A Species-Specific Approach to the Use of Non-Antimony Treatments for Cutaneous Leishmaniasis

Abstract

We used a species-specific approach to treat 10 patients with cutaneous leishmaniasis diagnosed using polymerase chain reaction. Non-antimony treatments (oral miltefosine, ketoconazole, and liposomal amphotericin B) were chosen as an alternative to pentavalent antimony drugs based on likely or proven drug efficacy against the infecting species. Leishmania Viannia panamensis was diagnosed in three patients and treated successfully with oral ketoconazole. Miltefosine treatment cured two patients with L. infantum chagasi. A wide variety of Leishmania responded to liposomal amphotericin B administered for 5–7 days. Three patients with L. V. braziliensis, one patient with L. tropica, and two patients with L. infantum chagasi were treated successfully. One person with L. V. braziliensis healed slowly because of a resistant bacterial superinfection, and a second patient with L. infantum chagasi relapsed and was retreated with miltefosine. These drugs were reasonably well-tolerated. In this limited case series, alternative non-antimony–based regimens were convenient, safe, and effective.

Leishmaniasis cutánea causada por Leishmania braziliensis y uso de anfotericina B liposomal. Comunicación de un caso clínico importado

“…Las tasas de curación fueron 97 y 71%, respectivamente y además, el tratamiento con anfotericina liposomal fue mejor tolerado 8 . Respecto a la evidencia del uso de anfotericina liposomal en LC causada por L. brazi-liensis sólo existen reportes de casos esporádicos con un total de cuatro pacientes, todos ellos importados, con una edad promedio de 32 años (rango entre 9 y 55 años) [14][15][16] . En todos los casos se logró completar el esquema de tratamiento, en los cuales las dosis utilizadas van desde 3 mg/kg por siete días hasta 5 mg/kg, por 10 días.…”

Real-time PCR using FRET technology for Old World cutaneous leishmaniasis species differentiation

“…It has been shown previously that the cpb gene could serve as an ideal target to differentiate between the different Leishmania species [ 29 , 30 , 45 , 50 ] with a very high sensitivity (100 %) [ 51 ]. However, in contrast to previous assays targeting the cpb gene which were only able to distinguish between Leishmania complexes [ 52 ] or required multiple PCRs and post-PCR processing [ 15 , 30 , 45 ], here we developed unique primers that can differentiate between the three OWCL species in a single rapid step.…”

“…Molecular diagnostic methods such as PCR are the current preferred method of diagnosis due to their high specificity, sensitivity (98–100 %) and speed [ 12 , 13 ]. Identification of the parasite at the species level is often crucial for epidemiological studies, transmission control measures, disease prognosis and choice of treatment [ 14 , 15 ]. Before the advent of PCR protocols, the species of Leishmania was determined by enzyme-based assays such as Multi Locus Enzyme Typing (MLET) which were both time-consuming and labour-intensive.…”

Cutaneous Leishmaniasis: Current Treatment Practices in the USA for Returning Travelers

“…Adverse effects for these azoles include gastrointestinal symptoms and hepatotoxicity [34•]. Serum chemistries should be monitored weekly for high-dose regimens.…”