Immunotherapy of American cutaneous leishmaniasis in Venezuela during the period 1990–1999

Abstract

Of a total of 11532 Venezuelan patients with American cutaneous leishmaniasis (ACL) receiving immunotherapy with a combined vaccine containing heat-killed Leishmania promastigotes and bacille Calmette-Guerin (BCG) during the period 1990-99, we evaluated 5341 from 4 widely separated geographical states. Clinical healing varied from 91.2 to 98.7%, with an average of 95.7%. Adverse reactions were mild and limited to those associated with BCG vaccination alone. Immunotherapy failures in 143 patients included 54.5% with typical localized ulcers and 45.5% with non-mucosal intermediate cutaneous leishmaniasis (ICL). Less than 2% of the patients in this study had lesions suggestive of ICL. The disproportionately large number of immunotherapy failures in the ICL group suggests that it should not be used as monotherapy in this group. Weaker reactivity to purified protein derivative in immunotherapy failures, while not statistically significant in the small group reported here, suggests the possibility that these patients develop a relatively torpid immune response. The high percentage of clinical cures achieved with immunotherapy, associated with few secondary effects and low cost, support the use of immunotherapy in the routine treatment of localized ACL.

Therapy of Venezuelan patients with severe mucocutaneous or early lesions of diffuse cutaneous leishmaniasis with a vaccine containing pasteurized Leishmania promastigotes and bacillus Calmette-Guerin: preliminary report

“…BCG has been clearly associated with the induction of a Th1 immune response (Tokunga et al 1999) and is probably the most acceptable TH1-inducing adjuvant presently available for use in humans. While immunotherapy with BCG and autoclaved promastigotes of L. (L.) amazonensis is associated with clinical cure in more than 95% of Venezuelan patients with uncomplicated LCL (Convit et al 1989(Convit et al , 2003, it is less effective in intermediate forms of the disease and ineffective, except for transitory improvement, even when combined with chemotherapy in some of these patients and in those suffering from DCL.…”

“…Since these early studies, more than 11,500 Venezuelan patients with LCL have been treated with this form of IT, with clinical healing in more than 95% (Convit et al 2003). As reported previously (Convit et al 1989), a significant number of small groups of patients with MCL and DCL showed clinical improvement with the vaccine containing autoclaved promastigotes when chemotherapy was included in the therapeutic regime, but immunotherapy alone was not evaluated in these groups.…”

Current diagnosis and treatment of cutaneous and mucocutaneous leishmaniasis

“…Leishmania antigen alone or in combination with other antigens, such as BCG, has been used to treat tegumentary leishmaniasis with partial success. Convit et al [110] and Mayrink et al [111] revisited immunotherapy and reported the treatment of LCL and ML using vaccines based on whole promastigote preparations, obtaining cure rates ranging from 76 to 94%. Recombinant Leishmania antigen has been identified as a candidate for immunotherapy.…”

Immunological stimulation for the treatment of leishmaniasis: a modality worthy of serious consideration

“…1 Machado-Pinto et al showed a highly significant cure rate for CL using Mayrink's vaccine (Biobras, Montes Claros, Brazil) plus a low dose of antimonials, with far fewer side effects of myalgia, severe pain at the site of injection, nausea, vomiting, headache, joint pain, etc. than associated with full doses of antimonials.…”