Successful treatment of refractory mucosal leishmaniasis with pentoxifylline plus antimony.

Lessa, Hélio A.; Machado, Paulo Roberto Lima; Lima, F. Reis; Cruz, Álvaro A.; Bacellar, Olı́via; Guerreiro, Jaqueline; Carvalho, Edgar M.

doi:10.4269/ajtmh.2001.65.87

Cited by 157 publications

(140 citation statements)

References 14 publications

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“…Thus, carefully inhibiting TNFassociated pathways may be beneficial to the healing process and enhancement of ulcer cicatrization. The TNF inhibitors have been successfully introduced as a therapeutic option in the treatment of patients with ML, 19 and CL. 9 Nevertheless, these inhibitors have been used in a small number of patients and clinical trials are in need.…”

Section: Discussionmentioning

confidence: 99%

Lesion Size Correlates with Leishmania Antigen-Stimulated TNF-Levels in Human Cutaneous Leishmaniasis

Oliveira¹,

Báfica²,

Rosato³

et al. 2011

The American Society of Tropical Medicine and Hygiene

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Cutaneous leishmaniasis (CL) is a worldwide disease endemic in several regions of the globe. The hallmark of CL is skin ulcers likely driven by efforts of the immune system to control Leishmania growth. Cytokines, such as tumor necrosis factor (TNF) and interferon-gamma can control disease progression in animal models. Nevertheless, the impact of these cytokines in CL ulcer outcome is not well established in humans. In this study, 96 CL patients from an endemic area of Leishmania braziliensis were enrolled for a follow-up study that consisted of clinical and immunological evaluations in a 2-year period. Statistical analysis revealed that healing time (P = 0.029), age (P = 0.002), and TNF levels (P = 0.0002) positively correlate with ulcer size at the time of the first clinical evaluation. Our findings suggest that ulcer size correlates with healing time and TNF levels support the use of TNF inhibitors combined with standard therapy to improve healing in CL patients with severe lesions.

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Section: Discussionmentioning

confidence: 99%

Lesion Size Correlates with Leishmania Antigen-Stimulated TNF-Levels in Human Cutaneous Leishmaniasis

Oliveira¹,

Báfica²,

Rosato³

et al. 2011

The American Society of Tropical Medicine and Hygiene

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“…imiquimod cream) [132]. The combination of oral pentoxyfilline 3 Â 400 mg/day with antimonials for 28 days has proved to have the same beneficial effects [160]. Physical treatment for CL, such as heat, cryotherapy, laser, or a combination of cryotherapy with intralesional meglumine antimoniate has been successfully applied in endemic countries [164e167].…”

Section: Local Treatmentmentioning

confidence: 99%

“…Local treatment may be useful as an adjuvant to systemic treatment to accelerate healing. Local treatment may also be considered in patients for whom systemic treatment is contraindicated, such as pregnant women or subjects suffering from cardiac problems [132,160]. Drugs in topical formulations offer significant advantages over systemic therapy, such as ease of administration, fewer adverse effects and positive costeffectiveness ratio.…”

Section: Local Treatmentmentioning

confidence: 99%

Leishmaniasis in travelers: A literature review

Mansueto

Seidita

Vitale

et al. 2014

Travel Medicine and Infectious Disease

112

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Summary Leishmaniasis is a vector-borne protozoan infection whose clinical spectrum ranges from asymptomatic infection to fatal visceral leishmaniasis. Over the last decades, an increase in imported leishmaniasis cases in developed, non-endemic countries, have been pointed-out from a review of the international literature. Among the possible causes are increasing international tourism, influx of immigrants from endemic regions and military operations. The main area for the acquisition of cutaneous leishmaniasis, especially for adventure travelers on long-term trips in highly-endemic forested areas, is represented from South America, whereas popular Mediterranean destinations are emerging as the main areas to acquire visceral variant. Leishmaniasis should be considered in the diagnostic assessment of patients presenting with a compatible clinical syndrome and a history of travel to an endemic area, even if this occurred several months or years before. Adventure travelers, researchers, military personnel, and other groups of travelers likely to be exposed to sand flies in endemic areas, should receive counseling regarding leishmaniasis and appropriate protective measures. ª

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“…7,11 Additionally, the use of pentoxifylline, a TNF-␣ inhibitor, has yielded promising results in the treatment of ML, 12 indicating a specific role of this cytokine in the development of ML lesions. Our data clearly show that expression of TNF-␣ and its release into extracellular spaces were maintained in the lamina propria of ML patients despite cicatrization.…”

Section: Mucosal Leishmaniasis (Ml) Caused By Leishmania (Viannia) Bmentioning

confidence: 99%

SHORT REPORT: PERSISTENCE OF TUMOR NECROSIS FACTOR-α IN SITU AFTER LESION HEALING IN MUCOSAL LEISHMANIASIS

Amato

Andrade

Neto

et al. 2003

The American Journal of Tropical Medicine and Hygiene

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Abstract. Mucosal leishmaniasis (ML) is a disease characterized by intense activation of inflammatory cells and extensive tissue destruction. Among the cytokines involved in the immune response to ML, tumor necrosis factor-␣ (TNF-␣) has attracted strong interest because of its roles in the modulation of the immune response. We studied 20 patients with ML who provided biopsy specimens before treatment and after lesion healing obtained by specific therapy. The biopsy specimens were subjected to immunohistochemical analysis for in situ quantification of cellular and extracellular TNF-␣. The amount of TNF-␣ was significantly lower in the healed lesions compared with pretreatment biopsy specimens, although TNF-␣ persisted at the tissue level even after lesion healing. This relevant finding demonstrates for the first time an in situ tissue reduction of TNF-␣ after treatment and shows persistence of TNF-␣ in healed lesions may be related to the maintenance of an immunopathologic background for relapses observed in ML.

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Successful treatment of refractory mucosal leishmaniasis with pentoxifylline plus antimony.

Cited by 157 publications

References 14 publications

Lesion Size Correlates with Leishmania Antigen-Stimulated TNF-Levels in Human Cutaneous Leishmaniasis

Lesion Size Correlates with Leishmania Antigen-Stimulated TNF-Levels in Human Cutaneous Leishmaniasis

Leishmaniasis in travelers: A literature review

SHORT REPORT: PERSISTENCE OF TUMOR NECROSIS FACTOR-α IN SITU AFTER LESION HEALING IN MUCOSAL LEISHMANIASIS

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