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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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Cutaneous Leishmaniasis: A 2022 Updated Narrative Review into Diagnosis and Management Developments. Am J Clin Dermatol 2022; 23:823-840. [PMID: 36103050 PMCID: PMC9472198 DOI: 10.1007/s40257-022-00726-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 01/10/2023]
Abstract
This review is an update of an earlier narrative review published in 2015 on developments in the clinical management of cutaneous leishmaniasis (CL) including diagnosis, treatment, prevention and control measurements. CL is a vector-borne infection caused by the protozoan parasite Leishmania. The vector is the female sandfly. Globally, CL affects 12 million cases and annually 2 million new cases occur. CL is endemic in almost 100 countries and the total risk population is approximately 350 million people. WHO lists CL an emerging and uncontrolled disease and a neglected tropical disease. Local experience-based evidence remains the mainstay for the management of CL. Whereas intralesional therapeutic options are the first treatment option for most CL patients, those with mucocutaneous and disseminated involvement require a systemic therapeutic approach. Moreover, different Leishmania species can vary in their treatment outcomes. Therefore, species determination is critical for optimal CL clinical management. New DNA techniques allow for relatively easy Leishmania species determination, yet they are not easily implemented in resource-limited settings. There is a desperate need for novel, less toxic, and less painful treatment options, especially for children with CL. Yet, the large and well conducted studies required to provide the necessary evidence are lacking. To further control and potentially eliminate CL, we urgently need to improve vector control, and diagnostics, and we require efficient and safe vaccines. Alas, since CL primarily affects poor people, biotechnical companies dedicate little investment into the research programs that could lead to diagnostic, pharmaceutical, and vaccine innovations.
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Abstract
Annular configuration is conspicuous in the clinical manifestation of many skin diseases and can be helpful for the diagnosis and differential diagnosis. Variations may include arciform, ring-form, annular, circinate, serpiginous, gyrated, polycyclic, targeted or figurate forms, in different colors, sizes, and numbers, with various textures and surfaces. In infectious dermatoses, the annular reactions can be specific or nonspecific, while the underlying mechanisms remain largely unknown. In the specific reactions caused by direct invasion of the pathogens, the contest between the centrifugal outspread of the infectious agents and the centripetal impedance of the host immune response is supposed to determine the final conformation. Examples include erythema infectiosum, orf, erythema multiforme, and pityriasis rosea of viral origin. Bacterial infections that may display annular lesions include erythrasma, erythema (chronicum) migrans of Lyme borreliosis, secondary syphilis, cutaneous tuberculosis, and leprosy. Superficial mycosis, such as dermatophytosis, candida intertrigo, tinea imbricata, and subcutaneous mycosis, such as chromoblastomycosis, and algae infection protothecosis, are characterized by annular progression of the skin lesions. The creeping serpiginous extension is an alarming sign for the diagnosis of cutaneous larva migrans. A better understanding of the virulence and pathogenicity of the pathogens and the way and type of immune response will help to clarify the pathogenesis.
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Affiliation(s)
- Wei-Ting Liu
- Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Pei-Lun Sun
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou Branch, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kusmarinah Bramono
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia
| | - Mohammad Ezmerli
- Department of Dermatology, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Chao-Chun Yang
- Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; International Center for Wound Repair and Regeneration, National Cheng Kung University, Tainan, Taiwan.
| | - WenChieh Chen
- Department of Dermatology and Allergy, Technische Universität München, Munich, Germany.
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Briggs N, Wei BM, Ahuja C, Baker C, Foppiano Palacios C, Lee E, O’Grady N, Singanamala S, Singh K, Bandaranayake TD, Cohen JM, Damsky W, Davis MW, Mejia R, Nelson CA, Topal JE, Azar MM. Mucocutaneous Leishmaniasis in a Pregnant Immigrant. Open Forum Infect Dis 2022; 9:ofac360. [PMID: 35928503 PMCID: PMC9345408 DOI: 10.1093/ofid/ofac360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 07/20/2022] [Indexed: 01/05/2023] Open
Abstract
Cutaneous leishmaniasis is a parasitic infection that causes significant maternal morbidity, and even fetal mortality, during pregnancy, yet there are limited therapeutic options. Here, we report a case of leishmaniasis in a pregnant immigrant with exuberant mucocutaneous lesions with favorable response to liposomal amphotericin B.
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Affiliation(s)
- Neima Briggs
- Correspondence: Neima Briggs, MD, PhD, Yale School of Medicine, PO Box 208022, New Haven, CT 06520-8022, USA ()
| | - Brian M Wei
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Chaarushi Ahuja
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Catherine Baker
- Department of Pharmacy Services, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Carlo Foppiano Palacios
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Emily Lee
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Niamh O’Grady
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Santhi Singanamala
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Katelyn Singh
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Thilinie D Bandaranayake
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jeffrey M Cohen
- Department of Pharmacy Services, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - William Damsky
- Department of Pharmacy Services, Yale New Haven Hospital, New Haven, Connecticut, USA
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Matthew W Davis
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Rojelio Mejia
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Caroline A Nelson
- Department of Pharmacy Services, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Jeffrey E Topal
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Marwan M Azar
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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Piccica M, Lagi F, Bartoloni A, Zammarchi L. Efficacy and safety of pentamidine isethionate for tegumentary and visceral human leishmaniasis: a systematic review. J Travel Med 2021; 28:6246322. [PMID: 33890115 DOI: 10.1093/jtm/taab065] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 03/23/2021] [Accepted: 04/14/2021] [Indexed: 11/14/2022]
Abstract
RATIONALE FOR REVIEW We performed a systematic review of the literature to investigate the efficacy and safety of pentamidine isethionate for the treatment of human tegumentary and visceral leishmaniasis. KEY FINDINGS A total of 616 papers were evaluated, and 88 studies reporting data on 3108 cases of leishmaniasis (2082 patients with tegumentary leishmaniasis and 1026 with visceral leishmaniasis) were finally included. The majority of available studies were on New World cutaneous leishmaniasis and visceral leishmaniasis caused by Leishmania donovani. At the same time, few data are available for Old World cutaneous leishmaniasis, mucosal leishmaniasis, and visceral leishmaniasis caused by L. infantum. Pooled cure rate for tegumentary leishmaniasis was 78.8% (CI 95%, 76.9-80.6%) and 92.7% (CI 95%, 88.3-97.1%) according to controlled randomized trial and observational studies and case report and case series respectively. Pooled cure rate for visceral leishmaniasis was 84.8% (CI 95%, 82.6-87.1%) and 90.7% (CI 95%, 84.1-97.3%) according to controlled randomized trial and observational studies and case report and case series, respectively. Comparable cure rate was observed in recurrent and refractory cases of visceral leishmaniasis. Concerning the safety profile, among about 2000 treated subjects with some available information, the most relevant side effects were six cases of arrhythmia (including four cases of fatal ventricular fibrillation), 20 cases of irreversible diabetes, 26 cases of muscular aseptic abscess following intramuscular administration. CONCLUSIONS/RECOMMENDATIONS Pentamidine isethionate is associated with a similar cure rate of the first-line anti-leishmanial drugs. Severe and irreversible adverse effect appear to be rare. The drug may still have a role in the treatment of any form of human leishmaniasis when the first-line option has failed or in patients who cannot tolerate other drugs also in the setting of travel medicine. In difficult cases, the drug can also be considered as a component of a combination treatment regimen.
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Affiliation(s)
- Matteo Piccica
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Filippo Lagi
- Infectious and Tropical Diseases Unit, Azienda Ospedaliero-Universitaria Careggi, largo Brambilla 3, Firenze (FI), Florence 50134, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Infectious and Tropical Diseases Unit, Azienda Ospedaliero-Universitaria Careggi, largo Brambilla 3, Firenze (FI), Florence 50134, Italy
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Infectious and Tropical Diseases Unit, Azienda Ospedaliero-Universitaria Careggi, largo Brambilla 3, Firenze (FI), Florence 50134, Italy
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Mudugal R, Bains A, Elhence P, Bharti JN. Relapsing erythematous papuloplaque lesions on the forearm of a middle-aged man. Clin Exp Dermatol 2021; 47:209-212. [PMID: 34387883 DOI: 10.1111/ced.14820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 11/28/2022]
Affiliation(s)
- R Mudugal
- Department of, Dermatology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - A Bains
- Department of, Dermatology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - P Elhence
- Department of, Pathology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - J N Bharti
- Department of, Pathology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Volpedo G, Pacheco-Fernandez T, Holcomb EA, Cipriano N, Cox B, Satoskar AR. Mechanisms of Immunopathogenesis in Cutaneous Leishmaniasis And Post Kala-azar Dermal Leishmaniasis (PKDL). Front Cell Infect Microbiol 2021; 11:685296. [PMID: 34169006 PMCID: PMC8217655 DOI: 10.3389/fcimb.2021.685296] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/24/2021] [Indexed: 12/18/2022] Open
Abstract
Leishmaniasis is a neglected tropical disease that affects 12 million people worldwide. The disease has high morbidity and mortality rates and is prevalent in over 80 countries, leaving more than 300 million people at risk of infection. Of all of the manifestations of this disease, cutaneous leishmaniasis (CL) is the most common form and it presents as ulcerating skin lesions that can self-heal or become chronic, leading to disfiguring scars. This review focuses on the different pathologies and disease manifestations of CL, as well as their varying degrees of severity. In particular, this review will discuss self-healing localized cutaneous leishmaniasis (LCL), leishmaniasis recidivans (LR), mucocutaneous leishmaniasis (MCL), anergic diffuse cutaneous leishmaniasis (ADCL), disseminated leishmaniasis (DL), and Post Kala-azar Dermal Leishmaniasis (PKDL), which is a cutaneous manifestation observed in some visceral leishmaniasis (VL) patients after successful treatment. The different clinical manifestations of CL are determined by a variety of factors including the species of the parasites and the host's immune response. Specifically, the balance between the pro and anti-inflammatory mediators plays a vital role in the clinical presentation and outcome of the disease. Depending upon the immune response, Leishmania infection can also transition from one form of the disease to another. In this review, different forms of cutaneous Leishmania infections and their immunology are described.
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Affiliation(s)
- Greta Volpedo
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
- Department of Microbiology, College of Arts and Sciences, The Ohio State University, Columbus, OH, United States
| | - Thalia Pacheco-Fernandez
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Erin A. Holcomb
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Natalie Cipriano
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Blake Cox
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Abhay R. Satoskar
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
- Department of Microbiology, College of Arts and Sciences, The Ohio State University, Columbus, OH, United States
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Use of the intramuscular route to administer pentamidine isethionate in Leishmania guyanensis cutaneous leishmaniasis increases the risk of treatment failure. Travel Med Infect Dis 2018; 24:31-36. [PMID: 29482012 DOI: 10.1016/j.tmaid.2018.02.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 02/12/2018] [Accepted: 02/22/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND New world cutaneous leishmaniasis (NWCL) can be found in French Guiana as well as in several other parts of Central and South America. Leishmania guyanensis accounts for nearly 90% of cases in French Guiana and is treated with pentamidine isethionate, given by either intramuscular or intravenous injection. The military population is particularly exposed due to repeated missions in the rainforest. The purpose of the present study was to identify the factors associated with pentamidine isethionate treatment failure in a series of service members with L. guyanensis NWCL acquired in French Guiana. METHOD All the French service members reported as having acquired leishmaniasis in French Guiana from December 2013 to June 2016 were included. RESULTS Seventy-three patients infected with L. guyanensis were included in the final analysis. Patients treated with IV pentamidine isethionate had better response rates than those treated with IM pentamidine isethionate (p = 0.002, adjusted odds ratio (AOR) = 0.15, 95% CI [0.04-0.50]). The rate of treatment success was 85.3% (95% CI [68.9-95.0]) for IV pentamidine isethionate and 51.3% (95% CI [34.8-67.6]) for IM pentamidine isethionate. CONCLUSIONS The use of intramuscular pentamidine isethionate in the treatment of Leishmania guyanensis cutaneous leishmaniasis is associated with more treatment failures than intravenous pentamidine isethionate.
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Ginouvès M, Simon S, Nacher M, Demar M, Carme B, Couppié P, Prévot G. In Vitro Sensitivity of Cutaneous Leishmania Promastigote Isolates Circulating in French Guiana to a Set of Drugs. Am J Trop Med Hyg 2017; 96:1143-1150. [PMID: 28167598 DOI: 10.4269/ajtmh.16-0373] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AbstractAnti-leishmaniasis drug resistance is a common problem worldwide. The aim of this study was to inventory the general in vitro level of sensitivity of Leishmania isolates circulating in French Guiana and to highlight potential in vitro pentamidine-resistant isolates. This sensitivity study was conducted on 36 patient-promastigote isolates for seven drugs (amphotericin B, azithromycin, fluconazole, meglumine antimoniate, miltefosine, paromomycin, and pentamidine) using the Cell Counting Kit-8 viability test. The IC50 values obtained were heterogeneous. One isolate exhibited high IC50 values for almost all drugs tested. Pentamidine, which is the first-line treatment in French Guiana, showed efficacy at very low doses (mean of 0.0038 μg/mL). The concordance of the in vitro pentamidine results with the patients' clinical outcomes was 94% (K = 0.82).
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Affiliation(s)
- Marine Ginouvès
- Laboratoire Associé, Centre National de Référence Leishmania, Laboratoire Hospitalo-Universitaire de Parasitologie et Mycologie, General Hospital, Cayenne, French Guiana.,Laboratoire des Ecosystèmes Amazoniens et Pathologie Tropicale (EPaT), Université de Guyane, Labex CEBA, DFR Santé, Cayenne, French Guiana
| | - Stéphane Simon
- Laboratoire des Ecosystèmes Amazoniens et Pathologie Tropicale (EPaT), Université de Guyane, Labex CEBA, DFR Santé, Cayenne, French Guiana.,Laboratoire Associé, Centre National de Référence Leishmania, Laboratoire Hospitalo-Universitaire de Parasitologie et Mycologie, General Hospital, Cayenne, French Guiana
| | - Mathieu Nacher
- Laboratoire des Ecosystèmes Amazoniens et Pathologie Tropicale (EPaT), Université de Guyane, Labex CEBA, DFR Santé, Cayenne, French Guiana.,Centre d'Investigation Clinique Epidémiologie Clinique Antilles Guyane CIC EC 1424, General Hospital, Cayenne, French Guiana
| | - Magalie Demar
- Laboratoire des Ecosystèmes Amazoniens et Pathologie Tropicale (EPaT), Université de Guyane, Labex CEBA, DFR Santé, Cayenne, French Guiana.,Laboratoire Associé, Centre National de Référence Leishmania, Laboratoire Hospitalo-Universitaire de Parasitologie et Mycologie, General Hospital, Cayenne, French Guiana.,Laboratoire Hospitalo-Universitaire de Parasitologie et Mycologie, General Hospital, Cayenne, French Guiana
| | - Bernard Carme
- Laboratoire des Ecosystèmes Amazoniens et Pathologie Tropicale (EPaT), Université de Guyane, Labex CEBA, DFR Santé, Cayenne, French Guiana
| | - Pierre Couppié
- Laboratoire des Ecosystèmes Amazoniens et Pathologie Tropicale (EPaT), Université de Guyane, Labex CEBA, DFR Santé, Cayenne, French Guiana.,Service de Dermatologie, Institut Guyanais de Dermatologie Tropicale, General Hospital, Cayenne, French Guiana
| | - Ghislaine Prévot
- Laboratoire des Ecosystèmes Amazoniens et Pathologie Tropicale (EPaT), Université de Guyane, Labex CEBA, DFR Santé, Cayenne, French Guiana
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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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Bourreau E, Ginouves M, Prévot G, Hartley MA, Gangneux JP, Robert-Gangneux F, Dufour J, Sainte-Marie D, Bertolotti A, Pratlong F, Martin R, Schütz F, Couppié P, Fasel N, Ronet C. Presence ofLeishmaniaRNA Virus 1 inLeishmania guyanensisIncreases the Risk of First-Line Treatment Failure and Symptomatic Relapse. J Infect Dis 2015; 213:105-11. [DOI: 10.1093/infdis/jiv355] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 06/09/2015] [Indexed: 12/25/2022] Open
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de Vries HJC, Reedijk SH, Schallig HDFH. Cutaneous leishmaniasis: recent developments in diagnosis and management. Am J Clin Dermatol 2015; 16:99-109. [PMID: 25687688 PMCID: PMC4363483 DOI: 10.1007/s40257-015-0114-z] [Citation(s) in RCA: 240] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This review focuses on recent developments in the diagnosis, treatment, management, and strategies for the prevention and control of cutaneous leishmaniasis (CL) caused by both Old and New World Leishmania species. CL is caused by the vector-borne protozoan parasite Leishmania and is transmitted via infected female sandflies. The disease is endemic in more than 98 countries and an estimated 350 million people are at risk. The overall prevalence is 12 million cases and the annual incidence is 2–2.5 million. The World Health Organization considers CL a severely neglected disease and a category 1 emerging and uncontrolled disease. The management of CL differs from region to region and is primarily based on local experience-based evidence. Most CL patients can be treated with topical treatments, but some Leishmania species can cause mucocutaneous involvement requiring a systemic therapeutic approach. Moreover, Leishmania species can vary in their sensitivity to available therapeutic options. This makes species determination critical for the choice of treatment and the clinical outcome of CL. Identification of the infecting parasite used to be laborious, but now the Leishmania species can be identified relatively easy with new DNA techniques that enable a more rational therapy choice. Current treatment guidelines for CL are based on poorly designed and reported trials. There is a lack of evidence for potentially beneficial treatments, a desperate need for large well-conducted studies, and standardization of future trials. Moreover, intensified research programs to improve vector control, diagnostics, and the therapeutic arsenal to contain further incidence and morbidity are needed.
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Affiliation(s)
- Henry J C de Vries
- Department of Dermatology, Academic Medical Center (AMC), University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands,
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Species-directed therapy for leishmaniasis in returning travellers: a comprehensive guide. PLoS Negl Trop Dis 2014; 8:e2832. [PMID: 24787001 PMCID: PMC4006727 DOI: 10.1371/journal.pntd.0002832] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 03/14/2014] [Indexed: 02/06/2023] Open
Abstract
Background Leishmaniasis is increasingly reported among travellers. Leishmania species vary in sensitivity to available therapies. Fast and reliable molecular techniques have made species-directed treatment feasible. Many treatment trials have been designed poorly, thus developing evidence-based guidelines for species-directed treatment is difficult. Published guidelines on leishmaniasis in travellers do not aim to be comprehensive or do not quantify overall treatment success for available therapies. We aimed at providing comprehensive species-directed treatment guidelines. Methodology/Principal Findings English literature was searched using PubMed. Trials and observational studies were included if all cases were parasitologically confirmed, the Leishmania species was known, clear clinical end-points and time points for evaluation of treatment success were defined, duration of follow-up was adequate and loss to follow-up was acceptable. The proportion of successful treatment responses was pooled using mixed effects methods to estimate the efficacy of specific therapies. Final ranking of treatment options was done by an expert panel based on pooled efficacy estimates and practical considerations. 168 studies were included, with 287 treatment arms. Based on Leishmania species, symptoms and geography, 25 clinical categories were defined and therapy options ranked. In 12/25 categories, proposed treatment agreed with highest efficacy data from literature. For 5/25 categories no literature was found, and in 8/25 categories treatment advise differed from literature evidence. For uncomplicated cutaneous leishmaniasis, combination of intralesional antimony with cryotherapy is advised, except for L. guyanensis and L. braziliensis infections, for which systemic treatment is preferred. Treatment of complicated (muco)cutaneous leishmaniasis differs per species. For visceral leishmaniasis, liposomal amphotericin B is treatment of choice. Conclusions/Significance Our study highlights current knowledge about species-directed therapy of leishmaniasis in returning travellers and also demonstrates lack of evidence for treatment of several clinical categories. New data can easily be incorporated in the presented overview. Updates will be of use for clinical decision making and for defining further research. Human leishmaniasis is caused by unicellular parasites that are injected into the skin by sand-flies, small, flying insects. Many different Leishmania species cause various manifestations of disease, both of the skin and internal organs. Leishmaniasis is a curable disease but clear guidelines on the best available treatment are lacking. Leishmania species differ in sensitivity to available drugs. Until recently, identification of the infecting Leishmania parasite was laborious, thus therapy could not precisely be targeted to the infecting species, in contrast to many other infectious diseases. Nowadays, Leishmania parasites can be identified relatively easily with new DNA techniques. We studied efficacy of therapies for diseases due to different Leishmania species, limited to the English literature. Efficacy was summarized and presented in an easy to read format. Because of difficulties with identification of parasite species in earlier studies, quality of evidence was often limited. Our findings are a major help for clinicians to easily find optimal treatment for specific patients. Moreover, our results demonstrate where additional research is needed to further improve treatment of leishmaniasis.
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Gomes CM, Cesetti MV, de Morais OO, Mendes MST, Roselino AM, Sampaio RNR. The influence of treatment on the development of leishmaniasis recidiva cutis: a 17-year case-control study in Midwestern Brazil. J Eur Acad Dermatol Venereol 2014; 29:109-14. [PMID: 24655077 DOI: 10.1111/jdv.12473] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Accepted: 02/18/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND The recurrence of American cutaneous leishmaniasis (ACL) in patients experiencing a long-term cure is often called leishmaniasis recidiva cutis (LRC). LRC is considered an unusual form of ACL. OBJECTIVE This study aims to estimate the incidence of LRC in ACL patients evaluated at a tertiary dermatologic centre in Midwestern Brazil. We also aim to evaluate the association between various treatment regimens and the development of LRC using multivariate analysis in a case-control study. METHODS We performed a 17-year epidemiological study using data from patients treated at our dermatologic centre from July 1994 to December 2011. A retrospective analysis was then performed to estimate risk and protective factors related to clinical presentation. We also assessed the influence of treatment regimens in the development of LRC. RESULTS The incidence of LRC among ACL patients was 1.34%. The analysis included 105 patients; 82 patients (78%) were in the control group, and 23 patients (22%) were in the LRC case group. The data analysis indicated that the standard treatment N-methylglucamine antimoniate (N-MA) reduced the development of LRC in bivariate (odds ratio (OR) = 0.34; 95% CI = 0.13-0.91) and multivariate analyses (OR = 0.16; 95% CI = 0.03-0.86; P = 0.03). However, no differences in LRC incidence were observed when the standard treatment N-MA and alternative drugs, such as pentamidine and amphotericin B, were considered (OR = 0.47; 95% CI = 0.16-1.35) CONCLUSION: We conclude that the standard treatment N-MA, as proposed by the Brazilian Ministry of Health, is effective in the prevention of LRC. Although other drugs have shown promising results in LRC, more scientific evidence is needed to assess their efficacy compared with N-MA.
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Affiliation(s)
- C M Gomes
- Department of Dermatology, Universidade de Brasília, Brasília, Brazil; Laboratório de Dermatomicologia, Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília, Brasília Brazil
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Pérez-Ayala A, Norman F, Pérez-Molina JA, Herrero JM, Monge B, López-Vélez R. Imported leishmaniasis: a heterogeneous group of diseases. J Travel Med 2009; 16:395-401. [PMID: 19930379 DOI: 10.1111/j.1708-8305.2009.00341.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Leishmaniasis is endemic in many countries. The existence of different species combined with host factors may condition clinical presentation, treatment options, and disease outcome. In an endemic country, a predominance of certain species and presentations may be expected, whereas from the perspective of a tropical medicine referral unit a wider variety of cases from diverse geographical areas may be observed. METHODS Retrospective study of imported leishmaniasis cases diagnosed at a Tropical Medicine referral unit in Spain, during the period of January 1995 to June 2008. RESULTS In total, 18 cases were diagnosed: 12 cutaneous leishmaniasis (CL), 4 mucocutaneous leishmaniasis (ML), and 2 visceral leishmaniasis (VL) cases. Two patients were immunosuppressed. The majority of CL cases (9/12) occurring in travelers were acquired in New World countries and were treated with pentavalent antimonials. Three ML cases were acquired in the New World, two received initial treatment with pentavalent antimonials and two with liposomal amphotericin B (LAmB). For all four ML cases, a change in drug choice and multiple treatment courses were necessary, and one remained refractory to treatment. Both VL cases were acquired in Africa and responded well to LAmB treatment. CONCLUSION The management of leishmaniasis in non-endemic countries is still a challenge for physicians. With the variety of cases presented, both in immigrants and travelers from different geographical areas, this series illustrates the great diversity of imported leishmaniasis in terms of presentation, treatment options, and outcome. We consider this entity is becoming increasingly more frequent and clinicians should be aware of strategies for its correct management.
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Affiliation(s)
- Ana Pérez-Ayala
- Tropical Medicine & Clinical Parasitology, Infectious Diseases Department, Ramón y Cajal Hospital, Madrid, Spain
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