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Liposomal amphotericin B in comparison to sodium stibogluconate for cutaneous infection due to Leishmania braziliensis

https://doi.org/10.1016/j.jaad.2006.06.044Get rights and content

Background

New World cutaneous leishmaniasis among Israeli travelers is mostly acquired in the Amazon Basin of Bolivia where Leishmania viannia (V.) braziliensis is endemic. Treatment with systemic pentavalent antimonial compounds is effective in achieving clinical cure in only 75% of cases. In this study, we assessed liposomal amphotericin B (AmBisome) as an alternative treatment for cutaneous L (V.) braziliensis infection.

Methods

A prospective evaluation was performed for cutaneous leishmaniasis due to L (V.) braziliensis, proven by polymerase chain reaction. A 3-mg/kg AmBisome dose was given for 5 consecutive days, and a sixth dose on day 10, all in an outpatient setting. This therapy was compared with a series of historical patients who were treated with sodium stibogluconate (SSG).

Results

Seven consecutive patients, 5 males and 2 females, received AmBisome treatment. All were returned travelers infected in Bolivia; their mean age was 23.1 years; 5 had failed to respond to a full course of SSG; two had a primary lesion; none had mucosal lesions. All achieved complete clinical cure within less than 1 month. Mean follow-up of 12 months revealed no relapses. Side effects were mild, and none had to terminate treatment prematurely. Comparison of AmBisome to SSG treatment shows that the former is safer, with fewer recurrence rates. Additionally, the expense of the total care with AmBisome is less than with SSG: 45% less if SSG was given in an inpatient setting; 15% less when SSG was given in an outpatient setting.

Limitations

This was a nonrandomized study, with relatively few patients.

Conclusion

AmBisome treatment for L (V.) braziliensis appears to be effective, better tolerated, and to have more cost benefit in countries where hospital-care costs are significant.

Section snippets

Background

In the last decade, travel to South and Central America has become increasingly common among young Israeli adults. New World cutaneous leishmaniasis, endemic to the Americas, is caused by Leishmania viannia (V.) and L mexicana species complexes.1 Infection by the Viannia species, particularly L viannia (V.) braziliensis, results in skin lesions that tend to be more persistent and may be further complicated by mucocutaneous involvement.2, 3

Almost all cases of South American leishmaniasis

Patients and methods

Patients with New World cutaneous leishmaniasis were included in this study. All the patients were travelers referred to the Center for Geographic Medicine and treated at the Department of Dermatology at Sheba Medical Center in Israel between May 2004 and November 2005. New World cutaneous leishmaniasis was defined as (1) presence of cutaneous lesions (ulcers, nodules, papules) clinically compatible with leishmaniasis; (2) history of recent travel to South America (New World); (3) smear or

Results

Seven consecutive patients with L (V.) braziliensis infection received this treatment. All were individual travelers, trekking and boating for several days in Madidi National Park in the Amazon region of Bolivia. The clinical and epidemiological data of the patients are shown in Table I. Five were men and 2 women; their mean age was 23.1 years (range, 21-24 years); the patients had a mean of 1.5 cutaneous lesions (range, 1-3). The distribution of the lesions was 57% on the upper aspect of limbs

Discussion

Travel to Latin America has become more common in recent years, where New World leishmaniasis is endemic, including the L viannia complexes. It is well established that L (V.) braziliensis requires systemic treatment because of the risk of mucocutaneous leishmaniasis developing.2 The traditional treatment has been pentavalent antimony (SSG or meglumine antimoniate 20 mg/kg per day given as an IV or intramuscular dose over 20 days).9 This regimen showed cure rates of 85% to 90% in studies of

References (19)

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Funding sources: None.

Conflicts of interest: None identified.

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