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de Barros RC, Araujo da Costa R, Farias SDP, de Albuquerque KCO, Marinho AMR, Campos MB, Marinho PSB, Dolabela MF. In silico studies on leishmanicide activity of limonoids and fatty acids from Carapa guianensis Aubl. Front Chem 2024; 12:1394126. [PMID: 39139919 PMCID: PMC11319150 DOI: 10.3389/fchem.2024.1394126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 07/01/2024] [Indexed: 08/15/2024] Open
Abstract
The oil of Carapa guianensis showed leishmanicidal activity, with its activity being related to limonoids, but fatty acids are the major constituents of this oil. The present study evaluated the physicochemical, pharmacokinetic, and toxicity profiles of limonoids and fatty acids already identified in the species. Based on these results, 2 limonoids (methyl angosinlate, 6-OH-methyl angosinlate) and 2 fatty acids (arachidic acid; myristic acid) were selected for the prediction of possible targets and molecular docking. Included in this study were: Gedunin, 6α-acetoxygedunin, Methyl angosenlato, 7-deacetoxy-7-oxogedunin, Andirobin, 6-hydroxy-angolensate methyl, 17β-hydroxyazadiradione, 1,2-dihydro-3β-hydroxy-7-deacetoxy-7-oxogedunin, xyllocensin k, 11beta-Hydroxygedunin, 6α,11-11β-diacetoxygedunin, Oleic Acid, Palmitic Acid, Stearic Acid, Arachidic Acid, Myristic Acid, Palmitoleic Acid, Linoleic Acid, Linolenic Acid, and Beenic Acid. Regarding physicochemical aspects, fatty acids violated LogP, and only limonoid 11 violated Lipinski's rule. A common pharmacokinetic aspect was that all molecules were well absorbed in the intestine and inhibited CYP. All compounds showed toxicity in some model, with fatty acids being mutagenic and carcinogenic, and limonoids not being mutagenic and carcinogenic at least for rats. In in vivo models, fatty acids were less toxic. Molecular dockings were performed on COX-2 steroids (15 and 16) and hypoxia-inducible factor 1 alpha for limonoids (3,6), with this target being essential for the intracellular development of leishmania. Limonoids 3 and 6 appear to be promising as leishmanicidal agents, and fatty acids are promising as wound healers.
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Affiliation(s)
| | | | | | | | | | | | | | - Maria Fani Dolabela
- Pharmaceutical Sciences Postgraduate Program, Federal University of Pará, Belém, PA, Brazil
- Faculty of Pharmacy, Federal University of Pará, Belém, PA, Brazil
- Biotechnology and Biodiversity Postgraduate Program (BIONORTE), Federal University of Pará, Belém, PA, Brazil
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2
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Santos GDA, Sousa JM, de Aguiar AHBM, Torres KCS, Coelho AJS, Ferreira AL, Lima MIS. Systematic Review of Treatment Failure and Clinical Relapses in Leishmaniasis from a Multifactorial Perspective: Clinical Aspects, Factors Associated with the Parasite and Host. Trop Med Infect Dis 2023; 8:430. [PMID: 37755891 PMCID: PMC10534360 DOI: 10.3390/tropicalmed8090430] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 09/28/2023] Open
Abstract
Leishmaniasis is a disease caused by protozoa of the genus Leishmania. Treatment options are limited, and there are frequent cases of treatment failure and clinical relapse. To understand these phenomena better, a systematic review was conducted, considering studies published between 1990 and 2021 in Portuguese, English, and Spanish. The review included 64 articles divided into three categories. Case reports (26 articles) focused on treatment failure and clinical relapse in cutaneous leishmaniasis patients (47.6%), primarily affecting males (74%) and children (67%), regardless of the clinical manifestation. Experimental studies on the parasite (19 articles), particularly with L. major (25%), indicated that alterations in DNA and genic expression (44.82%) played a significant role in treatment failure and clinical relapse. Population data on the human host (19 articles) identified immunological characteristics as the most associated factor (36%) with treatment failure and clinical relapse. Each clinical manifestation of the disease presented specificities in these phenomena, suggesting a multifactorial nature. Additionally, the parasites were found to adapt to the drugs used in treatment. In summary, the systematic review revealed that treatment failure and clinical relapse in leishmaniasis are complex processes influenced by various factors, including host immunology and parasite adaptation.
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Affiliation(s)
- Gustavo de Almeida Santos
- Postgraduate Program in Health and Environment, Center for Biological and Health Sciences, Federal University of Maranhão, São Luís 65080-805, Brazil;
- Department of Biology, Center for Biological and Health Sciences, Federal University of Maranhão, São Luís 65080-805, Brazil; (J.M.S.); (A.H.B.M.d.A.); (K.C.S.T.); (A.J.S.C.); (A.L.F.)
| | - Juliana Mendes Sousa
- Department of Biology, Center for Biological and Health Sciences, Federal University of Maranhão, São Luís 65080-805, Brazil; (J.M.S.); (A.H.B.M.d.A.); (K.C.S.T.); (A.J.S.C.); (A.L.F.)
| | - Antônio Henrique Braga Martins de Aguiar
- Department of Biology, Center for Biological and Health Sciences, Federal University of Maranhão, São Luís 65080-805, Brazil; (J.M.S.); (A.H.B.M.d.A.); (K.C.S.T.); (A.J.S.C.); (A.L.F.)
| | - Karina Cristina Silva Torres
- Department of Biology, Center for Biological and Health Sciences, Federal University of Maranhão, São Luís 65080-805, Brazil; (J.M.S.); (A.H.B.M.d.A.); (K.C.S.T.); (A.J.S.C.); (A.L.F.)
- Postgraduate Program in Health Sciences, Center for Biological and Health Sciences, Federal University of Maranhão, São Luís 65080-805, Brazil
| | - Ana Jessica Sousa Coelho
- Department of Biology, Center for Biological and Health Sciences, Federal University of Maranhão, São Luís 65080-805, Brazil; (J.M.S.); (A.H.B.M.d.A.); (K.C.S.T.); (A.J.S.C.); (A.L.F.)
- Postgraduate Program in Health Sciences, Center for Biological and Health Sciences, Federal University of Maranhão, São Luís 65080-805, Brazil
| | - André Leite Ferreira
- Department of Biology, Center for Biological and Health Sciences, Federal University of Maranhão, São Luís 65080-805, Brazil; (J.M.S.); (A.H.B.M.d.A.); (K.C.S.T.); (A.J.S.C.); (A.L.F.)
| | - Mayara Ingrid Sousa Lima
- Postgraduate Program in Health and Environment, Center for Biological and Health Sciences, Federal University of Maranhão, São Luís 65080-805, Brazil;
- Department of Biology, Center for Biological and Health Sciences, Federal University of Maranhão, São Luís 65080-805, Brazil; (J.M.S.); (A.H.B.M.d.A.); (K.C.S.T.); (A.J.S.C.); (A.L.F.)
- Postgraduate Program in Health Sciences, Center for Biological and Health Sciences, Federal University of Maranhão, São Luís 65080-805, Brazil
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3
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Leite-Silva J, Oliveira-Ribeiro C, Morgado FN, Pimentel MIF, Lyra MR, Fagundes A, Miranda LFC, Valete-Rosalino CM, Schubach AO, Conceição-Silva F. Is There Any Difference in the In Situ Immune Response in Active Localized Cutaneous Leishmaniasis That Respond Well or Poorly to Meglumine Antimoniate Treatment or Spontaneously Heal? Microorganisms 2023; 11:1631. [PMID: 37512804 PMCID: PMC10384164 DOI: 10.3390/microorganisms11071631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 07/30/2023] Open
Abstract
Localized cutaneous leishmaniasis caused by Leishmania braziliensis can either respond well or poorly to the treatment or heal spontaneously; It seems to be dependent on the parasite and/or host factors, but the mechanisms are not fully understood. We evaluated the in situ immune response in eighty-two active lesions from fifty-eight patients prior to treatment classified as early spontaneous regression (SRL-n = 14); treatment responders (GRL-n = 20); and non-responders (before first treatment/relapse, PRL1/PRL2-n = 24 each). Immunohistochemistry was used to identify cell/functional markers which were correlated with the clinical characteristics. PRL showed significant differences in lesion number/size, clinical evolution, and positive parasitological examinations when compared with the other groups. SRL presented a more efficient immune response than GRL and PRL, with higher IFN-γ/NOS2 and a lower percentage of macrophages, neutrophils, NK, B cells, and Ki-67+ cells. Compared to SRL, PRL had fewer CD4+ Tcells and more CD163+ macrophages. PRL1 had more CD68+ macrophages and Ki-67+ cells but less IFN-γ than GRL. PRL present a less efficient immune profile, which could explain the poor treatment response, while SRL had a more balanced immune response profile for lesion healing. Altogether, these evaluations suggest a differentiated profile of the organization of the inflammatory process for lesions of different tegumentary leishmaniasis evolution.
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Affiliation(s)
- Jéssica Leite-Silva
- Laboratory of Immunoparasitology, Oswaldo Cruz Institute (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro 21041-250, RJ, Brazil
| | - Carla Oliveira-Ribeiro
- Service of Oncological Dermatology-National Institute of Cancer (INCA), Rio de Janeiro 20570-120, RJ, Brazil
| | - Fernanda Nazaré Morgado
- Laboratory of Immunoparasitology, Oswaldo Cruz Institute (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro 21041-250, RJ, Brazil
| | - Maria Inês Fernandes Pimentel
- Laboratory of Clinical Research and Surveillance in Leishmaniasis (LAPCLIN VIGILEISH) National Institute of Infectology Evandro Chagas (INI), Fiocruz Rio de Janeiro 21041-250, RJ, Brazil
| | - Marcelo Rosandiski Lyra
- Laboratory of Clinical Research and Surveillance in Leishmaniasis (LAPCLIN VIGILEISH) National Institute of Infectology Evandro Chagas (INI), Fiocruz Rio de Janeiro 21041-250, RJ, Brazil
| | - Aline Fagundes
- Laboratory of Clinical Research and Surveillance in Leishmaniasis (LAPCLIN VIGILEISH) National Institute of Infectology Evandro Chagas (INI), Fiocruz Rio de Janeiro 21041-250, RJ, Brazil
| | - Luciana Freitas Campos Miranda
- Laboratory of Clinical Research and Surveillance in Leishmaniasis (LAPCLIN VIGILEISH) National Institute of Infectology Evandro Chagas (INI), Fiocruz Rio de Janeiro 21041-250, RJ, Brazil
| | - Claudia Maria Valete-Rosalino
- Laboratory of Clinical Research and Surveillance in Leishmaniasis (LAPCLIN VIGILEISH) National Institute of Infectology Evandro Chagas (INI), Fiocruz Rio de Janeiro 21041-250, RJ, Brazil
| | - Armando Oliveira Schubach
- Laboratory of Clinical Research and Surveillance in Leishmaniasis (LAPCLIN VIGILEISH) National Institute of Infectology Evandro Chagas (INI), Fiocruz Rio de Janeiro 21041-250, RJ, Brazil
| | - Fátima Conceição-Silva
- Laboratory of Immunoparasitology, Oswaldo Cruz Institute (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro 21041-250, RJ, Brazil
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Tagliazucchi L, Perea-Martinez A, Fiorini G, Manzano JI, Genovese F, García-Hernández R, Pinetti D, Gamarro F, Costi MP. Label-Free Mass Spectrometry Proteomics Reveals Different Pathways Modulated in THP-1 Cells Infected with Therapeutic Failure and Drug Resistance Leishmania infantum Clinical Isolates. ACS Infect Dis 2023; 9:470-485. [PMID: 36762976 PMCID: PMC10012269 DOI: 10.1021/acsinfecdis.2c00457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
As the world is facing increasing difficulties to treat leishmaniasis with current therapies, deeper investigation into the molecular mechanisms responsible for both drug resistance and treatment failure (TF) is essential in drug discovery and development. So far, few available drugs cause severe side effects and have developed several resistance mechanisms. Drug resistance and TF parasite strains from clinical isolates may have acquired altered expression of proteins that characterize specific mechanisms leading to therapy inefficacy. This work aims to identify the biochemical pathways of THP-1 human monocytes infected by different Leishmania infantum clinical isolates from patients with either resistance or with TF outcome, using whole cell differential Mass Spectrometry proteomics. We have adopted network enrichment analysis to integrate the transcriptomics and the proteomic results of infected cells studies. Transferrin receptor C (TFRC) and nucleoside diphosphate kinase 3 (NDK3) were discovered as overexpressed proteins in THP-1 cells infected with paromomycin, antimony, and miltefosine resistant L. infantum lines. The overall achievements represent founding concepts to confirm new targets involved in the parasitic drug resistance and TF mechanisms, and to consider in perspective the importance of a dual host-guest pharmacological approach to treat the acute stage of the disease.
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Affiliation(s)
- Lorenzo Tagliazucchi
- Department of Life Science, University of Modena and Reggio Emilia, Via Campi 103, 41125 Modena, Italy.,Clinical and Experimental Medicine (CEM) Ph.D. Program, University of Modena and Reggio Emilia, Via Campi 287, 41125 Modena, Italy
| | - Ana Perea-Martinez
- Instituto de Parasitología y Biomedicina "López-Neyra" (IPBLN-CSIC), Avda. del Conocimiento 17, 18016 Armilla, Granada, Spain
| | - Greta Fiorini
- Department of Life Science, University of Modena and Reggio Emilia, Via Campi 103, 41125 Modena, Italy
| | - José Ignacio Manzano
- Instituto de Parasitología y Biomedicina "López-Neyra" (IPBLN-CSIC), Avda. del Conocimiento 17, 18016 Armilla, Granada, Spain
| | - Filippo Genovese
- Centro Interdipartimentale Grandi Strumenti (CIGS), University of Modena and Reggio Emilia, Via Campi 213/A, 41125 Modena, Italy
| | - Raquel García-Hernández
- Instituto de Parasitología y Biomedicina "López-Neyra" (IPBLN-CSIC), Avda. del Conocimiento 17, 18016 Armilla, Granada, Spain
| | - Diego Pinetti
- Centro Interdipartimentale Grandi Strumenti (CIGS), University of Modena and Reggio Emilia, Via Campi 213/A, 41125 Modena, Italy
| | - Francisco Gamarro
- Instituto de Parasitología y Biomedicina "López-Neyra" (IPBLN-CSIC), Avda. del Conocimiento 17, 18016 Armilla, Granada, Spain
| | - Maria Paola Costi
- Department of Life Science, University of Modena and Reggio Emilia, Via Campi 103, 41125 Modena, Italy
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Intralesional Meglumine Antimoniate: Safe, Feasible and Effective Therapy for Cutaneous Leishmaniasis in Bolivia. Trop Med Infect Dis 2022; 7:tropicalmed7100286. [PMID: 36288028 PMCID: PMC9607986 DOI: 10.3390/tropicalmed7100286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/30/2022] [Accepted: 10/01/2022] [Indexed: 11/24/2022] Open
Abstract
The standard of care for cutaneous leishmaniasis includes the intramuscular/intravenous administration of pentavalent antimonials that are toxic and poorly tolerated. Primary health care usually lacks trained health staff for the diagnosis and treatment of leishmaniasis in Cochabamba Bolivia. Taking these aspects into account, a Bolivian consortium set out to explore the intralesional administration of meglumine antimoniate to treat cutaneous leishmaniasis during primary care under programmatic conditions. A four-step strategy consisting of clinical training for intralesional treatment and the promotion and periodic follow-up of health staff was carried out. The training process was applied in situ to personnel of nine primary health care centres. The intralesional treatment was applied five times every other day. Clinical follow-up after six-months of treatment showed a 77% healing proportion and 5% of therapeutic failure among 152 enrolled patients. The drug volume used in the intralesional procedure was on average 1.7 mL/ulcer treated. In conclusion, the strategy used was successful and effective, accomplishing a healing proportion similar to the long standardized treatment with a reduced time of administration, no severe side effects, and it is feasible to conduct by trained health staff. Our study supports the current PAHO/WHO recommendation for the intralesional administration of pentavalent antimonials for the treatment of cutaneous leishmaniasis.
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Lago T, Carvalho LP, Nascimento M, Guimarães LH, Lago J, Castellucci L, Carvalho AM, Lago A, Carvalho EM. Influence of Obesity on Clinical Manifestations and Response to Therapy in Cutaneous Leishmaniasis Caused by Leishmania braziliensis. Clin Infect Dis 2021; 73:1020-1026. [PMID: 33725723 DOI: 10.1093/cid/ciab236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 03/15/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cutaneous leishmaniasis (CL) caused by Leishmania braziliensis is characterized by a single ulcer or multiple cutaneous lesions with raised borders. Cure rates <60% are observed in response to meglumine antimoniate therapy. We investigated the impact of obesity on CL clinical presentation and therapeutic response. METHODS A total of 90 age-matched patients with CL were included (30 obese, 30 overweight, and 30 with normal body mass index [BMI]). CL was diagnosed through documentation of L. braziliensis DNA by polymerase chain reaction or identification of amastigotes in biopsied skin-lesion samples. Serum cytokine levels were determined by chemiluminescence. Antimony therapy with Glucantime (Sanofi-Aventis; 20 mg/kg/day) was administered for 20 days. RESULTS Obese CL patients may present hypertrophic ulcers rather than typical oval, ulcerated lesions. A direct correlation between BMI and healing time was noted. After 1 course of antimony, cure was achieved in 73% of patients with normal BMI, 37% of overweight subjects, yet just 18% of obese CL patients (P < .01). Obese CL cases additionally presented higher leptin levels than overweight patients or those with normal BMI (P < .05). CONCLUSIONS Obesity modifies the clinical presentation of CL and host immune response and is associated with greater failure to therapy.
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Affiliation(s)
- Tainã Lago
- Immunology Service, Professor Edgard Santos University Hospital Complex, Federal University of Bahia, Salvador, Brazil.,Postgraduate Course in Health Sciences, Federal University of Bahia Medical School, Salvador, Brazil
| | - Lucas P Carvalho
- Immunology Service, Professor Edgard Santos University Hospital Complex, Federal University of Bahia, Salvador, Brazil.,Postgraduate Course in Health Sciences, Federal University of Bahia Medical School, Salvador, Brazil.,Gonçalo Moniz Institute (IGM), Fiocruz, Salvador, Brazil
| | - Mauricio Nascimento
- Postgraduate Course in Health Sciences, Federal University of Bahia Medical School, Salvador, Brazil.,Gonçalo Moniz Institute (IGM), Fiocruz, Salvador, Brazil
| | - Luiz H Guimarães
- Federal University of Southern Bahia, Teixeira de Freitas, Brazil
| | - Jamile Lago
- Immunology Service, Professor Edgard Santos University Hospital Complex, Federal University of Bahia, Salvador, Brazil.,Postgraduate Course in Health Sciences, Federal University of Bahia Medical School, Salvador, Brazil
| | - Léa Castellucci
- Immunology Service, Professor Edgard Santos University Hospital Complex, Federal University of Bahia, Salvador, Brazil.,Postgraduate Course in Health Sciences, Federal University of Bahia Medical School, Salvador, Brazil
| | | | - Alex Lago
- Immunology Service, Professor Edgard Santos University Hospital Complex, Federal University of Bahia, Salvador, Brazil.,Postgraduate Course in Health Sciences, Federal University of Bahia Medical School, Salvador, Brazil
| | - Edgar M Carvalho
- Immunology Service, Professor Edgard Santos University Hospital Complex, Federal University of Bahia, Salvador, Brazil.,Postgraduate Course in Health Sciences, Federal University of Bahia Medical School, Salvador, Brazil.,Gonçalo Moniz Institute (IGM), Fiocruz, Salvador, Brazil
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Cantanhêde LM, Mattos CB, Cruz AK, Ikenohuchi YJ, Fernandes FG, Medeiros EHRT, da Silva-Júnior CF, Cupolillo E, Ferreira GEM, Ferreira RDGM. Overcoming the Negligence in Laboratory Diagnosis of Mucosal Leishmaniasis. Pathogens 2021; 10:pathogens10091116. [PMID: 34578149 PMCID: PMC8465713 DOI: 10.3390/pathogens10091116] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/12/2021] [Accepted: 08/25/2021] [Indexed: 11/27/2022] Open
Abstract
The northern region of Brazil, which has the largest number of cases of tegumentary leishmaniasis (TL) in the country, is also the region that has the highest diversity of species of vectors and Leishmania parasites. In this region, cases of mucosal leishmaniasis (ML), a clinical form of TL, exceed the national average of cases, reaching up to 12% of the total annual TL notifications. ML is associated with multiple factors, such as the parasite species and the viral endosymbiont Leishmania RNA virus 1 (LRV1). Being a chronic parasitological disease, laboratory diagnosis of ML poses a challenge for health services. Here, we evaluated more than 700 clinical samples from patients with clinical suspicion of TL, including patients with cutaneous leishmaniasis (CL) and mucosal leishmaniasis, comparing the results of parasitological tests—direct parasitological examination by microscopy (DP) and conventional PCR (cPCR) targeting of both kDNA and hsp70. The DP was performed by collecting material from lesions through biopsies (mucosal lesions) or scarification (cutaneous lesions); for PCR, a cervical brush was used for sample collection. Blood samples were tested employing standardized real-time PCR (qPCR) protocol targeting the HSP70 gene. PCR tests showed higher sensitivity than DP for both CL and ML samples. Considering ML samples only (N = 89), DP showed a sensitivity of 49.4% (N = 44) against 98.8% (N = 88) for kDNA PCR. The qPCR hsp70 for blood samples from patients with ML (N = 14) resulted in superior sensitivity (50%; N = 7) compared to DP (21.4%; N = 3) for samples from the same patients. Our results reinforced the need to implement a molecular test for the diagnosis of ML, in addition to proposing methods less invasive for collecting material from TL patients. Sample collection using a cervical brush in lesions observed in CL and ML patients is easy to perform and less invasive, compared to scarification and biopsies. Blood samples could be a good source for qPCR diagnosis for ML patients. Thus, we propose here a standardized method for collection and for performing of molecular diagnosis of clinical samples from suspicious ML patients that can be applied in reference services for improving ML diagnosis.
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Affiliation(s)
- Lilian Motta Cantanhêde
- Laboratory of Genetic Epidemiology, FIOCRUZ, Porto Velho 76812245, Rondonia, Brazil
- Leishmaniasis Research Laboratory, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro 21040360, Rio de Janeiro, Brazil
| | | | - Ana Karoline Cruz
- Laboratory of Genetic Epidemiology, FIOCRUZ, Porto Velho 76812245, Rondonia, Brazil
| | | | | | | | | | - Elisa Cupolillo
- Leishmaniasis Research Laboratory, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro 21040360, Rio de Janeiro, Brazil
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8
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Serine proteases profiles of Leishmania (Viannia) braziliensis clinical isolates with distinct susceptibilities to antimony. Sci Rep 2021; 11:14234. [PMID: 34244581 PMCID: PMC8271011 DOI: 10.1038/s41598-021-93665-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 06/29/2021] [Indexed: 11/10/2022] Open
Abstract
Glucantime (SbV) is the first-line treatment against American Tegumentary Leishmaniasis. Resistance cases to this drug have been reported and related to host characteristics and parasite phenotypes. In this study, 12 Leishmania (Viannia) braziliensis isolates from patients that presented clinical cure (Responders—R) and relapse or therapeutic failure (Non-responders—NR) after treatment with antimony, were analyzed. These parasites were assessed by in vitro susceptibility to SbIII and SbV, serine proteases activity measured with substrate (z-FR-AMC) and specific inhibitors (TLCK, AEBSF and PMSF). In vitro susceptibility of axenic amastigotes to SbIII showed a significant difference between R and NR groups. The protease assays showed that TLCK inhibited almost 100% of activity in both axenic amastigotes and promastigotes while AEBSF inhibited around 70%, and PMSF showed lower inhibition of some isolates. Principal component and clustering analysis performed with these data yielded one homogeneous cluster with only NR isolates and three heterogeneous clusters with R and NR isolates. Additionally, differential expression of subtilisins (LbrM.13.0860 and LbrM.28.2570) and TXNPx (LbrM.15.1080) was evaluated in promastigotes and axenic amastigotes from both groups. The results showed a higher expression of LbrM.13.0860 and LbrM.15.1080 genes in axenic amastigotes, while LbrM.28.2570 gene had the lowest expression in all isolates, regardless of the parasite form. The data presented here show a phenotypic heterogeneity among the parasites, suggesting that exploration of in vitro phenotypes based on SbIII and serine proteases profiles can aid in the characterization of L. (V.) braziliensis clinical isolates.
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García-Bustos MF, González-Prieto G, Paniz-Mondolfi AE, Parodi C, Beckar J, Monroig S, Ramos F, Mora MC, Delgado-Noguera LA, Hashiguchi Y, Jaime D, Moreno S, Ruiz-Morales L, Lemir CG, Barrio A. Risk factors for antimony treatment failure in American Cutaneous Leishmaniasis in Northwestern-Argentina. PLoS Negl Trop Dis 2021; 15:e0009003. [PMID: 33497376 PMCID: PMC7864468 DOI: 10.1371/journal.pntd.0009003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/05/2021] [Accepted: 11/23/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND To date, there is no specific literature available on the determinants for therapeutic failure (TF) with meglumine antimoniate (MA) in Northwestern-Argentina. This study aimed to identify epidemiological, clinical, and treatment-related factors that could be involved in TF. METHODOLOGY/PRINCIPAL FINDINGS We performed a case-control study. Cases were represented by patients who showed TF after administration of the first course of MA treatment, whereas, controls were determined as patients who evolved towards healing after the first MA cycle received. Crude Odds Ratios and their corresponding 90% confidence intervals (CI) were calculated, and risk factors were then tested by multivariate analysis using logistic binary regression. Three hundred and eighty-four patients with a presumptive diagnosis of ACL were recruited, and 153 with a positive diagnosis were selected. We included in the study 71 patients, who underwent specific treatment with MA, presented complete data on response to treatment, and had a minimum post-treatment follow-up of 6 months in cutaneous leishmaniasis, and 12 months in mucosal leishmaniasis. Of these, 34 (47.9%) presented TF. In the initial analysis, TF was significantly associated with the geographical area of disease acquisition (p = 0.036), the presence of mucosal lesions (p = 0.042), the presence of concomitant skin and mucosal lesions (p = 0.002), and lesion age ≥ 6 months (p = 0.018). Risk factors influencing TF in the final multivariate model included the geographical area where the disease was acquired (adjusted Odd Ratio 8.062; 95% CI 1.914-33.959; p = 0.004), and lesion age ≥ 6 months (adjusted Odd Ratio 10.037; 95% CI 1.383-72.843; p = 0.023). CONCLUSIONS/SIGNIFICANCE The results of the present study suggest the existence of some risk factors linked to TF in Northwestern-Argentina, which deserve further investigation. Herein we recorded a high percentage of TF and we described clinical and epidemiological characteristics associated with TF that could be taken into account improving the clinical management of patients.
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Affiliation(s)
- María F. García-Bustos
- Instituto de Patología Experimental, Consejo Nacional de Investigaciones Científicas y Técnicas, Salta, Argentina
- Escuela Universitaria en Ciencias de la Salud, Universidad Católica de Salta, Salta, Argentina
- Facultad de Ciencias de la Salud, Universidad Nacional de Salta, Salta, Argentina
- * E-mail: (MFGB); (AB)
| | | | - Alberto E. Paniz-Mondolfi
- Instituto de Investigaciones Biomédicas IDB, Departamento de Enfermedades Infecciosas y Medicina Tropical, Laboratorio de Patología de Enfermedades Infecciosas, Clínica IDB Cabudare, Cabudare, Venezuela
| | - Cecilia Parodi
- Instituto de Patología Experimental, Consejo Nacional de Investigaciones Científicas y Técnicas, Salta, Argentina
| | - Josefina Beckar
- Servicio de Otorrinolaringología, Hospital San Bernardo, Salta, Argentina
| | - Sibila Monroig
- Servicio de Otorrinolaringología, Hospital Papa Francisco, Salta, Argentina
| | - Federico Ramos
- Instituto de Patología Experimental, Consejo Nacional de Investigaciones Científicas y Técnicas, Salta, Argentina
| | - María C. Mora
- Instituto de Patología Experimental, Consejo Nacional de Investigaciones Científicas y Técnicas, Salta, Argentina
| | - Lourdes A. Delgado-Noguera
- Leishmania Collaborative Network, Emerging Pathogens Division, The Venezuelan Science Incubator, Cabudare, Venezuela
- Decanato de Ciencias de la Salud, Universidad Centroccidental Lisandro Alvarado (UCLA), Barquisimeto, Venezuela
| | - Yoshihisa Hashiguchi
- Department of Parasitology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Daniela Jaime
- Servicio de Dermatología, Hospital Joaquín Castellanos, Güemes, Salta, Argentina
| | - Sonia Moreno
- Servicio de Dermatología, Hospital Señor del Milagro, Salta, Argentina
| | | | - César G. Lemir
- Servicio de Infectología, Hospital San Bernardo, Salta, Argentina
| | - Alejandra Barrio
- Facultad de Ciencias de la Salud, Universidad Nacional de Salta, Salta, Argentina
- * E-mail: (MFGB); (AB)
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Clinical, epidemiological and transmission cycle aspects of leishmaniasis urbanization in Barreiras, Bahia, Brazil. Spat Spatiotemporal Epidemiol 2020; 36:100395. [PMID: 33509434 DOI: 10.1016/j.sste.2020.100395] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 10/13/2020] [Accepted: 12/07/2020] [Indexed: 11/22/2022]
Abstract
Leishmaniasis remains one of the world's leading infectious diseases and a public health problem for Bahia and Brazil. We made a retrospective cohort study of leishmaniasis cases reported between 2007 and 2016 in the Barreiras city, an important agribusiness city whose urbanization process was recent. Leishmaniasis presented epidemiological data with similar characteristics of the disease in other regions of the Brazil, that is, with the highest prevalence of visceral leishmaniasis found in children, while cutaneous leishmaniais was found in adults. The disease presented an urban configuration with wide distribution in the Barreiras city. We found the vectors of the different clinical forms of the disease occurring in the urban area of Barreiras city, particularly the sand fly of the Lutzmyia longipalpis, Evandromyia sallesi and Nyssomyia intermedia species. More studies will be necessary to indentify whether these species are really incriminated in the urban transmission of the parasites in the urban areas. This study indicates the places of the spatio-temporal greatest occurrence and transmission of the disease in the urban zones of Barreiras city.
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Kakooei Z, Hajjaran H, Akhoundi B, Charehdar S, Elikaee S, Shafeghat Z, Hassanpour H, Satvat MT, Kazemi-Rad E, Mohebali M. Treatment Failure in Cutaneous Leishmaniasis Patients Referred to the School of Public Health, Tehran University of Medical Sciences during 2008-2017. J Arthropod Borne Dis 2020; 14:363-375. [PMID: 33954210 PMCID: PMC8053072 DOI: 10.18502/jad.v14i4.5274] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 12/03/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Cutaneous leishmaniasis (CL) is a vector borne disease predominantly found in tropical and subtropical countries, including Iran. For more than 6 decades, pentavalent antimonials have been used successfully worldwide for the treatment of leishmaniasis, but over the past few years, clinical resistance to these medications has increased. In this study, we evaluated CL patients who did not show any desirable responses to the anti-leishmanial treatment within a 10-year period (2008 to 2017). METHODS All patients from different parts of Iran suspected of having cutaneous leishmaniasis, who were referred to the laboratory of leishmaniosis in Tehran University of Medical Sciences from 2008-2017 were parasitological examined. RESULTS During this period, a total of 1480 suspected CL patients were referred to the laboratory of leishmaniosis. Samples from 655 patients (70.8%) suspected of having CL were positive microscopically. The failure rate in patients treated with anti-leishmaniasis medications for a minimum of three complete treatment periods was 1.83% (12 cases). There was no association between the number and size of skin lesions and patient characteristics. Also, the route of drug administration had no significant effect on the number and size of lesions. CONCLUSION In the present study, treatment failure was found in some confirmed CL patients treated with meglumine antimoniate. Over the past few years, it seems that had been increased in resistance to these medications. So, a review of the correct implementation of the treatment protocol and/or a combination therapy may be helpful in preventing an increase in the rate of treatment failure.
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Affiliation(s)
- Zahra Kakooei
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Homa Hajjaran
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Behnaz Akhoundi
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Sorour Charehdar
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Samira Elikaee
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Shafeghat
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Hassanpour
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Department of Medical Parasitology, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Mohammad Taghi Satvat
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Kazemi-Rad
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Mohebali
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Center for Research of Endemic Parasites of Iran (CREPI), Tehran University of Medical Sciences, Tehran, Iran
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Cataneo AHD, Tomiotto-Pellissier F, Miranda-Sapla MM, Assolini JP, Panis C, Kian D, Yamauchi LM, Colado Simão AN, Casagrande R, Pinge-Filho P, Costa IN, Verri WA, Conchon-Costa I, Pavanelli WR. Quercetin promotes antipromastigote effect by increasing the ROS production and anti-amastigote by upregulating Nrf2/HO-1 expression, affecting iron availability. Biomed Pharmacother 2019; 113:108745. [DOI: 10.1016/j.biopha.2019.108745] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 02/15/2019] [Accepted: 02/25/2019] [Indexed: 12/23/2022] Open
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Ferreira Terceiro BR, Torraca TSDS, Braga FPB, Martins ACDC, Brahim LR, Saheki MN, Miranda LDFC, Schubach ADO, Valete-Rosalino CM. Good response to pentamidine isethionate in a case of Mucosal Leishmaniasis caused by Leishmania (Viannia) braziliensis that was difficult to treat: Case Report. Rev Soc Bras Med Trop 2019; 52:e20180236. [DOI: 10.1590/0037-8682-0236-2018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 08/07/2018] [Indexed: 11/22/2022] Open
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do Nascimento Volpe RAF, Navasconi TR, Dos Reis VN, Hioka N, Becker TCA, Lonardoni MVC, Aristides SMA, Silveira TGV. Photodynamic Therapy for the Treatment of American Tegumentary Leishmaniasis: Evaluation of Therapies Association in Experimentally Infected Mice With Leishmania (Leishmania) amazonensis. J Lasers Med Sci 2018; 9:274-282. [PMID: 31119023 DOI: 10.15171/jlms.2018.49] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Introduction: American tegumentary leishmaniasis (ATL) is a zoonotic disease caused by protozoan parasites of the genus Leishmania that affects the skin and mucous membrane. Currently, the available drugs for the treatment are injectable, with side effects, long-term treatment regimen and there is the possibility of drug resistance. Thus, alternative therapies have been tested, including photodynamic therapy (PDT). We evaluated the efficacy of PDT on its own and associated with the prescribed ATL treatment. Methods: BALB/c mice were infected with Leishmania (Leishmania) amazonensis and divided into 6 groups: Gluc+PDT, treated with Glucantime® and photodynamic therapy (PDT) with methylene blue (MB)/red LED (light-emitting diode); Gluc, treated with Glucantime®; PDT, treated with PDT with MB/red LED; Ampho+PDT, treated with amphotericin and PDT with MB/red LED; Ampho, treated with amphotericin; and control, which were infected but not treated. Two treatment cycles were performed. After 165 days of infection, the parasite load was determined. Results: Statistical differences were not found (P>0.05) between measures of volume and thickness of the infected footpads in the treated groups when compared with the control group. However, there was a significant reduction (P<0.05) in the parasitic load of the popliteal lymph nodes of the Gluc+PDT, Gluc, PDT and Ampho groups when compared to the control group. In the histological analysis of the infected footpads, the Gluc+PDT group presented a smaller amount of amastigote nests and lower intensity of the mononuclear infiltrate when compared to the Gluc and PDT groups. Conclusion: The results showed that although there is no significant difference in the evaluations of footpad size (thickness and volume), there is a downward measurement tendency in the Gluc+PDT group, as it can be observed by volume data and corroborated by parasite negative load.
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Affiliation(s)
| | - Taisa Rocha Navasconi
- Graduate Program in Health Sciences, Universidade Estadual de Maringá, Maringá, Brazil
| | - Vanessa Nesi Dos Reis
- Graduate Program in Health Sciences, Universidade Estadual de Maringá, Maringá, Brazil
| | - Noboru Hioka
- Department of Chemistry, Universidade Estadual de Maringá, Maringá, Brazil
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Conceição-Silva F, Leite-Silva J, Morgado FN. The Binomial Parasite-Host Immunity in the Healing Process and in Reactivation of Human Tegumentary Leishmaniasis. Front Microbiol 2018; 9:1308. [PMID: 29971054 PMCID: PMC6018218 DOI: 10.3389/fmicb.2018.01308] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 05/29/2018] [Indexed: 01/09/2023] Open
Abstract
Leishmaniasis is a vector-borne infectious disease caused by different species of protozoa from the Leishmania genus. Classically, the disease can be classified into two main clinical forms: Visceral (VL) and Tegumentary (TL) leishmaniasis. TL is a skin/mucosal granulomatous disease that manifests mainly as cutaneous localized or disseminated ulcers, papules diffusely distributed, mucosal lesions or atypical lesions. Once the etiology of the infection is confirmed, treatment can take place, and different drugs can be administered. It has already been shown that, even when the scar is clinically evident, inflammation is still present in the native tissue, and the decrease of the inflammatory process occurs slowly during the 1st years after clinical healing. The maintenance of residual parasites in the scar tissue is also well documented. Therefore, it is no longer a surprise that, under some circumstances, therapeutic failure and/or lesion reactivation occurs. All over the years, an impressive amount of data on relapses, treatment resistance and lesion reactivation after healing has been collected, and several factors have been pointed out as having a role in the process. Different factors such as Leishmania species, parasite variability, Leishmania RNA virus 1, parasite load, parasite persistence, age, nutritional status, gender, co-morbidities, co-infection, pregnancy, immunosuppression, lesion duration, number and localization of lesions, drug metabolism, irregular treatment and individual host cellular immune response were described and discussed in the present review. Unfortunately, despite this amount of information, a conclusive understanding remains under construction. In addition, multifactorial influence cannot be discarded. In this context, knowing why leishmaniasis has been difficult to treat and control can help the development of new approaches, such as drugs and immunotherapy in order to improve healing maintenance. In this sense, we would like to highlight some of the findings that may influence the course of Leishmania infection and the therapeutic response, with an emphasis on TL.
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Affiliation(s)
- Fatima Conceição-Silva
- Laboratory of Immunoparasitology, Oswaldo Cruz Institute (Fiocruz), Rio de Janeiro, Brazil
| | - Jessica Leite-Silva
- Laboratory of Immunoparasitology, Oswaldo Cruz Institute (Fiocruz), Rio de Janeiro, Brazil
| | - Fernanda N. Morgado
- Laboratory of Leishmaniasis Research, Oswaldo Cruz Institute (Fiocruz), Rio de Janeiro, Brazil
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Gagini T, de Oliveira Schubach A, de Fatima Madeira M, Maria Valete-Rosalino C, Fernandes Pimentel MI, da Silva Pacheco R. Genotypic profiles of Leishmania (Viannia) braziliensis strains from cutaneous leishmaniasis patients and their relationship with the response to meglumine antimoniate treatment: a pilot study. ACTA ACUST UNITED AC 2017; 24:34. [PMID: 28959938 PMCID: PMC5621350 DOI: 10.1051/parasite/2017035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 09/04/2017] [Indexed: 11/20/2022]
Abstract
Background: Forty-four strains isolated from a cohort of cutaneous leishmaniasis (CL) patients who did or did not respond to one course of treatment with meglumine antimoniate were investigated to explore genetic polymorphisms in parasite kinetoplast DNA minicircles. Leishmania (Viannia) braziliensis strains isolated from responder (R) and non-responder (NR) patients who acquired infection in Rio de Janeiro or in other Brazilian states were studied using low-stringency single-specific primer polymerase chain reaction (LSSP-PCR) to identify genetic polymorphisms. Results: Polymorphisms were observed in parasites recovered from patient lesions. No association was found between a specific genotype and R or NR patients. Phenetic analysis grouped the genotypes into three main clusters, with similarity indices varying from 0.72 to 1.00. Although no specific genotype association was detected, at least one group of L. (V.) braziliensis genotypes that circulates in Rio de Janeiro was discriminated in clusters I and III, showing phenotypes of good and poor responses to treatment, respectively. Cluster I comprised parasite profiles recovered from R patients from Rio de Janeiro and in cluster III, NR samples were prevalent. Cluster II comprised 24 isolates, with 21 from Rio de Janeiro and three from other states, equally distributed between R and NR patients. Additionally, we found that parasites sharing all common genetic characteristics acted differently in response to treatment. Conclusions: These results are of clinical-epidemiological importance since they demonstrate that populations of L. (V.) braziliensis that exhibit high levels of genetic similarity also display different phenotypes associated with meglumine antimoniate responses in cutaneous leishmaniasis patients.
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Affiliation(s)
- Thalita Gagini
- Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Instituto Nacional de Infectologia Evandro Chagas INI/FIOCRUZ, Manguinhos, Rio de Janeiro, Brazil
| | - Armando de Oliveira Schubach
- Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Instituto Nacional de Infectologia Evandro Chagas INI/FIOCRUZ, Manguinhos, Rio de Janeiro, Brazil
| | - Maria de Fatima Madeira
- Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Instituto Nacional de Infectologia Evandro Chagas INI/FIOCRUZ, Manguinhos, Rio de Janeiro, Brazil
| | - Cláudia Maria Valete-Rosalino
- Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Instituto Nacional de Infectologia Evandro Chagas INI/FIOCRUZ, Manguinhos, Rio de Janeiro, Brazil - Departamento de Otorrinolaringologia e Oftalmologia, Faculdade de Medicina, UFRJ, Hospital Universitário Clementino Fraga Filho, Cidade Universitária - Ilha do Fundão, Rio de Janeiro, Brazil
| | - Maria Inês Fernandes Pimentel
- Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Instituto Nacional de Infectologia Evandro Chagas INI/FIOCRUZ, Manguinhos, Rio de Janeiro, Brazil
| | - Raquel da Silva Pacheco
- Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Instituto Nacional de Infectologia Evandro Chagas INI/FIOCRUZ, Manguinhos, Rio de Janeiro, Brazil
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Oliveira-Ribeiro C, Pimentel MIF, Oliveira RDVC, Fagundes A, Madeira MDF, Mello CX, Mouta-Confort E, Valete-Rosalino CM, Vasconcellos EDCF, Lyra MR, Quintella LP, Fatima Antonio LD, Schubach A, Conceição-Silva F. Clinical and laboratory profiles of patients with early spontaneous healing in cutaneous localized leishmaniasis: a historical cohort study. BMC Infect Dis 2017; 17:559. [PMID: 28793868 PMCID: PMC5550953 DOI: 10.1186/s12879-017-2658-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 08/01/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Skin ulcers in American cutaneous leishmaniasis (ACL) may heal spontaneously after months/years. However, few cases may present quick heal even during diagnosis procedure (early spontaneous healing- ESH). The main objective of this study was to compare ESH patients with cases requiring specific treatment [non-ESH (NESH)]. METHODS A historical cohort study of ACL patients (n = 445) were divided into 2 groups: ESH - spontaneously healed patients (n = 13; 2.90%), and NESH- treated patients (n = 432; 97.10%). We compared clinical and laboratorial findings at diagnosis, including the lesion healing process. RESULTS ESH patients had a higher percentage of single lesions (p = 0.027), epithelialized lesion on initial examination (p = 0.001), lesions located in the dorsal trunk (p = 0.017), besides earlier healing (p < 0.001). NESH presents higher frequency of ulcerated lesions (p = 0.002), amastigotes identified in histopathology exams (p = 0.005), positive cultures (p = 0.001), and higher positivity in ≥3 parasitological exams (p = 0.030). All ESH cases were positive in only a single exam, especially in PCR. CONCLUSIONS ESH group apparently presented a lower parasitic load evidenced by the difficulty of parasitological confirmation and its positivity only by PCR method. The absence or deficiency of specific treatment is commonly identified as predisposing factors for recurrence and metastasis in ACL. However, due to the drugs toxicity, the treatment of cases which progress to early spontaneous healing is controversial. ESH patients were followed for up to 5 years after cure, with no evidence of recrudescence, therefore suggesting that not treating these patients is justifiable, but periodic dermatological and otorhinolaryngological examinations are advisable to detect a possible relapse.
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Affiliation(s)
- Carla Oliveira-Ribeiro
- Laboratório de Imunoparasitologia, Instituto Oswaldo Cruz IOC/FIOCRUZ, Pavilhão 26 - 4° andar, sala 406-C, Av. Brasil 4365, Manguinhos, Rio de Janeiro, RJ, 21040-360, Brazil
- Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses - LAPCLIN VIGILEISH, Instituto Nacional de Infectologia Evandro Chagas INI/FIOCRUZ, Rio de Janeiro, Brazil
| | - Maria Inês Fernandes Pimentel
- Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses - LAPCLIN VIGILEISH, Instituto Nacional de Infectologia Evandro Chagas INI/FIOCRUZ, Rio de Janeiro, Brazil
| | | | - Aline Fagundes
- Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses - LAPCLIN VIGILEISH, Instituto Nacional de Infectologia Evandro Chagas INI/FIOCRUZ, Rio de Janeiro, Brazil
| | - Maria de Fatima Madeira
- Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses - LAPCLIN VIGILEISH, Instituto Nacional de Infectologia Evandro Chagas INI/FIOCRUZ, Rio de Janeiro, Brazil
- Jovem Cientista do Nosso Estado, Fundação Carlos Chagas Filho de Amparo à Pesquisa no Estado do Rio de Janeiro (FAPERJ), Rio de Janeiro, Brazil
- Fellow Researcher of the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Rio de Janeiro, Brazil
| | - Cintia Xavier Mello
- Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses - LAPCLIN VIGILEISH, Instituto Nacional de Infectologia Evandro Chagas INI/FIOCRUZ, Rio de Janeiro, Brazil
| | - Eliame Mouta-Confort
- Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses - LAPCLIN VIGILEISH, Instituto Nacional de Infectologia Evandro Chagas INI/FIOCRUZ, Rio de Janeiro, Brazil
| | - Claudia Maria Valete-Rosalino
- Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses - LAPCLIN VIGILEISH, Instituto Nacional de Infectologia Evandro Chagas INI/FIOCRUZ, Rio de Janeiro, Brazil
- Jovem Cientista do Nosso Estado, Fundação Carlos Chagas Filho de Amparo à Pesquisa no Estado do Rio de Janeiro (FAPERJ), Rio de Janeiro, Brazil
- Departamento de Otorrinolaringologia e Oftalmologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Erica de Camargo Ferreira Vasconcellos
- Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses - LAPCLIN VIGILEISH, Instituto Nacional de Infectologia Evandro Chagas INI/FIOCRUZ, Rio de Janeiro, Brazil
| | - Marcelo Rosandiski Lyra
- Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses - LAPCLIN VIGILEISH, Instituto Nacional de Infectologia Evandro Chagas INI/FIOCRUZ, Rio de Janeiro, Brazil
| | - Leonardo Pereira Quintella
- Serviço de Anatomia Patológica- SEAP, Instituto Nacional de Infectologia Evandro Chagas. INI/FIOCRUZ, Rio de Janeiro, Brazil
| | - Liliane de Fatima Antonio
- Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses - LAPCLIN VIGILEISH, Instituto Nacional de Infectologia Evandro Chagas INI/FIOCRUZ, Rio de Janeiro, Brazil
| | - Armando Schubach
- Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses - LAPCLIN VIGILEISH, Instituto Nacional de Infectologia Evandro Chagas INI/FIOCRUZ, Rio de Janeiro, Brazil
- Fellow Researcher of the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Rio de Janeiro, Brazil
- Cientista do Nosso Estado, Fundação Carlos Chagas Filho de Amparo à Pesquisa no Estado do Rio de Janeiro (FAPERJ), Rio de Janeiro, Brazil
| | - Fatima Conceição-Silva
- Laboratório de Imunoparasitologia, Instituto Oswaldo Cruz IOC/FIOCRUZ, Pavilhão 26 - 4° andar, sala 406-C, Av. Brasil 4365, Manguinhos, Rio de Janeiro, RJ, 21040-360, Brazil.
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Risk factors for therapeutic failure to meglumine antimoniate and miltefosine in adults and children with cutaneous leishmaniasis in Colombia: A cohort study. PLoS Negl Trop Dis 2017; 11:e0005515. [PMID: 28379954 PMCID: PMC5393627 DOI: 10.1371/journal.pntd.0005515] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 04/17/2017] [Accepted: 03/21/2017] [Indexed: 01/24/2023] Open
Abstract
Introduction Reports of therapeutic failure to meglumine antimoniate (MA) and miltefosine in cutaneous leishmaniasis (CL) varies between species, populations and geographic regions. This study aimed to determine the clinical, drug-related factors, and Leishmania species associated with treatment failure in children and adults with cutaneous leishmaniasis. Methods A cohort study was performed with children (2–12 years old) and adults (18–65 years old) with CL, who have participated in clinical studies at CIDEIM Cali, Tumaco and Chaparral. Incidence of therapeutic failure was estimated by treatment and age groups. Descriptive, bivariate, and multiple logistic regression analyses were performed for the complete cohort and pediatric patients. Results Two hundred and thirty patients were included (miltefosine: 112; MA: 118), of which 60.4% were children and 83.9% were infected with L.V. panamensis. Overall incidence of therapeutic failure was 15.65% (95%CI: 10.92–20.38), and was lower for miltefosine than for MA (8.92%, 95%CI: 3.59–14.26 versus 22.03%, 95%CI:14.48–29.58, p = 0.006). Treatment failure was associated with age ≤8 years (OR: 3.29; 95%CI: 1.37–7.89), disease duration ≤1 month (OR: 3.29; 95%CI: 1.37–7.89), regional lymphadenopathy (OR: 2.72; 95%CI: 1.10–6.70), treatment with MA (OR: 3.98; 95%CI: 1.66–9.50), and adherence <90% (OR: 3.59; 95%CI: 1.06–12.11). In children, higher Z-score of height/age was a protective factor (OR: 0.58; 95%CI: 0.36–0.93), while treatment with MA was a risk factor (OR: 40.82; 95%CI: 2.45–677.85), demonstrating significant interaction with age (p = 0.03). Conclusions Clinical and drug-related factors determine therapeutic failure in CL. High risk of failure in children treated with MA indicates the need to reconsider this drug as first line treatment in this population. Trial registration Clinical trial registration: NCT00487253 Clinical trial registration: NCT01462500 Clinical trial registration: NCT01464242 Cutaneous leishmaniasis (CL) is a parasitic disease that causes chronic, often ulcerated, skin lesions. Treatment require administration of systemic and poorly tolerated drugs, of which, the most commonly used is meglumine antimoniate (MA) injections during 20 days. Although children and adults might have different responses to these drugs, Colombian treatment guidelines recommends meglumine antimoniate for all age groups. In this study, we explored the factors that influence the therapeutic response in children and adults with CL treated with MA and miltefosine. We included 230 children and adults in the analysis, and we found that young age (≤8 years old), presence of regional lymphadenopathy, disease duration ≤1 month, poor adherence to treatment (<90%) were associated with increased odds of treatment failure. Additionally, being treated with MA was a risk factor for therapeutic failure, especially for children. A better nutritional status (higher Z-score of height/age) was a protector factor in pediatric patients. These results highlight the urgent need to reconsider MA as first line treatment in children in Colombia and to evaluate better treatment options for this population.
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Pharmacokinetics of Miltefosine in Children and Adults with Cutaneous Leishmaniasis. Antimicrob Agents Chemother 2017; 61:AAC.02198-16. [PMID: 27956421 PMCID: PMC5328512 DOI: 10.1128/aac.02198-16] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 11/25/2016] [Indexed: 12/15/2022] Open
Abstract
An open-label pharmacokinetics (PK) clinical trial was conducted to comparatively assess the PK and explore the pharmacodynamics (PD) of miltefosine in children and adults with cutaneous leishmaniasis (CL) in Colombia. Sixty patients, 30 children aged 2 to 12 years and 30 adults aged 18 to 60 years, were enrolled. Participants received miltefosine (Impavido) at a nominal dose of 2.5 mg/kg/day for 28 days. Miltefosine concentrations were measured in plasma and peripheral blood mononuclear cells by liquid chromatography-tandem mass spectrometry of samples obtained during treatment and up to 6 months following completion of treatment, when therapeutic outcome was determined. Fifty-two patients were cured, 5 pediatric patients failed treatment, and 3 participants were lost to follow-up. Leishmania (Viannia) panamensis predominated among the strains isolated (42/46; 91%). Noncompartmental analysis demonstrated that plasma and intracellular miltefosine concentrations were, overall, lower in children than in adults. Exposure to miltefosine, estimated by area under the concentration-time curve and maximum concentration, was significantly lower in children in both the central and intracellular compartments (P < 0.01). Leishmania persistence was detected in 43% of study participants at the end of treatment and in 27% at 90 days after initiation of treatment. Clinical response was not dependent on parasite elimination. In vitro miltefosine susceptibility was similar for Leishmania strains from adults and children. Our results document PK differences for miltefosine in children and adults with cutaneous leishmaniasis that affect drug exposure and could influence the outcome of treatment, and they provide bases for optimizing therapeutic regimens for CL in pediatric populations. (This study has been registered at ClinicalTrials.gov under identifier NCT01462500.)
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Aronson N, Herwaldt BL, Libman M, Pearson R, Lopez-Velez R, Weina P, Carvalho EM, Ephros M, Jeronimo S, Magill A. Diagnosis and Treatment of Leishmaniasis: Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH). Clin Infect Dis 2016; 63:e202-e264. [PMID: 27941151 DOI: 10.1093/cid/ciw670] [Citation(s) in RCA: 176] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 09/22/2016] [Indexed: 12/25/2022] Open
Abstract
It is important to realize that leishmaniasis guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. The IDSA and ASTMH consider adherence to these guidelines to be voluntary, with the ultimate determinations regarding their application to be made by the physician in the light of each patient's individual circumstances.
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Affiliation(s)
- Naomi Aronson
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - Michael Libman
- McGill University Health Centre, Montreal, Quebec, Canada
| | | | | | - Peter Weina
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | | | | | - Selma Jeronimo
- Federal University of Rio Grande do Norte, Natal, Brazil
| | - Alan Magill
- Bill and Melinda Gates Foundation, Seattle, Washington
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Vita GF, Pereira MAVDAC, Ferreira I, Sanavria A, Barbosa CG, Aurnheimer RDCM, Mello ERD, Silva CBD, Cabral RBG. STATUS OF THE AMERICAN TEGUMENTARY LEISHMANIASIS IN THE STATE OF RIO DE JANEIRO , BRAZIL, FROM 2004 TO 2013. Rev Inst Med Trop Sao Paulo 2016; 58:71. [PMID: 27680176 PMCID: PMC5048642 DOI: 10.1590/s1678-9946201658071] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 05/30/2016] [Indexed: 11/22/2022] Open
Abstract
The aim of the present study was to analyze the status of the American Tegumentary
Leishmaniasis (ATL) in the state of Rio de Janeiro, from 2004 to
2013, through its spatiotemporal distribution. We also described variables considered
relevant to the epidemiology of the disease, such as the clinical form, gender,
ethnic group, age group, and progression of disease. This is a descriptive study,
which used notified secondary data from the Brazilian Information System of
Notifiable Diseases (SINAN), Ministry of Health, Brazil, regarding confirmed
diagnoses. To help the calculation of coefficients of detection and mortality, we
used population data from the Brazilian Institute of Geography and Statistics (IBGE).
We analyzed 1,470 cases of ATL with the predominance of the cutaneous clinical form
(1,292/87.89%). The data has also revealed seven deaths, a predominance of males
(922/62.72%), and a higher incidence of ATL in the white ethnic group (731/49.72%).
We observed a high incidence of ATL in the group of 20 - 39 years old (477/32.44%).
We concluded that there was a decrease in the number of ATL cases in the state of
Rio de Janeiro, based on a coefficient of detection of
1.44/100.000 inhabitants in 2004 decreasing to 0.20/100.000 inhabitants in 2013. The
localities with the highest occurrences of ATL were the metropolitan region (843
cases) and the municipality of Rio de Janeiro (740 cases). In 2005,
the highest incidence of the disease was observed (351 cases) in the study. Among the
variables selected to describe the epidemiology of the disease, the following
categories: cutaneous clinical form, male patients, white ethnic group, and the age
group of 20 - 39 years old were more affected than the others.
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Affiliation(s)
- Gilmar Ferreira Vita
- Universidade Federal Rural do Rio de Janeiro(UFRRJ), Animal Biology Program of Post-Graduation, Seropédica, Rio de Janeiro, Brazil
| | | | - Ildemar Ferreira
- Universidade Federal Rural do Rio de Janeiro(UFRRJ), Institute of Animal Biology, Seropédica, Rio de Janeiro, Brazil
| | - Argemiro Sanavria
- Universidade Federal Rural do Rio de Janeiro(UFRRJ), Institute of Veterinary Medicine. Seropédica, Rio de Janeiro, Brazil
| | - Celso Guimarães Barbosa
- Universidade Federal Rural do Rio de Janeiro(UFRRJ), Institute of Chemical. Seropédica, Rio de Janeiro, Brazil
| | | | - Ericson Ramos de Mello
- Universidade Federal Rural do Rio de Janeiro(UFRRJ), Institute of Animal Biology, Seropédica, Rio de Janeiro, Brazil
| | - Claudia Bezerra da Silva
- Universidade Federal Rural do Rio de Janeiro(UFRRJ), Institute of Veterinary Medicine. Seropédica, Rio de Janeiro, Brazil
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Alavi-Naini R, Fazaeli A, O'Dempsey T. Topical Treatment Modalities for Old World Cutaneous Leishmaniasis: A Review. Prague Med Rep 2015; 113:105-18. [DOI: 10.14712/23362936.2015.26] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Diagnosis and therapy of cutaneous leishmaniasis (CL) can be difficult due to the variability of the clinical pictures and resistance to therapy. There is no vaccine currently available for CL. The aim of the present review is to describe different topical treatment modalities for old world CL. The mainstays of treatment for old world CL are pentavalent antimony compounds which are administered parenterally or intralesionally. New topical treatment alternatives have been available within the past few years. Amongst several treatments used topically, physical therapies including cryotherapy, heat therapy and CO2 laser are promising for the treatment of old world CL. Along with that, other randomized placebo controlled trials should be designed to find new effective therapeutic regimens.
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Field validation of a Leishmania (Leishmania) mexicana exo-antigens ELISA for diagnosing tegumentary leishmaniasis in regions of Leishmania (Viannia) predominance. Braz J Infect Dis 2015; 19:302-7. [PMID: 25985901 PMCID: PMC9425357 DOI: 10.1016/j.bjid.2015.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 03/14/2015] [Accepted: 03/17/2015] [Indexed: 01/19/2023] Open
Abstract
Background Several tests are performed to obtain better accuracy when diagnosing American tegumentary leishmaniasis (ATL). It is believed that antigens released via secretion, excretion and metabolism are more specific than are antigens released by the lysis of Leishmania parasites. Such antigens are known as exo-antigens (exo-Ag) and are formed from products released by cultured parasites in a way that is similar to that in which they cause infections in hosts. Objective We attempted to validate a Leishmania mexicana ELISA exo-Ag for ATL diagnosis in Midwestern Brazil. Methods A total of 281 patients were included in the study. We analysed pre-treatment blood from 98 ATL patients; out of those, 85.7% and 14.3% had cutaneous and mucosal forms, respectively. Results The exo-Ag accuracy was 83.99% (95% CI = 79.24–87.81) with a sensitivity value of 90.82% (95% CI = 83.46–95.09) and an overall specificity value of 80.33% (95% CI = 73.97–85.44). The positive predictive value and negative predictive value were 71.20% (95% CI = 62.72–78.41) and 94.23% (95% CI = 89.40–96.94), respectively. Among healthy controls, exo-Ag had a specificity of 91.25% (95% CI = 83.02–95.70); additionally, the test had specificity rates of 66.67% (95% CI = 46.71–82.03) in Chagas disease patients, 60.61% (95% CI = 43.68–75.32) in patients with rheumatic diseases, 76.92% (95% CI = 49.74–91.82) in pemphigus foliaceus patients, 87.50% (95% CI = 52.91–97.76) in leprosy patients, 87.50% (95% CI = 63.98–96.50) in VRDL-positive patients, and 77.78 (95% CI = 45.26–93.68) in deep mycosis patients. Conclusion Based on the indicators of validity, we conclude that the results obtained in this study enable the recommendation of the exo-Ag ELISA for ATL diagnosis once it presented a reasonable accuracy compared to classical methods. Cost evaluations are necessary to completely define the role of this technique in large scale.
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Antonio LDF, Fagundes A, Oliveira RVC, Pinto PG, Bedoya-Pacheco SJ, Vasconcellos EDCFE, Valete-Rosalino MC, Lyra MR, Passos SRL, Pimentel MIF, Schubach ADO. Montenegro skin test and age of skin lesion as predictors of treatment failure in cutaneous leishmaniasis. Rev Inst Med Trop Sao Paulo 2015; 56:375-80. [PMID: 25229216 PMCID: PMC4172107 DOI: 10.1590/s0036-46652014000500002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 02/21/2014] [Indexed: 11/22/2022] Open
Abstract
A case-control study was conducted to examine the association among
the Montenegro skin test (MST), age of skin lesion and therapeutic
response in patients with cutaneous leishmaniasis (CL) treated at
Evandro Chagas National Institute of Infectious Diseases (INI),
Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil. For each
treatment failure (case), two controls showing skin lesion healing
following treatment, paired by sex and age, were randomly selected. All patients
were treated with 5 mg Sb5+/kg/day of intramuscular
meglumine antimoniate (Sb5+) for 30 successive days.
Patients with CL were approximately five times more likely to fail when lesions
were less than two months old at the first appointment. Patients with treatment
failure showed less intense MST reactions than patients progressing to clinical
cure. For each 10 mm of increase in MST response, there was a 26% reduction
in the chance of treatment failure. An early treatment - defined as a treatment
applied for skin lesions, which starts when they are less than two months old at
the first appointment -, as well as a poor cellular immune response, reflected
by lower reactivity in MST, were associated with treatment failure in cutaneous
leishmaniasis.
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Affiliation(s)
- Liliane de Fátima Antonio
- Laboratório de Vigilância em Leishmanioses (Lab VigiLeish), Instituto de Pesquisa Clínica Evandro Chagas (IPEC)/Fiocruz, Brazil
| | - Aline Fagundes
- Laboratório de Vigilância em Leishmanioses (Lab VigiLeish), Instituto de Pesquisa Clínica Evandro Chagas (IPEC)/Fiocruz, Brazil
| | | | - Priscila Garcia Pinto
- Laboratório de Vigilância em Leishmanioses (Lab VigiLeish), Instituto de Pesquisa Clínica Evandro Chagas (IPEC)/Fiocruz, Brazil
| | - Sandro Javier Bedoya-Pacheco
- Laboratório de Vigilância em Leishmanioses (Lab VigiLeish), Instituto de Pesquisa Clínica Evandro Chagas (IPEC)/Fiocruz, Brazil
| | | | - Maria Cláudia Valete-Rosalino
- Laboratório de Vigilância em Leishmanioses (Lab VigiLeish), Instituto de Pesquisa Clínica Evandro Chagas (IPEC)/Fiocruz, Brazil
| | - Marcelo Rosandiski Lyra
- Laboratório de Vigilância em Leishmanioses (Lab VigiLeish), Instituto de Pesquisa Clínica Evandro Chagas (IPEC)/Fiocruz, Brazil
| | - Sônia Regina Lambert Passos
- Laboratório de Epidemiologia Clínica (Lab. EpiClin), Instituto de Pesquisa Clínica Evandro Chagas (IPEC)/Fiocruz, Brazil
| | - Maria Inês Fernandes Pimentel
- Laboratório de Vigilância em Leishmanioses (Lab VigiLeish), Instituto de Pesquisa Clínica Evandro Chagas (IPEC)/Fiocruz, Brazil
| | - Armando de Oliveira Schubach
- Laboratório de Vigilância em Leishmanioses (Lab VigiLeish), Instituto de Pesquisa Clínica Evandro Chagas (IPEC)/Fiocruz, Brazil
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In vitro sensitivity of paired Leishmania (Viannia) braziliensis samples isolated before meglumine antimoniate treatment and after treatment failure or reactivation of cutaneous leishmaniasis. DISEASE MARKERS 2015; 2015:943236. [PMID: 25802480 PMCID: PMC4329789 DOI: 10.1155/2015/943236] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 01/09/2015] [Indexed: 11/17/2022]
Abstract
This study evaluated the in vitro sensitivity of paired Leishmania braziliensis samples isolated from the same patient before pentavalent antimonial treatment (Sample A) and after treatment failure or cutaneous leishmaniasis reactivation (Sample B) in patients undergoing intralesional administration or injections (5 mgSb(V)/kg/d) of meglumine antimoniate. Fourteen samples from 7 patients were studied. After 24 h of drug exposure, 50% lethal dose (LD50) values for promastigotes ranged from 0.37 mg/mL to 5.86 mg/mL for samples obtained before treatment (A) and 0.89 mg/mL to 7.80 mg/mL for samples obtained after treatment (B). After 48 h, LD50 values ranged from 0.37 mg/mL to 5.75 mg/mL and 0.70 mg/mL to 7.68 mg/mL for A and B samples, respectively. After 48 h, LD50 values for amastigotes ranged from 11.7 to 44.3 μg/mL for A samples and 13.7 to 52.7 μg/mL for B samples. Of 7 patients, 1 discontinued treatment and 6 were cured after retreatment with amphotericin B (4 cases) or meglumine antimoniate (2 cases). Overall the B samples had higher LD50 values than A samples; however the difference was not significant. These results do not support the hypothesis that low-dose and intralesional treatments induce selection of resistant parasites in vitro and suggest that other factors may influence therapeutic outcome in patients with poor response to initial treatment.
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Efficacy of glucantime for treatment of cutaneous leishmaniasis in Central Iran. J Infect Public Health 2013; 6:120-4. [DOI: 10.1016/j.jiph.2012.11.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 10/25/2012] [Accepted: 11/07/2012] [Indexed: 11/22/2022] Open
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Liposomal amphotericin B in comparison to sodium stibogluconate for Leishmania braziliensis cutaneous leishmaniasis in travelers. J Am Acad Dermatol 2013; 68:284-9. [DOI: 10.1016/j.jaad.2012.06.014] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Revised: 06/05/2012] [Accepted: 06/07/2012] [Indexed: 11/18/2022]
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Evaluation of Genetic Polymorphism of Leishmania (V.) braziliensis Isolates Obtained from the Same Patient before and after Therapeutic Failure or Reactivation of Cutaneous Lesions. J Trop Med 2013; 2012:808132. [PMID: 23304168 PMCID: PMC3530180 DOI: 10.1155/2012/808132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 11/14/2012] [Accepted: 11/19/2012] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to investigate genetic polymorphism in Leishmania braziliensis population previously typed through isoenzyme electrophoresis, isolated from the same patient in two different moments: (A) before the beginning of treatment and (B) after treatment failure to meglumine antimoniate or reactivation after successful initial treatment. Fifteen pairs of isolates were assessed using the polymorphic molecular marker LSSP-PCR and following the phenetic analysis. The genetic profiles of the 30 samples were grouped in four clusters. Only two patients presented total identity in the A and B isolates. Most isolates presented similarity coefficients varying from 0.63 to 0.91. In this group of patients genetic polymorphisms could be observed indicating low similarity between the pairs of isolates. The results demonstrate the existence of genetic polymorphism between the samples isolated before treatment and after reactivation or treatment failure, suggesting a possible differentiation of the structure of the original parasite population which could be involved in the mechanisms of resistance to treatment or reactivation of lesions in the ATL. This phenomenon is important, although other factors also could be involved in this context and are discussed in this paper.
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Diniz DS, Costa ASV, Escalda PMF. The effect of age on the frequency of adverse reactions caused by antimony in the treatment of American tegumentary leishmaniasis in Governador Valadares, State of Minas Gerais, Brazil. Rev Soc Bras Med Trop 2012; 45:597-600. [DOI: 10.1590/s0037-86822012000500011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 10/04/2011] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION: Governador Valadares is an endemic area of American tegumentary leishmaniasis (ATL). The detection rate was 15.36 per 100,000 habitants from 2001 to 2006 (Miranda, 2008). This study aimed to analyze the effects of age on the frequency of adverse reactions caused by antimony in the treatment of ATL in the City of Governador Valadares, State of Minas Gerais, Brazil, during 2009. METHODS: Data were collected from the forms of the Information System for Notifiable Diseases, and from charts, questionnaires, and home visits to patients. RESULTS: The study included 40 patients, 26 (65%) of whom were males. Individuals over the age of 50 had a 66% higher rate of adverse effects than subjects who were 50 years old or less (CI 95%, 1.14-2.41). The average age of individuals who reported some type of adverse effect was 44.11 years (SD = 20.14), while the average age of the group that did not report any adverse effect was of 25.46 years (SD = 18.37; p < 0.01). Clinical healing was 67.5%, and 10% of patients discontinued the treatment. CONCLUSIONS: In the treatment of ATL, the age of patients should be considered, because most adverse reactions occur in individuals over 50 years of age. For this reason, the drug should be used with restriction in these cases.
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Motta JOC, Sampaio RNR. A pilot study comparing low-dose liposomal amphotericin B with N-methyl glucamine for the treatment of American cutaneous leishmaniasis. J Eur Acad Dermatol Venereol 2011; 26:331-5. [PMID: 21492255 DOI: 10.1111/j.1468-3083.2011.04070.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cutaneous leishmaniasis is an infectious re-emerging disease that has increased in incidence worldwide. Antimony, a highly toxic drug, remains the first choice therapy to treat it. Liposomal amphotericin B is active against Leishmania and is less toxic than antimony. OBJECTIVE To compare low-dose liposomal amphotericin B with N-methyl glucamine for the treatment of American cutaneous leishmaniasis. PATIENTS/METHODS In a controlled open-label trial 35 patients with a localized form of American cutaneous leishmaniasis were included. They were allocated to a first group treated with 1.5 mg/kg/day of liposomal amphotericin B for 5 days, or to a second one treated with 20 mgSbV/kg/day of N-methyl glucamine for 20 days. RESULTS In the first group, 50% and 81% of patients experienced a clinical cure and clinical improvement respectively. There was a 100% clinical cure in the second group. CONCLUSION Liposomal amphotericin B seems to be promising and safe for the treatment of American cutaneous leishmaniasis.
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Affiliation(s)
- J O C Motta
- Hospital Universitário de Brasília, Brasilia-DF, Brazil.
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Pimentel MIF, Baptista C, Rubin ÉF, Vasconcellos ÉDCFE, Lyra MR, Salgueiro MDM, Saheki MN, Rosalino CMV, Madeira MDF, Silva AFD, Confort EM, Schubach ADO. American cutaneous leishmaniasis caused by Leishmania (Viannia) braziliensis resistant to meglumine antimoniate, but with good response to pentamidine: a case report. Rev Soc Bras Med Trop 2011; 44:254-6. [DOI: 10.1590/s0037-86822011000200026] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Accepted: 11/16/2010] [Indexed: 11/22/2022] Open
Abstract
This is a case report of a Brazilian soldier with cutaneous leishmaniasis. The lesion relapsed following two systemic treatments with meglumine antimoniate. The patient was treated with amphotericin B, which was interrupted due to poor tolerance. Following isolation of Leishmania sp., six intralesional infiltrations of meglumine antimoniate resulted in no response. Leishmania sp promastigotes were again isolated. The patient was submitted to intramuscular 4mg/kg pentamidine. Parasites from the first and second biopsies were identified as Leishmania (Viannia) braziliensis; those isolated from the first biopsy were more sensitive to meglumine antimoniate in vitro than those isolated from the second biopsy. No relapse was observed.
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Epidemiological and clinical characteristics of cutaneous leishmaniasis and their relationship with the laboratory data, south of Brazil. Braz J Infect Dis 2011. [DOI: 10.1016/s1413-8670(11)70133-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Abstract
Leishmaniasis is a cluster of diseases caused by protozoa in the genus Leishmania. There are three basic clinical forms: cutaneous, mucocutaneous, and visceral leishmaniasis. The present review focuses on the diagnosis and treatment of cutaneous and mucocutaneous leishmaniasis. Characteristics of both the human host and the parasite species influence the clinical disease manifestations that range from asymptomatic exposure, to self-healing skin ulcers, to life-threatening widespread destructive ulcerations. Whether through medical treatment or through spontaneous resolution, skin ulcerations generally result in disfiguring scars with significant social and economic impact. Tests to confirm the diagnosis should be performed on patients who have recently visited endemic areas and have skin or mucosal manifestations consistent with leishmaniasis. Treatment depends on the species of Leishmania and the risk of widespread or disfiguring disease. Because of increasing trends in global travel, educating health care providers to recognize and treat leishmaniasis in both endemic and non-endemic countries is imperative.
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Affiliation(s)
- Consuelo V David
- Divisions of Dermatology and Adult Infectious Disease, Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90502, USA
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Amato VS, Tuon FF, Imamura R, Abegão de Camargo R, Duarte MI, Neto VA. Mucosal leishmaniasis: description of case management approaches and analysis of risk factors for treatment failure in a cohort of 140 patients in Brazil. J Eur Acad Dermatol Venereol 2009; 23:1026-34. [DOI: 10.1111/j.1468-3083.2009.03238.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tuon FF, Amato VS, Graf ME, Siqueira AM, Nicodemo AC, Neto VA. Treatment of New World cutaneous leishmaniasis - a systematic review with a meta-analysis. Int J Dermatol 2008; 47:109-24. [DOI: 10.1111/j.1365-4632.2008.03417.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Llanos-Cuentas A, Tulliano G, Araujo-Castillo R, Miranda-Verastegui C, Santamaria-Castrellon G, Ramirez L, Lazo M, De Doncker S, Boelaert M, Robays J, Dujardin JC, Arevalo J, Chappuis F. Clinical and Parasite Species Risk Factors for Pentavalent Antimonial Treatment Failure in Cutaneous Leishmaniasis in Peru. Clin Infect Dis 2008; 46:223-31. [DOI: 10.1086/524042] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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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] [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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Affiliation(s)
- Amer Al-Jawabreh
- Leishmania Research Unit, Jericho, Palestinian Authority; and Al-Quds University, Jerusalem, Abu-Deis, Israel.
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