American tegumentary leishmaniasis - a case of therapeutic challenge

Abstract

American Tegumentary Leishmaniasis (ATL) is a chronic, non-contagious, infectious disease affecting millions of people worldwide. The timely and proper treatment is of great importance to prevent the disease from progressing to destructive and severe forms. Treatment for ATL recommended by the Brazilian Ministry of Health is similar for the whole country, regardless of the species of Leishmania. It is known that the response to treatment may vary with the strain of the parasite, the immune status of the patient and clinical form. We report the case of a healthy patient, coming from Manaus, Amazonas state, Brazil, who presented resistance to treatment with N-methyl-glutamine and liposomal amphotericin B, only being healed after using pentamidine.

Molecular Identification of Parasites Causing Cutaneous Leishmaniasis in Panama

“…Relapses, therapeutic failure, and treatment resistance have been reported in human leishmaniasis caused by species of Leishmania subgenus Viannia. [69][70][71][72][73][74] In this sense, the biology, clinical relevance, and response to treatment of the non-L. (V.) panamensis parasites (including genetic variants "Leishmania [V.] sp. 1, Leishmania [V.] sp.…”

Geospatial-temporal distribution of Tegumentary Leishmaniasis in Colombia (2007–2016)

“…Likewise, the great diversity of circulating Leishmania species in Colombia plays a fundamental role in the permanence and propagation of the disease, given that neither epidemiological surveillance, nor treatment, take this variable into account. This assumes that all species are equally susceptible to treatment, which has been refuted in multiple studies [ 4 , 11 , 33 – 35 ]. The presence of some vectors in over half of the departments in Colombia ( Fig 5 ) shows the importance of this factor in the perpetuation of the epidemiological cycle.…”

“…CL is considered a widespread public health issue with an elevated prevalence, considered endemic in 98 countries, adding up to a population at risk of over 350 million people. Meanwhile, Mucocutaneous Leishmaniasis (ML) affects a smaller percentage of the population, producing disfiguring lesions which compromise both the oral and nasal mucosae [ 1 , 2 , 4 ]. In the clinical practice, CL and ML are known as Tegumentary Leishmaniasis (TL).…”

Treatment of tegumentary leishmaniasis in two hemodialysis patients with end-stage renal disease using two series of pentamidine

“…The safety levels of the doses, such as those used in the treatment of ATL at the FMT-HVD, for non-dialysis patients, and the implications of higher doses than those recommended in relation to renal, hepatic, or medullary toxicity have been widely investigated 5 , 8 , 9 . However, there are still no reports on the pharmacokinetics and MIC levels of pentamidine tested in patients with leishmaniasis 4 , nor are there any studies involving patients with both ESRD and leishmaniasis.…”

“…All patients undergo renal and hepatic assessments before and after the treatment. Renal alterations have not been reported, and hepatic and/or hematological involvement associated with this medication is rare 8 . Furthermore, in cutaneous or mucocutaneous leishmaniasis, which is caused by several species of Leishmania, renal manifestations related to the parasite have not been reported, and this event is usually associated with the choice of medication used for the treatment 5 , 9 .…”