and hard palates, causing facial disfiguration and leading to respiratory disturbances. Treatment of ML, based on several therapies, depends on use of toxic compounds, and few drugs have emerged over the past 40 years. Drug resistance has increased, and the cure rate is no better than 70% in the largest studies. Despite these data, there has been no systematic review of therapies used to treat this important tropical disease. The aim of this study is to determine the best drug management for treatment of ML in Latin America based on the best studies offered by the medical literature. The MEDLINE, LILACS, EMBASE, Web of Science, and Cochrane Library databases were searched to identify articles related to ML and therapy. The studies were independently selected by 2 authors. Articles with sufficient data for cure and treatment failures, internal and external validity information, and > 4 patients in each treatment were included. Validation of this systematic review was based on guidelines to guarantee quality; 22 articles met our inclusion criteria. Stibogluconate achieved a 51% cure rate (76/150 patients), and 88% of patients treated with meglumine were cured (121 patients). Pentamidine and amphotericin were as effective as meglumine. Use of itraconazole and other therapies (pentoxifylline, allopurinol, or interferon-gamma) was controversial, and numbers of patients in some studies were insufficient for statistical analysis. Meglumine may be the drug of choice in the treatment of ML, as it offers similar cure rates when compared with amphotericin B and pentamidine. Cost, adverse effects, local experience, and availability of drugs to treat ML are strong points to be considered before determining the best management of this disease, especially in developing countries.
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Affiliation(s)
- Valdir Sabbaga Amato
- Infectious and Parasitic Clinic, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil.
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Gomes-Silva A, de Cássia Bittar R, Dos Santos Nogueira R, Amato VS, da Silva Mattos M, Oliveira-Neto MP, Coutinho SG, Da-Cruz AM. Can interferon-gamma and interleukin-10 balance be associated with severity of human Leishmania (Viannia) braziliensis infection? Clin Exp Immunol 2007; 149:440-4. [PMID: 17614975 PMCID: PMC2219325 DOI: 10.1111/j.1365-2249.2007.03436.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [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: 11/27/2022] Open
Abstract
Suitable levels of interferon (IFN)-gamma and interleukin (IL)-10 seem to favour the outcome of cutaneous leishmaniasis (CL), while high IFN-gamma and low IL-10 production are associated with severity of mucosal leishmaniasis (ML). Considering that cytokine balance is important for the maintenance of protective responses in leishmaniasis, our aim was to investigate leishmanial antigens-induced IFN-gamma and IL-10 levels maintained in healed individuals who had different clinical outcomes of Leishmania infection. Thirty-three individuals who recovered from L. braziliensis infection were studied: cured CL (CCL), cured ML (CML), spontaneous healing of CL (SH) or asymptomatic individuals (ASY). Cytokines were quantified by enzyme-linked immunosorbent assay (ELISA) in culture supernatants of L. braziliensis-stimulated peripheral blood mononuclear cells (PBMC). IFN-gamma levels were higher in CML (7593 +/- 5994 pg/ml) in comparison to SH (3163 +/- 1526 pg/ml), ASY (1313 +/- 1048 pg/ml) or CCL (1897 +/- 2087 pg/ml). Moreover, cured ML cases maintained significantly lower production of IL-10 (127 +/- 57.8 pg/ml) in comparison to SH (1373 +/- 244 pg/ml), ASY (734 +/- 233 pg/ml) or CCL (542 +/- 375 pg/ml). Thus, a high IFN-gamma/IL-10 ratio observed in CML can indicate unfavourable cytokine balance. On the other hand, no significant difference in the IFN-gamma/IL-10 ratio was observed when CCL individuals were compared to SH or ASY subjects. In conclusion, even after clinical healing, ML patients maintained a high IFN-gamma/IL-10 secretion profile in response to leishmanial antigens. This finding can explain a delayed down-modulation of exacerbated inflammatory responses, which can be related in turn to the necessity of prolonged therapy in ML management. Conversely, lower IFN-gamma/IL-10 balance observed in CCL, SH and ASY individuals can represent a better-modulated immune response associated with a favourable prognosis.
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Affiliation(s)
- A Gomes-Silva
- Laboratório de Imunoparasitologia, Departamento de Imunologia, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil
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Llanos-Cuentas A, Echevarria J, Seas C, Chang E, Cruz M, Alvarez E, Rosales E, Campos P, Bryceson A. Parenteral aminosidine is not effective for Peruvian mucocutaneous leishmaniasis. Am J Trop Med Hyg 2007; 76:1128-31. [PMID: 17556623] [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: 05/15/2023] Open
Abstract
Few therapeutic options are available for mucocutaneous leishmaniasis (MCL). We conducted a randomized open trial to evaluate the efficacy, safety, and tolerance of parenteral aminosidine sulphate (AS) 14 mg/kg/d for 21 days compared with intravenous meglumine antimonate (MA) 20 mg/kg/d for 28 days in patients with moderate MCL in Cuzco, Peru. Cure was defined as complete healing with re-epithelialization within 1 year of follow-up. The trial was stopped after 38 patients were enrolled (17 in the MA group and 21 in the AS group) because of marked differences in response. Study groups were comparable in baseline characteristics. Cure rates were 0/21 in the AS group compared with 8/17 (47%, 95% confidence interval: 23-71%) in the MA group (P < 0.001). Side effects and laboratory abnormalities were mild in both groups. We conclude that parenteral AS given on its own is not effective for MCL in Peru.
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Affiliation(s)
- Alejandro Llanos-Cuentas
- Instituto de Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.
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Abstract
Epidemiology, disease patterns, immunology, diagnosis, treatment and control measures of leishmaniasis are described. Various issues relating to leishmaniasis are highlighted: the relative lack of importance given to this disease compared with other infections, climate change and its possible impact on extension of endemicity of this infection, and new diagnostic tests which are improving diagnosis, especially in resource poor areas. Other important aspects discussed include the potential for newer oral therapy to change the way this disease is managed; Leishmania-HIV coinfection and groups at risk; and development of an effective vaccine.
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MESH Headings
- Animals
- Antiprotozoal Agents/therapeutic use
- HIV Infections/complications
- Humans
- Immunity, Cellular
- Leishmaniasis, Cutaneous/complications
- Leishmaniasis, Cutaneous/diagnosis
- Leishmaniasis, Cutaneous/drug therapy
- Leishmaniasis, Cutaneous/immunology
- Leishmaniasis, Mucocutaneous/complications
- Leishmaniasis, Mucocutaneous/diagnosis
- Leishmaniasis, Mucocutaneous/drug therapy
- Leishmaniasis, Mucocutaneous/immunology
- Leishmaniasis, Visceral/complications
- Leishmaniasis, Visceral/diagnosis
- Leishmaniasis, Visceral/drug therapy
- Leishmaniasis, Visceral/immunology
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Affiliation(s)
- Tonio V Piscopo
- St Luke's Hospital, Guardamangia Hill, Guardamangia, MSD 09, Malta.
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Machado PRL, Lessa H, Lessa M, Guimarães LH, Bang H, Ho JL, Carvalho EM. Oral Pentoxifylline Combined with Pentavalent Antimony: A Randomized Trial for Mucosal Leishmaniasis. Clin Infect Dis 2007; 44:788-93. [PMID: 17304449 DOI: 10.1086/511643] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.5] [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: 08/29/2006] [Accepted: 11/13/2006] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Mucosal leishmaniasis is associated with intense tissue damage and high tumor necrosis factor-alpha production. Therapeutic failure occurs in up to 42% of cases; patients who experience treatment failure will require >1 pentavalent antimony (Sb(v)) course or alternative drugs to achieve a cure. We previously showed that an inhibitor of tumor necrosis factor-alpha (pentoxifylline) combined with Sb(v) cured 90% patients refractory to monotherapy with Sb(v). METHODS A double-blind, placebo-controlled trial involving 23 patients with mucosal leishmaniasis evaluated the efficacy of pentoxifylline when administered in association with Sb(v), compared with Sb(v) treatment alone. Eleven patients were randomized to receive Sb(v) plus oral pentoxifylline for 30 days, and 12 patients received Sb(v) plus oral placebo. The criterion for cure was a complete healing of lesions. RESULTS All patients in the pentoxifylline group experienced a cure with 1 course of Sb(v), whereas 5 (41.6%) of 12 patients in the placebo group required a second course of Sb(v) (P=.037). The healing time +/- standard deviation in the pentoxifylline group was 83+/-36 days, compared with 145+/-99 days in the placebo group (P=.049). No relapses were documented in either group at the 2-year follow-up visit. CONCLUSIONS The addition of pentoxifylline to Sb(v) in mucosal leishmaniasis reduces the healing time significantly and prevents the need for further courses of Sb(v).
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Affiliation(s)
- Paulo R L Machado
- Serviço de Imunologia, Hospital Universitário Prof. Edgard Santos, Universidade Federal da Bahia, Salvador-Bahia, Brazil
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Soto J, Toledo J, Valda L, Balderrama M, Rea I, Parra R, Ardiles J, Soto P, Gomez A, Molleda F, Fuentelsaz C, Anders G, Sindermann H, Engel J, Berman J. Treatment of Bolivian Mucosal Leishmaniasis with Miltefosine. Clin Infect Dis 2007; 44:350-6. [PMID: 17205440 DOI: 10.1086/510588] [Citation(s) in RCA: 102] [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] [Received: 09/15/2006] [Accepted: 10/18/2006] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Although mucosal leishmaniasis is a prominent disease, it has been studied only to a limited extent. It is classically treated with parenteral antimony or, as a last resort, amphotericin B. METHODS We treated Bolivian mucosal leishmaniasis due to Leishmania braziliensis with the oral agent miltefosine, 2.5 mg/kg/day for 28 days, and followed-up for 12 months. RESULTS Seventy-two patients were evaluable. The cure rate for the 36 patients who had "mild" disease (i.e., affecting nasal skin and nasal mucosa) was 83%. The cure rate for the 36 patients who had more extensive disease (involving the palate, pharynx, and larynx) was 58%. Patients refused to be randomized to parenteral agents, but the cure rate for an almost contemporary group who was receiving amphotericin B (45 mg/kg over 90 days) was 7 (50%) of 14. CONCLUSIONS In this unrandomized trial, oral miltefosine was at least as effective as heroic doses of parenteral amphotericin B. The cure rate for miltefosine was approximately equivalent to historical cure rates using parenteral pentavalent antimony for mild and extensive disease in neighboring Peru. Although gastrointestinal side reactions do occur with miltefosine, its toxicity profile is superior to that of antimony and far superior to that of amphotericin B--in part because of the inherent attractiveness of oral versus parenteral agents. Our results suggest that miltefosine should be the treatment of choice for mucosal disease in North and South America.
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Affiliation(s)
- J Soto
- Consorcio de Investigaciones Bioclinicas, Bogota, Colombia.
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Rabelink NM, de Steenwinkel JEM, van Biezen P, van Daele PLA, Gyssens IC. [A patient with long-term, unrecognized leishmaniasis]. Ned Tijdschr Geneeskd 2006; 150:2715-9. [PMID: 17194010] [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] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
A man from Surinam presented at the Department of Internal Medicine with a perforated septum and progressive collapse of the nose. This condition had existed for 22 years, though earlier analysis had not revealed the cause. Microscopic analysis showed a granulomatous inflammatory reaction, with cultures revealing of Leishmania. The diagnosis was mucocutaneous leishmaniasis and PCR indicated Leishmania braziliensis complex. The patient was treated for mucocutaneous leishmaniasis by a 28-day course of intravenous sodium-stibogluconate therapy. Initially, treatment was stopped briefly due to neurotoxicity, but was recommenced and successfully completed. After treatment the infection parameters returned to normal and the patient was referred for reconstructive nasal surgery. Due to a low parasitic load mucocutaneous leishmaniasis can be difficult to detect, especially in chronic cases. However, the use of molecular techniques has improved both the sensitivity and specificity of detection. The ability to distinguish between different species and sub-species is of prognostic and therapeutic relevance.
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