The Elderly Respond to Antimony Therapy for Cutaneous Leishmaniasis Similarly to Young Patients but Have Severe Adverse Reactions

Abstract

There is evidence that elderly patients with cutaneous leishmaniasis (CL) have more mucosal and disseminated diseases than young patients and their cells produce less antigen-induced interferon (IFN)-γ. Herein, we compared the roles of interleukin (IL)-10 and IL-15 as modulators of antigen-induced immune responses and the incidence of adverse reaction and response to therapy in young versus elderly patients with CL. Study participants included 35 senior (60-85 years) and 35 young (18-40 years) patients who had a diagnosis of CL documented by typical cutaneous lesions containing DNA. Elderly patients had less lymph node enlargement. Antigen-induced blood cell cytokine responses were studied in the absence or presence of IL-10 antibody or exogenously added recombinant IL-15. The ratio of IFN-γ/IL-10 was lower in elderly patients, and IFN-γ production was enhanced by either neutralization of IL-10 or exogenous recombinant IL-15 in blood cells from elderly but not young patients. Patients were treated three times weekly with antimony at 20 mg/kg/day for 20 doses. Although there was no difference in response to therapy between the two groups, two young patients needed rescue therapy with amphotericin B. Ventricular arrhythmias and ventricular overload were more frequent in elderly patients. We conclude that elderly patients have alterations in the immune response that may influence clinical manifestations, but we did not find that they had a higher failure rate than young subjects to antimony therapy. However, because of the high rate of electrocardiographic abnormalities during therapy, antimony should not be used in elderly patients with CL.

Variable gene expression and parasite load predict treatment outcome in cutaneous leishmaniasis

“…Cutaneous leishmaniasis (CL) is characterized by the development of cutaneous lesions that may resolve in several months or in some cases lead to the development of metastatic lesions (1,2). The response to drug treatment is highly variable, and antimony -the current firstline treatment for cutaneous leishmaniasis in Brazil -is not only toxic but also has a high failure rate (1)(2)(3)(4)(5)(6). As the current drug therapy for leishmaniasis, pentavalent antimony, is often unsuccessful, defining the pathways leading to disease could potentially identify targets for host-directed therapies.…”

Emerging Trends in Clinical Tropical Medicine Research

“…Acceptance varied with shape and color of the potties. Lago et al 8 † Geriatric treatment Individuals aged 60-85 years responded equally compared with persons aged 18-40 years but had increased cardiac arrhythmias and cardiac overload. Lai et al 16 Diagnostics Plasmodium knowlesi was detected within 20 minutes with high sensitivity and specificity.…”

“…The inclusion of geriatric populations-a group that is often neglected but is increasing in size in tropical clinical research-was refreshing. 8 So, too, was the inclusion of the young. 9,10 Whereas the findings may not have been surprising in terms of both efficacy and tolerability in children compared with young adults, toxicity in older patients with cutaneous leishmaniasis treated with systemic antimony drugs was increased to the point that it is not recommended.…”

“…9,10 Whereas the findings may not have been surprising in terms of both efficacy and tolerability in children compared with young adults, toxicity in older patients with cutaneous leishmaniasis treated with systemic antimony drugs was increased to the point that it is not recommended. 8 It was good to see actual data rather than leaving clinicians to extrapolate based on nonsimilar patient populations when making treatment decisions.…”

Introductory Chapter: Leishmaniasis: An Emerging Clinical Syndrome

“…A recent report indicated relapse of post kala-azar dermal leishmaniasis (PKDL) 1 year after successful treatment of VL with miltefosine and paromomycin [5]. Antimony therapy is also not advised in elderly patients with CL due to severe adverse side effects [6]. The potential of the visceralizing species, Leishmania donovani to cause localized cutaneous lesions is also not fully understood [7].…”