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Liposomal amphotericin B in travelers with cutaneous and muco-cutaneous leishmaniasis: Not a panacea.
PLoS Negl Trop Dis. 2017 Nov; 11(11):e0006094.PN

Abstract

BACKGROUND

Complex cutaneous and muco-cutaneous leishmaniasis (CL and MCL) often requires systemic therapy. Liposomal amphotericin B (L-AmB) has a strong potential for a solid clinical benefit in this indication.

METHODS

We conducted a retrospective analysis of data from a French centralized referral treatment program and from the "LeishMan" European consortium database. All patients with parasitologically proven CL or MCL who received at least one dose of L-AmB were included. Positive outcome was based on ulcer closure as per recent WHO workshop guidelines.

RESULTS

From 2008 through 2016, 43 travelers returning from 18 countries (Old World n = 28; New World n = 15) were analyzed with a median follow-up duration of 79 days [range 28-803]. Main clinical forms were: localized CL with one or multiple lesions (n = 32; 74%) and MCL (n = 8; 19%). As per published criteria 19 of 41 patients (46%) were cured 90 days after one course of L-AmB. When the following items -improvement before day 90 but no subsequent follow-up, delayed healing (>3 months) and healing after a second course of L-AmB- were included in the definition of cure, 27 of 43 patients (63%) had a positive outcome. Five patients (MCL = 1; CL = 4) experienced a relapse after a median duration of 6 months [range 3-27] post treatment and 53% of patients (23/43) experienced at least one adverse event including severe hypokalaemia and acute cardiac failure (one patient each). In multivariate analysis, tegumentary infection with L. infantum was associated with complete healing after L-AmB therapy (OR 5.8 IC 95% [1.03-32]) while infection with other species had no impact on outcome.

CONCLUSION

In conditions close to current medical practice, the therapeutic window of L-AmB was narrow in travellers with CL or MCL, with the possible exception of those infected with L. infantum. Strict follow-up is warranted when using L-AmB in patients with mild disease.

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Authors+Show Affiliations

Guery R
Service de Maladies Infectieuses et Tropicales, Centre d'Infectiologie Necker-Pasteur, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants Malades, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
Henry B
Service de Maladies Infectieuses et Tropicales, Centre d'Infectiologie Necker-Pasteur, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants Malades, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
Martin-Blondel G
Service des Maladies Infectieuses et Tropicales, CHU de Toulouse, INSERM U1043-CNRS UMR 5282, Centre de Physiopathologie Toulouse-Purpan, Toulouse, France.
Rouzaud C
Service de Maladies Infectieuses et Tropicales, Centre d'Infectiologie Necker-Pasteur, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants Malades, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
Cordoliani F
Service de Dermatologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot-Paris VII, Paris, France.
Harms G
Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Gangneux JP
Service de Parasitologie-Mycologie, CHU de Rennes, INSERM U1085, Université Rennes 1, Rennes, France.
Foulet F
Unité de Mycologie, Département de Biologie-Pathologie, CHU Henri Mondor, DHU VIC, Assistance Publique-Hôpitaux de Paris, Créteil, France.
Bourrat E
Service de Pédiatrie Général, Hôpital Robert Debré, Service de Dermatologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot-Paris VII, Paris, France.
Baccard M
Service de Dermatologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot-Paris VII, Paris, France.
Morizot G
Plateforme ICAReB, Institut Pasteur, Paris, France.
Consigny PH
Centre Médical de l'Institut Pasteur, Consultation de Maladies Infectieuses, Tropicales et de Médecine des Voyages, Centre d'Infectiologie Necker-Pasteur, Institut Pasteur, Paris, France.
Berry A
Service de Parasitologie-Mycologie, CHU de Toulouse, INSERM U1043-CNRS UMR 5282, Centre de Physiopathologie Toulouse-Purpan, Toulouse, France.
Blum J
Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland.
Lortholary O
Service de Maladies Infectieuses et Tropicales, Centre d'Infectiologie Necker-Pasteur, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants Malades, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
Buffet P
INTS, Unité Biologie Intégrée du Globule Rouge, Laboratoire d'Excellence GR-Ex, Centre d'Infectiologie Necker-Pasteur, Institut Pasteur, Paris, France.
French Cutaneous Leishmaniasis Study group & the LeishMan network
No affiliation info available

MeSH

AdolescentAdultAgedAged, 80 and overAmphotericin BAntiprotozoal AgentsChildChild, PreschoolFemaleHumansInfantLeishmaniaLeishmaniasis, CutaneousLeishmaniasis, MucocutaneousMaleMiddle AgedRetrospective StudiesTravelTreatment Outcome

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29155816

Citation

Guery, Romain, et al. "Liposomal Amphotericin B in Travelers With Cutaneous and Muco-cutaneous Leishmaniasis: Not a Panacea." PLoS Neglected Tropical Diseases, vol. 11, no. 11, 2017, pp. e0006094.
Guery R, Henry B, Martin-Blondel G, et al. Liposomal amphotericin B in travelers with cutaneous and muco-cutaneous leishmaniasis: Not a panacea. PLoS Negl Trop Dis. 2017;11(11):e0006094.
Guery, R., Henry, B., Martin-Blondel, G., Rouzaud, C., Cordoliani, F., Harms, G., Gangneux, J. P., Foulet, F., Bourrat, E., Baccard, M., Morizot, G., Consigny, P. H., Berry, A., Blum, J., Lortholary, O., & Buffet, P. (2017). Liposomal amphotericin B in travelers with cutaneous and muco-cutaneous leishmaniasis: Not a panacea. PLoS Neglected Tropical Diseases, 11(11), e0006094. https://doi.org/10.1371/journal.pntd.0006094
Guery R, et al. Liposomal Amphotericin B in Travelers With Cutaneous and Muco-cutaneous Leishmaniasis: Not a Panacea. PLoS Negl Trop Dis. 2017;11(11):e0006094. PubMed PMID: 29155816.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Liposomal amphotericin B in travelers with cutaneous and muco-cutaneous leishmaniasis: Not a panacea. AU - Guery,Romain, AU - Henry,Benoit, AU - Martin-Blondel,Guillaume, AU - Rouzaud,Claire, AU - Cordoliani,Florence, AU - Harms,Gundel, AU - Gangneux,Jean-Pierre, AU - Foulet,Françoise, AU - Bourrat,Emmanuelle, AU - Baccard,Michel, AU - Morizot,Gloria, AU - Consigny,Paul-Henri, AU - Berry,Antoine, AU - Blum,Johannes, AU - Lortholary,Olivier, AU - Buffet,Pierre, AU - ,, Y1 - 2017/11/20/ PY - 2017/09/01/received PY - 2017/11/02/accepted PY - 2017/12/04/revised PY - 2017/11/21/pubmed PY - 2017/12/14/medline PY - 2017/11/21/entrez SP - e0006094 EP - e0006094 JF - PLoS neglected tropical diseases JO - PLoS Negl Trop Dis VL - 11 IS - 11 N2 - BACKGROUND: Complex cutaneous and muco-cutaneous leishmaniasis (CL and MCL) often requires systemic therapy. Liposomal amphotericin B (L-AmB) has a strong potential for a solid clinical benefit in this indication. METHODS: We conducted a retrospective analysis of data from a French centralized referral treatment program and from the "LeishMan" European consortium database. All patients with parasitologically proven CL or MCL who received at least one dose of L-AmB were included. Positive outcome was based on ulcer closure as per recent WHO workshop guidelines. RESULTS: From 2008 through 2016, 43 travelers returning from 18 countries (Old World n = 28; New World n = 15) were analyzed with a median follow-up duration of 79 days [range 28-803]. Main clinical forms were: localized CL with one or multiple lesions (n = 32; 74%) and MCL (n = 8; 19%). As per published criteria 19 of 41 patients (46%) were cured 90 days after one course of L-AmB. When the following items -improvement before day 90 but no subsequent follow-up, delayed healing (>3 months) and healing after a second course of L-AmB- were included in the definition of cure, 27 of 43 patients (63%) had a positive outcome. Five patients (MCL = 1; CL = 4) experienced a relapse after a median duration of 6 months [range 3-27] post treatment and 53% of patients (23/43) experienced at least one adverse event including severe hypokalaemia and acute cardiac failure (one patient each). In multivariate analysis, tegumentary infection with L. infantum was associated with complete healing after L-AmB therapy (OR 5.8 IC 95% [1.03-32]) while infection with other species had no impact on outcome. CONCLUSION: In conditions close to current medical practice, the therapeutic window of L-AmB was narrow in travellers with CL or MCL, with the possible exception of those infected with L. infantum. Strict follow-up is warranted when using L-AmB in patients with mild disease. SN - 1935-2735 UR - https://www.unboundmedicine.com/medline/citation/29155816/Liposomal_amphotericin_B_in_travelers_with_cutaneous_and_muco_cutaneous_leishmaniasis:_Not_a_panacea_ DB - PRIME DP - Unbound Medicine ER -