Influence of Leishmania (Viannia) species on the response to antimonial treatment in patients with American tegumentary leishmaniasis.

Abstract

BACKGROUND:

Pentavalent antimonials (SbV) are the first-line chemotherapy for American tegumentary leishmaniasis (ATL). There are, however, reports of the occurrence of treatment failure with these drugs. Few studies in Latin America have compared the response to SbV treatment in ATL caused by different Leishmania species.

METHODS:

Clinical parameters and response to SbV chemotherapy were studied in 103 patients with cutaneous leishmaniasis (CL) in Peru. Leishmania isolates were collected before treatment and typed by multilocus polymerase-chain-reaction restriction fragment-length polymorphism analysis.

RESULTS:

The 103 isolates were identified as L. (Viannia) peruviana (47.6%), L. (V.) guyanensis (23.3%), L. (V.) braziliensis (22.3%), L. (V.) lainsoni (4.9%), L. (Leishmania) mexicana (1%), and a putative hybrid, L. (V.) braziliensis/L. (V.) peruviana (1%). L. (V.) guyanensis was most abundant in central Peru. Of patients infected with the 3 former species, 21 (21.9%) did not respond to SbV chemotherapy. The proportions of treatment failure (after 12 months of follow-up) were 30.4%, 24.5%, and 8.3% in patients infected with L. (V.) braziliensis, L. (V.) peruviana, and L. (V.) guyanensis, respectively. Infection with L. (V.) guyanensis was associated with significantly less treatment failure than L. (V.) braziliensis, as determined by multiple logistic regression analysis (odds ratio, 0.07 [95% confidence interval, 0.007-0.8]; P=.03).

CONCLUSIONS:

Leishmania species can influence SbV treatment outcome in patients with CL. Therefore, parasite identification is of utmost clinical importance, because it should lead to a species-oriented treatment.

• Authors: Jorge Arevalo, Luis Ramirez, Vanessa Adaui, Mirko Zimic, Gianfranco Tulliano, César Miranda-Verástegui, Marcela Lazo, Raúl Loayza-Muro, Simonne De Doncker, Anne Maurer, Francois Chappuis, Jean-Claude Dujardin, Alejandro Llanos-Cuentas
• Journal: The Journal of infectious diseases (J Infect Dis) Vol. 195 Issue 12 Pg. 1846-51 (Jun 15 2007) ISSN: 0022-1899 [Print] United States
• PMID: 17492601 (Publication Type: Journal Article)

Chemical References

• Antiprotozoal Agents
• Organometallic Compounds
• Meglumine
• Meglumine Antimoniate
• Antimony

Topics

• Animals
• Antimony (therapeutic use)
• Antiprotozoal Agents (therapeutic use)
• Geography
• Humans
• Leishmania (classification, isolation & purification, pathogenicity)
• Leishmaniasis, Cutaneous (drug therapy, epidemiology, parasitology)
• Meglumine (therapeutic use)
• Meglumine Antimoniate
• Organometallic Compounds (therapeutic use)
• Peru (epidemiology)
• Polymerase Chain Reaction
• Polymorphism, Restriction Fragment Length
• Species Specificity
• Treatment Failure