Clinical and Parasite Species Risk Factors for Pentavalent Antimonial Treatment Failure in Cutaneous Leishmaniasis in Peru

Autor: Jorge Arevalo, Marleen Boelaert, Roger V. Araujo-Castillo, Jean-Claude Dujardin, Gianfranco Tulliano, Marcela Lazo, Jo Robays, Giovanna Santamaria-Castrellon, François Chappuis, Alejandro Llanos-Cuentas, Simonne De Doncker, Luis Eduardo Ramirez, Cesar Miranda-Verastegui
Rok vydání: 2008
Předmět:
Male
America
Latin
chemistry.chemical_compound
Risk Factors
Peru
Treatment Failure
Prospective Studies
Child
Leishmaniasis
Leishmania
Age Factors
Protozoal diseases
Leishmania/isolation & purification
Pentavalent antimonial
Infectious Diseases
Antiprotozoal Agents/administration & dosage/adverse effects
Female
Drug therapy
medicine.drug
Adult
Microbiology (medical)
medicine.medical_specialty
Adolescent
Sodium stibogluconate
Antiprotozoal Agents
Leishmaniasis
Cutaneous
Pharmacotherapy
Cutaneous leishmaniasis
Internal medicine
medicine
Animals
Humans
Leishmaniasis
Cutaneous/drug therapy/parasitology
Risk factor
ddc:613
Species
Antimonials
business.industry
Antimony Sodium Gluconate/administration & dosage/adverse effects
Odds ratio
medicine.disease
Confidence interval
Surgery
Cutaneous
Treatment failure
Risk factors
chemistry
Antimony Sodium Gluconate
Case-Control Studies
business
Zdroj: Clinical Infectious Diseases, Vol. 46, No 2 (2008) pp. 223-31
ISSN: 1537-6591
1058-4838
Popis: BACKGROUND: Treatment for cutaneous leishmaniasis (CL) with standard pentavalent antimonial therapy is hampered by cumbersome administration, toxicity, and potential failure. Knowledge of factors influencing treatment outcome is essential for successful management. METHODS: A case-control study of incident cases was performed with patients experiencing their first CL episode. The standard treatment for CL for these patients was 20 mg/kg/day of sodium stibogluconate for 20 days. Clinical and epidemiological data were recorded, and parasite isolates were species typed. Patients were followed up for 6 months to assess treatment outcome. Clinical cure was defined as complete wound closure and re-epithelization without inflammation or infiltration; new lesions, wound reopening, or signs of activity were classified as treatment failure. Descriptive, bivariate, and logistic regression analyses were performed. RESULTS: One hundred twenty-seven patients were recruited; 63 (49.6%) were infected with Leishmania (Viannia) peruviana, 29 (22.8%) were infected with Leishmania (Viannia) braziliensis, 27 (21.3%) were infected with Leishmania (Viannia) guyanensis, and 8 (6.3%) were infected with other species. Only patients infected with the 3 most common species were selected for risk-factor analysis (n=119). Final failure rate at 6 months was 24.4% (95% confidence interval [CI], 16.5%-32.1%), with 96% of failures occurring within the first 3 months of follow-up assessment. Risk factors for treatment failure identified in the final multivariate model were age (per year, odds ratio [OR], 0.95; 95% CI, 0.92-0.99; P=.017), stay of
Databáze: OpenAIRE
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