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Influence of Leishmania (Viannia) species on the response to antimonial treatment in patients with American tegumentary leishmaniasis.
Arevalo, Jorge; Ramirez, Luis; Adaui, Vanessa; Zimic, Mirko; Tulliano, Gianfranco; Miranda-Verástegui, César; Lazo, Marcela; Loayza-Muro, Raúl; De Doncker, Simonne; Maurer, Anne; Chappuis, Francois; Dujardin, Jean-Claude; Llanos-Cuentas, Alejandro.
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  • Arevalo J; Instituto de Medicina Tropical Alexander von Humboldt, Facultad de Ciencias, Universidad Peruana Cayetano Heredia, Lima, Peru, and Hôpitaux Universitaires de Genève, Department of Community Medicine, Switzerland. biomoljazz@gmail.com
J Infect Dis ; 195(12): 1846-51, 2007 Jun 15.
Article en En | MEDLINE | ID: mdl-17492601
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.
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Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Compuestos Organometálicos / Leishmaniasis Cutánea / Leishmania / Meglumina / Antimonio / Antiprotozoarios Tipo de estudio: Prognostic_studies Límite: Animals / Humans País/Región como asunto: America do sul / Peru Idioma: En Revista: J Infect Dis Año: 2007 Tipo del documento: Article País de afiliación: Suiza Pais de publicación: Estados Unidos
Buscar en Google
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PubMed Links

Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Compuestos Organometálicos / Leishmaniasis Cutánea / Leishmania / Meglumina / Antimonio / Antiprotozoarios Tipo de estudio: Prognostic_studies Límite: Animals / Humans País/Región como asunto: America do sul / Peru Idioma: En Revista: J Infect Dis Año: 2007 Tipo del documento: Article País de afiliación: Suiza Pais de publicación: Estados Unidos