Aminosidine and its combination with sodium stibogluconate in the treatment of diffuse cutaneous leishmaniasis caused by Leishmania aethiopica

Abstract

Treatment of diffuse cutaneous leishmaniasis (DCL) caused by Leishmania aethiopica remains unsatisfactory as the parasite is relatively insensitive to antimonial compounds. Reports of the clinical effectiveness of aminosidine sulphate, especially in combination with sodium stibogluconate, in visceral leishmaniasis and the finding that this antibiotic is potent against L. aethiopica in vitro, prompted us to evaluate its usefulness in DCL. Two patients with long-standing, active DCL were treated for 60 d with aminosidine sulphate, 14 mg/kg/d parenterally. The skin lesions resolved completely in both patients although they relapsed subsequently. Synergism between aminosidine and stibogluconate was demonstrated in vitro against parasites isolated from the patients. This led us to administer combined therapy, aminosidine sulphate 14 mg/kg/d and sodium stibogluconate 10 mg/kg/d, to the 2 patients in relapse and to another, third patient. Treatment was continued for 2 months beyond parasitological cure. Side effects were minimal. Following treatment, a return of specific cell-mediated immunity occurred, as expressed by a moderate infiltration of lymphocytes into the lesions and by lymphocyte proliferation in vitro in the presence of live Leishmania antigen, with synthesis of interleukin-2 and interferon gamma with one patient and interleukin 4 with the other. During follow-up periods of 2 to 21 months after treatment, no sign of relapse was seen.

Treatment of two patients with diffuse cutaneous leishmaniasis caused by Leishmania mexicana modifies the immunohistological profile but not the disease outcome

“…Bryceson (1970) and Teklemariam et al (1994) report definitive cures in DCL patients infected with Leishmania aethiopica using long-term treatments with pentamidine or aminosidine, successfully avoiding pentamidine toxicity by using weekly or fortnightly applications. Long-term administration of leishmanicidal drugs, given at larger intervals, seems to be a more appropriate form of treatment in DCL patients.…”

Risk map for cutaneous leishmaniasis in Ethiopia based on environmental factors as revealed by geographical information systems and statistics

“…Chronic forms of CL are known to be poor responders to available treatments (Teklemariam et al, 1994;Padovese et al, 2009). Thus, an integrated approach by identifying individual and environmental risk factors is needed controlling the disease.…”

Therapeutic switching in leishmania chemotherapy: a distinct approach towards unsatisfied treatment needs

“…Clinically there has been only one report against cutaneous leishmaniasis, suggesting resistance could develop. Following a 60 day parenteral course for treatment of two L. aethiopica cases, isolates taken from relapse patients were three to fivefold less sensitive to the drug after treatment than isolates taken before treatment in an amastigote-macrophage assay (Teklemariam et al 1994).…”