Response of cutaneous leishmaniasis (chiclero's ulcer) to treatment with meglumine antimoniate in Southeast Mexico.

Abstract

Abstract. Cutaneous leishmaniasis, known as chiclero's ulcer in southeastern Mexico, is characterized by a predominantly single, painless, ulcerated lesion, without lymphangitis or adenopathy. When located on the ear, it tends to become chronic, causing destruction of the pinna and disfigurement. It is caused predominantly by Leishmania (L.) mexicana. Although pentavalent antimonials (Sb5 ϩ ) are the mainstay of leishmanial therapy and have been used for more than 50 years, dosage regimens have been repeatedly modified and the best one has not been fully identified. The main purpose of the present study was to investigate the response of chiclero's ulcer to treatment with meglumine antimoniate. One hundred five patients were treated with meglumine antimoniate at a daily dose of 1 ampule per day (425 mg of Sb5 ϩ ) until healing. The lesions healed after a mean of 25 days (range ϭ 5-60 days).

Treatment Failure and Miltefosine Susceptibility in Dermal Leishmaniasis Caused by Leishmania Subgenus Viannia Species

“…However, pharmacokinetic analyses reported by Dorlo and collaborators showing a body size-associated decrease in miltefosine exposure when the body weight dosage used in adults is applied in children (23) support the plausibility of the idea that lower exposure to miltefosine promoted outgrowth of resistant parasites and unsuccessful treatment in this patient. The 8-yearold child with an infection that failed to respond to miltefosine despite the susceptibility of the infecting strain presented a lesion on the ear, a cartilaginous site recognized to be therapeutically challenging (24). Concurrent conditions, including altered renal function, immunosuppression, and hypertension (25), in the elderly adult patients are likely to have contributed to the poor clinical response to miltefosine treatment, independently of the susceptibility of the infecting Leishmania strain to miltefosine.…”

NRAMP1 Polymorphisms like Susceptibility Marker in Mexican Focus of Cutaneous Leishmaniasis

“…When the analysis was made with samples from patients with CL which needed higher doses of Glucantime than the mean of 25 ampules used by Vargas-Gonzalez [39], the association between polymorphisms (homo- and heterozygote mutation) in exon 3 caught our attention; 11 samples of 13 patients, which needed high doses of Glucantime, had a mutation in exon 3 and presented the allele (274C/T). We made a statistically important relationship between the presence of this allele in a patient and the need for high doses of Glucantime; the relative risk was found (OR = 3.94) (Table 4).…”

Cutaneous leishmaniasis in a returning traveller

“…Leishmanial lesions of the ear may last for several months to many years and may cause severe mutilation of the pinna if left untreated. 3 Practice CMAJ • Early diagnosis of cutaneous leishmaniasis is important to ensure early treatment and to limit mutilation or scarring.…”