Randomized, Double-Blind Clinical Trial of Topical Imiquimod 5% with Parenteral Meglumine Antimoniate in the Treatment of Cutaneous Leishmaniasis in Peru

Miranda‐Verástegui, César; Llanos-Cuentas, Alejandro; Arevalo, Iracema; Ward, Brian J.; Matlashewski, Greg

doi:10.1086/429238

Cited by 110 publications

(90 citation statements)

References 26 publications

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“…In the study of Miranda-Verastegui et al (2005), which was conducted in the endemic regions of the Peruvian Andes and tropical forest, they included 40 patients which were infected by L. peruviana and L. braziliensis. However, the side effects that were reported in the group treated with imiquimod, were erythema, edema, itching, burning and pain (Almeida and Santos 2011).…”

Section: Discussionmentioning

confidence: 99%

Topical treatment of experimental cutaneous leishmaniasis in golden hamster (Mesocricetus auratus) with formulations containing pentamidine

et al. 2017

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Current treatment of cutaneous leishmaniasis (CL) relies mainly on pentavalent antimonials salts and second-line drugs include pentamidine and amphotericin B, but these therapies have side effects and require parenteral administration. The aim of this work was to evaluate the topical formulations containing pentamidine isethionate (PI) in the experimental treatment of cutaneous leishmaniasis (CL). Golden hamsters (Mesocricetus auratus) were infected in the nose with Leishmania (Leishmania) amazonensis. Six treatment groups received different topical treatments of anhydrous or hydrating emulsions, for a maximum of 10 days, with an application of 50 mg day -1. After treatment tissue samples of lesions were evaluated by histology, transmission electron microscopy and biopsy cultivation. Compared with untreated group, topical treatment with hydrating emulsion with 10% PI and usnic acid (ACE5AU) showed significantly decrease in volume lesion (P= 0.028) on 20 th day after the end of the treatment with reduction of 27.37%. Topical treatment with anhydrous emulsion with 10% PI and usnic acid (ACPU) reduces parasite burden in Golden hamsters. This study demonstrated the potential of topical treatment to reduce the number of parasites that could be combined with others drugs and to have a faster and more effective treatment of cutaneous leishmaniasis.

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Section: Discussionmentioning

confidence: 99%

Topical treatment of experimental cutaneous leishmaniasis in golden hamster (Mesocricetus auratus) with formulations containing pentamidine

et al. 2017

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“…Itraconazole was not found effective in primary treatment of New world mucocutaneous leishmaniasis in a small controlled clinical trial [19], although anecdotal evidence suggests that this drug may have some utility in the treatment of New World cutaneous leishmaniasis [20,21], particularly in consolidation or maintenance therapy, as seen in our case. Local, topical treatment with photodynamic therapy [22], paromomcym [23], and the immune stimulator imiquimod [24][25][26] have also been shown to be effective treatments for L. (Vianna) braziliensis-related New World cutaneous leishmaniasis.…”

Section: Discussionmentioning

confidence: 99%

Leishmania mexicana infection of the eyelid in a traveler to Belize

Vinetz¹,

Soong²

2007

Braz J Infect Dis

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A 50 year-old man, a United States resident, presented in Texas with a violaceous non-ulcerating lesion, involving the entire lower eyelid. The patient had traveled to a jungle area of Belize several hours drive from the capital city. Leishmania mexicana was isolated. The lesion only partially resolved after an initial course of sodium stibogluconate, requiring retreatment. At two years of follow-up, there was no relapse. The parasite isolated from the patient caused a progressive, non-ulcerating lesion in an experimental mouse footpad infection. This is an unusual case of cutaneous leishmaniasis in a traveler. Travelers must be educated about personal protective measures to prevent exotic infections acquired during travel.

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“…In a randomized controlled trial of the new world CL, it was shown that in all patients treated with imiquimod alone, the disease was relapsed after treatment discontinuation but all patients treated with combination of imiquimod and MG were cured (Arevalo et al, 2007). Similar studies in Peruvian patients revealed the same results with small scar tissue, so it was proposed to recommend for the facial lesions (Miranda-Verastegui et al, 2005). Other reports in old world cutaneous leishmaniasis confirmed treatment failure when topical imiquimod cream used alone and its additive effect when used in association with antimony compounds (Arevalo et al, 2001;Seeberger et al, 2003).…”

Section: Immunomodulator As An Adjuvant Imiquimodmentioning

confidence: 95%

Topical Treatment Modalities for Old World Cutaneous Leishmaniasis: A Review

2012

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Diagnosis and therapy of cutaneous leishmaniasis (CL) can be difficult due to the variability of the clinical pictures and resistance to therapy. There is no vaccine currently available for CL. The aim of the present review is to describe different topical treatment modalities for old world CL. The mainstays of treatment for old world CL are pentavalent antimony compounds which are administered parenterally or intralesionally. New topical treatment alternatives have been available within the past few years. Amongst several treatments used topically, physical therapies including cryotherapy, heat therapy and CO 2 laser are promising for the treatment of old world CL. Along with that, other randomized placebo controlled trials should be designed to find new effective therapeutic regimens.

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Randomized, Double-Blind Clinical Trial of Topical Imiquimod 5% with Parenteral Meglumine Antimoniate in the Treatment of Cutaneous Leishmaniasis in Peru

Abstract: Combined antimony plus imiquimod treatment was well tolerated, accelerated healing of lesions, and improved scar quality. This therapy may have particular advantages for subjects with facial lesions.

Cited by 110 publications

References 26 publications

Topical treatment of experimental cutaneous leishmaniasis in golden hamster (Mesocricetus auratus) with formulations containing pentamidine

Topical treatment of experimental cutaneous leishmaniasis in golden hamster (Mesocricetus auratus) with formulations containing pentamidine

Leishmania mexicana infection of the eyelid in a traveler to Belize

Topical Treatment Modalities for Old World Cutaneous Leishmaniasis: A Review

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