Immunotherapy, immunochemotherapy and chemotherapy for American cutaneous leishmaniasis treatment

Abstract

The first choice of treatment for American cutaneous leishmaniasis is the pentavalent antimonial drug. Although it has been shown that this treatment is mostly effective and indicated, some disadvantages should be taken into account such as side effects, long term treatment inconveniences and counter-indication for patients suffering from cardiopathy, nephropathy; yet, aging, pregnancy and other conditions. With the advent of the vaccine anti-American cutaneous leishmaniasis as a prophylactic measure, studies on therapy using the vaccine associated or not with other drugs have been performed by many investigators and it is currently among the alternative treatments and prevention measures for American cutaneous leishmaniasis. In conclusion, the association between antimony and vaccine (immunochemotherapy) showed the same cure rate when compared with the standard treatment (100%) and it was also able to reduce the salt volume in 17.9% and treatment length from 87 to 62 days, decreasing side effects. Key-words: American cutaneous leishmaniasis. Treatment. Immunotherapy. RESUMOO tratamento de primeira escolha para leishmaniose tegumentar americana é o antimonial pentavalente. Embora este tratamento seja na maioria das vezes efetivo e indicado, devem ser consideradas as desvantagens tais como efeitos colaterais, longa duração do tratamento e contra-indicação para cardiopatas, nefropatas, idosos, grávidas e outras condições. Com o advento da vacina antileishmaniose tegumentar americana para fins profiláticos e terapêuticos, associando-a ou não a outros fármacos, muitas pesquisas têm sido desenvolvidas, sendo a vacina a principal entre os atuais recursos no tratamento e prevenção da leishmaniose tegumentar americana. Em conclusão, a associação do antimônio com a vacina (imunoquimioterapia) apresentou o mesmo índice de cura em relação ao tratamento padrão (100%), e ainda reduziu o volume do sal em 17,9% e o tempo de cura significativamente, de 87 para 62 dias; conseqüentemente, reduzindo os efeitos colaterais. Palavras-chaves: Leishmaniose tegumentar americana. Tratamento. Imunoterapia.

Antigenic extracts of Leishmania braziliensis and Leishmania amazonensis associated with saponin partially protects BALB/c mice against Leishmania chagasi infection by suppressing IL-10 and IL-4 production

“…Indeed, when compared with conventional therapy, L. amazonensis vaccine treatment reduced the time necessary for lesions in patients with cutaneous leishmaniasis to completely heal (Toledo et al 2001). Furthermore, Mayrink et al (2006) have shown that the association of a vaccine antigen with antimonium salts reduces both the total salt volume and the treatment length, thereby reducing the side effects otherwise associated with the use of antimonium salts.…”

Transient Success Using Prolonged Treatment with Miltefosine for a Patient with Diffuse Cutaneous Leishmaniasis Infected with Leishmania mexicana mexicana

“…Initially, dead promastigotes were used for the development of prophylactic vaccines in Brazilian patients. 10 The work by Pereira and others 11 reported the use of a vaccine containing killed promastigotes of Leishmania associated with the Bacillus Calmette-Guerin (BCG) alone or combined with chemotherapy. This vaccine may an alternative for patients who are intolerant or resistant to conventional treatment.…”

Two cases of visceral leishmaniasis in Colombia resistant to meglumine antimonial treatment

“…Immunochemotherapy (vaccine with antileishmanial drugs) is maybe an alternative treatment for those patients for whom SbV compounds are not indicated, clinical trial guidelines are being generate 7,11,16,28 .…”

“…Arrhythmias and sudden death have been reported with doses greater than 20 mg of SbV/kg body weight/day. Pentavalent antimonials should be used with caution in elderly patients and those with heart disease, nephropathy and in pregnancy 5,11,17 .…”

“…This complex provides substantial benefits to the patient, including the reduction of outpatient visits, and ambulatory expenses, over standard therapy 7,11,28 .…”