Low dose systemic or intralesional meglumine antimoniate treatment for American tegumentary leishmaniasis results in low lethality, low incidence of relapse, and low late mucosal involvement in a referral centre in Rio de Janeiro, Brazil (2001-2013).

Lucia Regina Brahim,Cláudia Maria Valete-Rosalino,Luiz Eduardo De Carvalho Paes,Marcelo Rosandiski Lyra,Cristina Maria Giordano Dias,Liliane De Fátima Antônio,Maria Cristina De Oliveira Duque,Armando De Oliveira Schubach,Maria Inês Fernandes Pimentel,Ananda Dutra Da Costa,Mauro Celio De Almeida Marzochi,Iracema Forni Vieira

doi:10.1590/0074-02760160478

Abstract

BACKGROUNDAmerican tegumentary leishmaniasis (ATL) is a non-lethal parasitic disease that presents with cutaneous (CL) and mucosal (ML) clinical forms. ATL treatment aims at healing the lesions and preventing the development of the late mucosal form. Systemic meglumine antimoniate (MA) therapy with 10-20 mg Sb5+/kg/day is the first choice of treatment. However, alternative therapies using 5 mg Sb5+/kg/day or intralesional (IL) MA are the usual regimens at the National Institute of Infectious Diseases (NIID), Rio de Janeiro, Brazil.OBJECTIVESTo evaluate lethality and the incidence of relapse and development of late ML in CL patients treated at NIID from 2001 until 2013.METHODSData were recovered from records of all ATL patients diagnosed during that period.FINDINGSOut of 777 patients, 753 were treated with MA (96.9%). Of those, 89.1% received alternative therapy of 9.9% IL and 79.2% systemic 5 mg Sb5+/kg/day. Some patients required 1-3 additional courses of treatment, thus making a total of 997 courses; 85.2% of them were subjected to alternative therapies. Lethality was 0.1%, relapse incidence 5.8%, and late ML incidence 0.25%. As a final outcome for the 777 patients, 95.9% were cured, 0.1% died and 4.0% were not able to follow-up.MAIN CONCLUSIONSAlternative MA schedules resulted in low lethality without increase of relapse or late ML incidence.

Highlights

American tegumentary leishmaniasis (ATL) is a non-lethal parasitic disease that presents with cutaneous (CL) and mucosal (ML) clinical forms
The indices from the cohorts were evaluated only in the database of National Institute of Infectious Diseases (NIID) patients and were calculated as percentages: “incidence of relapse” (% of naive patients first treated at NIID for the same clinical form and relapsed after the treatment); “incidence of mucosal leishmaniasis” (% of patients treated for cutaneous leishmaniasis (CL) at NIID that developed into ML); “lethality” (% death); “prevalence of relapse” (% of patients that relapsed after treatment); and “prevalence of mucosal leishmaniasis” (% of ML cases)
Since the late 1980s, meglumine antimoniate via IL or 5 mg Sb5+/kg/day, via IM or IV, was the standard treatment for ATL patients at NIID, and these alternative schedules have been effective with minimum adverse effects (Oliveira-Neto et al 1997a, b, c, Oliveira-Neto et al 2000, Vasconcellos et al 2010, 2012, Schubach & Conceição-Silva 2014)

Summary

Introduction

American tegumentary leishmaniasis (ATL) is a non-lethal parasitic disease that presents with cutaneous (CL) and mucosal (ML) clinical forms. ATL treatment aims at healing the lesions and preventing the development of the late mucosal form. Systemic meglumine antimoniate (MA) therapy with 10-20 mg Sb5+/kg/day is the first choice of treatment. Alternative therapies using 5 mg Sb5+/kg/day or intralesional (IL) MA are the usual regimens at the National Institute of Infectious Diseases (NIID), Rio de Janeiro, Brazil

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Conclusion