Mucosal leishmaniasis: description of case management approaches and analysis of risk factors for treatment failure in a cohort of 140 patients in Brazil

Abstract

The current first-line mucosal leishmaniasis therapy shows an adequate cure but later recurrence. HIV infection and systemic arterial hypertension should be investigated before start the treatment of mucosal leishmaniasis. Conflicts of interest The authors are not part of any associations or commercial relationships that might represent conflicts of interest in the writing of this study (e.g. pharmaceutical stock ownership, consultancy, advisory board membership, relevant patents, or research funding).

Efficacy and Safety of Liposomal Amphotericin B for the Treatment of Mucosal Leishmaniasis from the New World: A Retrospective Study

“…Of these, 17 interrupted the treatment because of acute kidney failure. 9 Our study suggests that liposomal amphotericin can be a safer drug. As a result, it can increase the probability of the patients completing the treatment and influence the outcome and cure rate.…”

“…In Andean countries, ML reaches an average of 7.1%, and Bolivia has a high frequency of 20%. 9,10 In Brazil, the incidence can range from 0.4% to 2.7%. 1 The treatment currently available for ML is systemic, and most cases are based on use of pentavalent antimonials.…”

“…However, recurrence is higher than other treatments and it is involved in serious adverse side effects. 3,9 A systematic review of ML treatment reported a mean cure rate of 88% with the use of pentavalent antimonial. 10 In different clinical situations, other alternative agents can be used, such as pentavalent antimonials plus oral pentoxifylline, amphotericin B deoxycholate, or liposomal amphotericin B.…”

Current diagnosis and treatment of cutaneous and mucocutaneous leishmaniasis

“…In the Old World, failure of this drug is approximately 13%, and this drug is considered as satisfactory for the treatment of cutaneous leishmaniasis. In ML, the cure rate ranges from 30 to 90% with antimonials, depending on the country in which the study was carried out and the dosage used [81][82][83].…”

Therapeutic Options of Cutaneous Leishmaniasis

“…The alternative treatment regimens include miltefosine, pentamidine isethionate, amphotericin B, antifungal agents (e.g., ketoconazole, fluconazole, itraconazol), paromomycine, and granulocyte macrophage colony-stimulating factor [11]. Pentamidine is an alternative agent to antimonials in the management of CL and from the other side have adverse effects such as hypoglycemia, hypotension, nausea, vomiting, dizziness, myalgia, headache, syncope, transient hyperglycemia and pain at the injection site [12,16,17]. Although other drugs also are effective in the treatment of leishmaniasis, their side effects, toxicity and difficulty of intravenous administration limit the healing processes.…”