Influence of Obesity on Clinical Manifestations and Response to Therapy in Cutaneous Leishmaniasis Caused by Leishmania braziliensis

Abstract

Background Cutaneous leishmaniasis (CL) caused by L. braziliensis is characterized by a single ulcer or multiple cutaneous lesions with raised borders. Cure rates below 60% are observed in response to meglumine antimoniate therapy. We investigated the impact of obesity on CL clinical presentation and therapeutic response. Methods A total of 90 age-matched CL patients were included (30 obese, 30 overweight and 30 with normal BMI). CL was diagnosed through documentation of L. braziliensis DNA by PCR or identification of amastigotes in biopsied skin lesion samples. Serum cytokine levels were determined by chemiluminescence. Antimony therapy with Glucantime (20mg/kg/day) was administered for 20 days. Results Obese CL patients may present hypertrophic ulcers rather than typical oval, ulcerated lesions. A direct correlation between BMI and healing time was noted. After one course of Antimony, cure was achieved in 73% of patients with normal BMI, 37% of overweight subjects, yet just 18% of obese CL patients (p<0.01). Obese CL cases additionally presented higher leptin levels than overweight patients or those with normal BMI (p<0.05). Conclusions Obesity modifies the clinical presentation of CL and host immune response, and is associated with greater failure to therapy.

Comorbidities involving parasitic diseases: A look at the benefits and complications

“…Obese patients had high levels of the hormone leptin, which the authors believe contributed to not only the severity of the disease but also the low efficacy of therapy compared with overweight patients with a normal BMI. 59 A similar relationship was found when the same disease was studies in patients with DM. Changes in immunological, biochemical, and hematological parasitological factors were associated with a significant increase in the number of cases and duration and size of lesions in patients with and without DM.…”

Intramacrophage lipid accumulation compromises T cell responses and is associated with impaired drug therapy against visceral leishmaniasis

“…Overweight and obesity are well-known risk factors for infections [18]. Cross-sectional studies have associated obesity with a higher risk of cutaneous leishmaniasis [CL] and failure to respond to therapy [19,20]. Models of diet-induced obesity in mice were used to demonstrate a higher susceptibility to CL and visceral leishmaniasis (VL), which was accompanied by systemic inflammation [21,22].…”

Cutaneous Leishmaniasis Prevalence and Clinical Overview: A Single Center Study from Saudi Arabia, Eastern Region, Al-Ahsa

“…CL is a skin disorder characterized by isolated or multiple lesions of verrucous or ulcerated plaques on exposed body parts accessible to the bites of infected female sandflies. Sometimes, they are accompanied by satellite lesions and/or nodular lymphangitis [ 7 , 8 ].…”

“…Where CL is endemic, the appearance of skin lesions in correlation with the history given by the patients is a key factor for establishing a diagnosis, relying heavily on a high level of clinical suspicion. However, skin biopsy and sterile tissue culture along with molecular testing with polymerase chain reaction (PCR) are usually required to distinguish leishmaniasis from other dermatological diseases and confirm the diagnosis [ 7 , 8 , 11 , 17 ]. Although CL is a self-limiting disease, therapeutic interventions are usually required to accelerate the healing process and minimize the risk of transmission between vectors and reservoirs.…”

“…Although CL is a self-limiting disease, therapeutic interventions are usually required to accelerate the healing process and minimize the risk of transmission between vectors and reservoirs. The response to the treatment varies depending on the Leishmania species or type and other factors, such as the age of the patient, the number and the size of the lesion, the type of medication used, and the patient’s compliance [ 7 , 8 ].…”