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Clinical and parasite species risk factors for pentavalent antimonial treatment failure in cutaneous leishmaniasis in Peru.
Clin Infect Dis. 2008 Jan 15; 46(2):223-31.CI

Abstract

BACKGROUND

Treatment for cutaneous leishmaniasis (CL) with standard pentavalent antimonial therapy is hampered by cumbersome administration, toxicity, and potential failure. Knowledge of factors influencing treatment outcome is essential for successful management.

METHODS

A case-control study of incident cases was performed with patients experiencing their first CL episode. The standard treatment for CL for these patients was 20 mg/kg/day of sodium stibogluconate for 20 days. Clinical and epidemiological data were recorded, and parasite isolates were species typed. Patients were followed up for 6 months to assess treatment outcome. Clinical cure was defined as complete wound closure and re-epithelization without inflammation or infiltration; new lesions, wound reopening, or signs of activity were classified as treatment failure. Descriptive, bivariate, and logistic regression analyses were performed.

RESULTS

One hundred twenty-seven patients were recruited; 63 (49.6%) were infected with Leishmania (Viannia) peruviana, 29 (22.8%) were infected with Leishmania (Viannia) braziliensis, 27 (21.3%) were infected with Leishmania (Viannia) guyanensis, and 8 (6.3%) were infected with other species. Only patients infected with the 3 most common species were selected for risk-factor analysis (n=119). Final failure rate at 6 months was 24.4% (95% confidence interval [CI], 16.5%-32.1%), with 96% of failures occurring within the first 3 months of follow-up assessment. Risk factors for treatment failure identified in the final multivariate model were age (per year, odds ratio [OR], 0.95; 95% CI, 0.92-0.99; P=.017), stay of <72 months in area of disease acquisition (OR, 30.45; 95% CI, 2.38-389.25; P=.009), duration of disease <5 weeks (OR, 4.39; 95% CI, 1.12-17.23; P=.034), additional lesion (per lesion, OR, 2.06; 95% CI, 1.3-3.28; P=.002), infection with L. (V.) peruviana (OR, 9.85; 95% CI, 1.01-95.65; P=.049), and infection with L. (V.) braziliensis (OR, 22.36; 95% CI, 1.89-263.96; P=.014).

CONCLUSIONS

The identification of parasite species and clinical risk factors for antimonial treatment failure should lead to an improved management of CL in patients in Peru.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Llanos-Cuentas A
Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.
Tulliano G
No affiliation info available
Araujo-Castillo R
No affiliation info available
Miranda-Verastegui C
No affiliation info available
Santamaria-Castrellon G
No affiliation info available
Ramirez L
No affiliation info available
Lazo M
No affiliation info available
De Doncker S
No affiliation info available
Boelaert M
No affiliation info available
Robays J
No affiliation info available
Dujardin JC
No affiliation info available
Arevalo J
No affiliation info available
Chappuis F
No affiliation info available

MeSH

AdolescentAdultAge FactorsAnimalsAntimony Sodium GluconateAntiprotozoal AgentsCase-Control StudiesChildFemaleHumansLeishmaniaLeishmaniasis, CutaneousMalePeruProspective StudiesRisk FactorsTreatment Failure

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18171254

Citation

Llanos-Cuentas, Alejandro, et al. "Clinical and Parasite Species Risk Factors for Pentavalent Antimonial Treatment Failure in Cutaneous Leishmaniasis in Peru." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 46, no. 2, 2008, pp. 223-31.
Llanos-Cuentas A, Tulliano G, Araujo-Castillo R, et al. Clinical and parasite species risk factors for pentavalent antimonial treatment failure in cutaneous leishmaniasis in Peru. Clin Infect Dis. 2008;46(2):223-31.
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, J. C., Arevalo, J., & Chappuis, F. (2008). Clinical and parasite species risk factors for pentavalent antimonial treatment failure in cutaneous leishmaniasis in Peru. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 46(2), 223-31. https://doi.org/10.1086/524042
Llanos-Cuentas A, et al. Clinical and Parasite Species Risk Factors for Pentavalent Antimonial Treatment Failure in Cutaneous Leishmaniasis in Peru. Clin Infect Dis. 2008 Jan 15;46(2):223-31. PubMed PMID: 18171254.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical and parasite species risk factors for pentavalent antimonial treatment failure in cutaneous leishmaniasis in Peru. AU - Llanos-Cuentas,Alejandro, AU - Tulliano,Gianfranco, AU - Araujo-Castillo,Roger, AU - Miranda-Verastegui,Cesar, AU - Santamaria-Castrellon,Giovanna, AU - Ramirez,Luis, AU - Lazo,Marcela, AU - De Doncker,Simonne, AU - Boelaert,Marleen, AU - Robays,Jo, AU - Dujardin,Jean-Claude, AU - Arevalo,Jorge, AU - Chappuis,Francois, PY - 2008/1/4/pubmed PY - 2008/2/27/medline PY - 2008/1/4/entrez SP - 223 EP - 31 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin Infect Dis VL - 46 IS - 2 N2 - BACKGROUND: Treatment for cutaneous leishmaniasis (CL) with standard pentavalent antimonial therapy is hampered by cumbersome administration, toxicity, and potential failure. Knowledge of factors influencing treatment outcome is essential for successful management. METHODS: A case-control study of incident cases was performed with patients experiencing their first CL episode. The standard treatment for CL for these patients was 20 mg/kg/day of sodium stibogluconate for 20 days. Clinical and epidemiological data were recorded, and parasite isolates were species typed. Patients were followed up for 6 months to assess treatment outcome. Clinical cure was defined as complete wound closure and re-epithelization without inflammation or infiltration; new lesions, wound reopening, or signs of activity were classified as treatment failure. Descriptive, bivariate, and logistic regression analyses were performed. RESULTS: One hundred twenty-seven patients were recruited; 63 (49.6%) were infected with Leishmania (Viannia) peruviana, 29 (22.8%) were infected with Leishmania (Viannia) braziliensis, 27 (21.3%) were infected with Leishmania (Viannia) guyanensis, and 8 (6.3%) were infected with other species. Only patients infected with the 3 most common species were selected for risk-factor analysis (n=119). Final failure rate at 6 months was 24.4% (95% confidence interval [CI], 16.5%-32.1%), with 96% of failures occurring within the first 3 months of follow-up assessment. Risk factors for treatment failure identified in the final multivariate model were age (per year, odds ratio [OR], 0.95; 95% CI, 0.92-0.99; P=.017), stay of <72 months in area of disease acquisition (OR, 30.45; 95% CI, 2.38-389.25; P=.009), duration of disease <5 weeks (OR, 4.39; 95% CI, 1.12-17.23; P=.034), additional lesion (per lesion, OR, 2.06; 95% CI, 1.3-3.28; P=.002), infection with L. (V.) peruviana (OR, 9.85; 95% CI, 1.01-95.65; P=.049), and infection with L. (V.) braziliensis (OR, 22.36; 95% CI, 1.89-263.96; P=.014). CONCLUSIONS: The identification of parasite species and clinical risk factors for antimonial treatment failure should lead to an improved management of CL in patients in Peru. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/18171254/Clinical_and_parasite_species_risk_factors_for_pentavalent_antimonial_treatment_failure_in_cutaneous_leishmaniasis_in_Peru_ DB - PRIME DP - Unbound Medicine ER -