TY - JOUR
T1 - Influence of Leishmania (Viannia) species on the response to antimonial treatment in patients with American tegumentary leishmaniasis
AU - Arevalo, Jorge
AU - Ramirez, Luis
AU - Adaui, Vanessa
AU - Zimic, Mirko
AU - Tulliano, Gianfranco
AU - Miranda-Verástegui, César
AU - Lazo, Marcela
AU - Loayza-Muro, Raúl
AU - De Doncker, Simonne
AU - Maurer, Anne
AU - Chappuis, Francois
AU - Dujardin, Jean Claude
AU - Llanos-Cuentas, Alejandro
N1 - Funding Information:
Financial support: European Community (INCO-Dev program, “Molecular tools for monitoring emergence and spread of drug resistance among natural populations of Leishmania” [contract ICA4-CT-2001-10076] and “Control strategies for visceral leishmaniasis (VL) and mucocutaneous leishmaniasis (MCL) in South America: applications of molecular epidemiology” [contract INCO-CT2005-015407]); Directorate-General for Development Cooperation of the Belgian Government (framework agreement 02, project 95501). a Deceased. This article is a tribute to the memory of Anne Maurer.
PY - 2007/6/15
Y1 - 2007/6/15
N2 - Background. Pentavalent antimonials (Sbv) are the first-line chemotherapy for American tegumentary leishmaniasis (ATL). There are, however, reports of the occurrence of treatment failure with these drugs. Few studies in Latin America have compared the response to Sbv treatment in ATL caused by different Leishmania species. Methods. Clinical parameters and response to Sbv chemotherapy were studied in 103 patients with cutaneous leishmaniasis (CL) in Peru. Leishmania isolates were collected before treatment and typed by multilocus polymerase-chain-reaction restriction fragment-length polymorphism analysis. Results. The 103 isolates were identified as L. (Viannia) peruviana (47.6%), L. (V.) guyanensis (23.3%), L. (V.) braziliensis (22.3%), L. (V.) lainsoni (4.9%), L. (Leishmania) mexicana (1%), and a putative hybrid, L. (V.) braziliensis/L. (V.) peruviana (1%). L. (V.) guyanensis was most abundant in central Peru. Of patients infected with the 3 former species, 21 (21.9%) did not respond to Sbv chemotherapy. The proportions of treatment failure (after 12 months of follow-up) were 30.4%, 24.5%, and 8.3% in patients infected with L. (V.) braziliensis, L. (V.) peruviana, and L. (V.) guyanensis, respectively. Infection with L. (V.) guyanensis was associated with significantly less treatment failure than L. (V.) braziliensis, as determined by multiple logistic regression analysis (odds ratio, 0.07 [95% confidence interval, 0.007-0.8]; P = .03). Conclusions. Leishmania species can influence Sbv treatment outcome in patients with CL. Therefore, parasite identification is of utmost clinical importance, because it should lead to a species-oriented treatment.
AB - Background. Pentavalent antimonials (Sbv) are the first-line chemotherapy for American tegumentary leishmaniasis (ATL). There are, however, reports of the occurrence of treatment failure with these drugs. Few studies in Latin America have compared the response to Sbv treatment in ATL caused by different Leishmania species. Methods. Clinical parameters and response to Sbv chemotherapy were studied in 103 patients with cutaneous leishmaniasis (CL) in Peru. Leishmania isolates were collected before treatment and typed by multilocus polymerase-chain-reaction restriction fragment-length polymorphism analysis. Results. The 103 isolates were identified as L. (Viannia) peruviana (47.6%), L. (V.) guyanensis (23.3%), L. (V.) braziliensis (22.3%), L. (V.) lainsoni (4.9%), L. (Leishmania) mexicana (1%), and a putative hybrid, L. (V.) braziliensis/L. (V.) peruviana (1%). L. (V.) guyanensis was most abundant in central Peru. Of patients infected with the 3 former species, 21 (21.9%) did not respond to Sbv chemotherapy. The proportions of treatment failure (after 12 months of follow-up) were 30.4%, 24.5%, and 8.3% in patients infected with L. (V.) braziliensis, L. (V.) peruviana, and L. (V.) guyanensis, respectively. Infection with L. (V.) guyanensis was associated with significantly less treatment failure than L. (V.) braziliensis, as determined by multiple logistic regression analysis (odds ratio, 0.07 [95% confidence interval, 0.007-0.8]; P = .03). Conclusions. Leishmania species can influence Sbv treatment outcome in patients with CL. Therefore, parasite identification is of utmost clinical importance, because it should lead to a species-oriented treatment.
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U2 - 10.1086/518041
DO - 10.1086/518041
M3 - Article
C2 - 17492601
AN - SCOPUS:34249885063
VL - 195
SP - 1846
EP - 1851
JO - Journal of Infectious Diseases
JF - Journal of Infectious Diseases
SN - 0022-1899
IS - 12
ER -