Clinical and Parasitological Features of Patients with American Cutaneous Leishmaniasis that Did Not Respond to Treatment with Meglumine Antimoniate

Autor: Carlos Saavedra, Carlos Daza, Jairo E. Perez-Franco, María Clara Echeverry, Maria L. Mariño, Marta L. Robayo, Myriam Consuelo López, Angela Bedoya, Mónica L. Cruz-Barrera
Rok vydání: 2015
Předmět:
0301 basic medicine
Male
Antimony
Meglumine antimoniate
Disease
Pathology and Laboratory Medicine
Cohort Studies
chemistry.chemical_compound
White Blood Cells
0302 clinical medicine
Recurrence
Animal Cells
Zoonoses
Medicine and Health Sciences
Treatment Failure
Leishmaniasis
Protozoans
Leishmania
Meglumine Antimoniate
biology
lcsh:Public aspects of medicine
American cutaneous leishmaniasis
U937 Cells
musculoskeletal system
Pentavalent antimonial
Chemistry
Infectious Diseases
Physical Sciences
Cellular Types
medicine.drug
Research Article
Chemical Elements
Neglected Tropical Diseases
Adult
medicine.medical_specialty
lcsh:Arctic medicine. Tropical medicine
lcsh:RC955-962
Sodium stibogluconate
Immune Cells
030231 tropical medicine
Immunology
Antiprotozoal Agents
Leishmaniasis
Cutaneous
Leishmania braziliensis
03 medical and health sciences
Inhibitory Concentration 50
Young Adult
Meglumine
Signs and Symptoms
Diagnostic Medicine
medicine
Organometallic Compounds
Parasitic Diseases
Humans
Protozoan Infections
Blood Cells
business.industry
Macrophages
Public Health
Environmental and Occupational Health
Organisms
Biology and Life Sciences
lcsh:RA1-1270
Cell Biology
biology.organism_classification
medicine.disease
Tropical Diseases
Dermatology
Parasitic Protozoans
030104 developmental biology
Cross-Sectional Studies
chemistry
Lesions
Parasitology
business
Zdroj: PLoS Neglected Tropical Diseases
PLoS Neglected Tropical Diseases, Vol 10, Iss 5, p e0004739 (2016)
ISSN: 1935-2735
Popis: Background American cutaneous leishmaniasis (ACL) is a complicated disease producing about 67.000 new cases per year. The severity of the disease depends on the parasite species; however in the vast majority of cases species confirmation is not feasible. WHO suggestion for ACL produced by Leishmania braziliensis, as first line treatment, are pentavalent antimonial derivatives (Glucantime or Sodium Stibogluconate) under systemic administration. According to different authors, pentavalent antimonial derivatives as treatment for ACL show a healing rate of about 75% and reasons for treatment failure are not well known. Methods In order to characterise the clinical and parasitological features of patients with ACL that did not respond to Glucantime, a cross-sectional observational study was carried out in a cohort of 43 patients recruited in three of the Colombian Army National reference centers for complicated ACL. Clinical and paraclinical examination, and epidemiological and geographic information were recorded for each patient. Parasitological, histopathological and PCR infection confirmation were performed. Glucantime IC50 and in vitro infectivity for the isolated parasites were estimated. Results Predominant infecting Leishmania species corresponds to L. braziliensis (95.4%) and 35% of the parasites isolated showed a significant decrease in in vitro Glucanatime susceptibility associated with previous administration of the medicament. Lesion size and in vitro infectivity of the parasite are negatively correlated with decline in Glucantime susceptibility (Spearman: r = (-)0,548 and r = (-)0,726; respectively). Conclusion A negative correlation between lesion size and parasite resistance is documented. L. braziliensis was found as the main parasite species associated to lesion of patients that underwent treatment failure or relapse. The indication of a second round of treatment in therapeutic failure of ACL, produced by L. braziliensis, with pentavalent antimonial derivatives is discussable.
Author Summary Cutaneous leishmaniasis is tropical and subtropical worldwide vector-borne disease produced by protozoan parasites from the genus Leishmania that include over 20 species and produce an estimated 0.7 million to 1.3 million new cases annually. The disease features are dependent on the patient immunological stage, the parasite biology and to some extent are determined by the geographic regions in which it occurs. New World cutaneous infections known as American Cutaneous Leishmaniasis (ACL) are associated with metastatic sequelae and treatment failure. In the present study we found that in patients with ACL infected in the Colombian Amazon and Orinoco regions and not responding to Glucantime treatment, the predominant species was L. braziliensis. In addition 35% of these lesion-isolated parasites show some level of drug resistance. We also found that these resistant parasites display reduced competence when infecting the human monocytic cell line U-937 in “in vitro” tests and are associated with lesions of reduced size. According to our findings the indication for a second round of treatment with pentavalent antimonial derivatives in patients with ACL that did not respond to the first round of treatment is arguable.
Databáze: OpenAIRE
Externí odkaz: