Amato Valdir Sabbaga, Tuon Felipe Francisco, Siqueira Andre Machado, Nicodemo Antonio Carlos, Neto Vicente Amato
Infectious and Parasitic Clinic, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil.
Am J Trop Med Hyg. 2007 Aug;77(2):266-74.
Mucosal leishmaniasis (ML) is an important endemic disease and public-health problem in underdeveloped countries because of its significant morbidity and mortality. Increases in ecological tourism have extended this problem to developed countries. This form of leishmaniasis, caused by reactivation after primary cutaneous lesion, has a natural history of progressive destruction of the nasal septa and soft and hard palates, causing facial disfiguration and leading to respiratory disturbances. Treatment of ML, based on several therapies, depends on use of toxic compounds, and few drugs have emerged over the past 40 years. Drug resistance has increased, and the cure rate is no better than 70% in the largest studies. Despite these data, there has been no systematic review of therapies used to treat this important tropical disease. The aim of this study is to determine the best drug management for treatment of ML in Latin America based on the best studies offered by the medical literature. The MEDLINE, LILACS, EMBASE, Web of Science, and Cochrane Library databases were searched to identify articles related to ML and therapy. The studies were independently selected by 2 authors. Articles with sufficient data for cure and treatment failures, internal and external validity information, and > 4 patients in each treatment were included. Validation of this systematic review was based on guidelines to guarantee quality; 22 articles met our inclusion criteria. Stibogluconate achieved a 51% cure rate (76/150 patients), and 88% of patients treated with meglumine were cured (121 patients). Pentamidine and amphotericin were as effective as meglumine. Use of itraconazole and other therapies (pentoxifylline, allopurinol, or interferon-gamma) was controversial, and numbers of patients in some studies were insufficient for statistical analysis. Meglumine may be the drug of choice in the treatment of ML, as it offers similar cure rates when compared with amphotericin B and pentamidine. Cost, adverse effects, local experience, and availability of drugs to treat ML are strong points to be considered before determining the best management of this disease, especially in developing countries.
黏膜利什曼病（ML）在欠发达国家是一种重要的地方病和公共卫生问题，因其具有显著的发病率和死亡率。生态旅游的增加已将这个问题扩展到了发达国家。这种利什曼病由原发性皮肤病变后重新激活引起，其自然病程是鼻中隔以及软硬腭进行性破坏，导致面部毁容并引发呼吸障碍。ML的治疗基于多种疗法，依赖于使用有毒化合物，并且在过去40年中几乎没有新的药物出现。耐药性有所增加，在规模最大的研究中治愈率也不超过70%。尽管有这些数据，但对于用于治疗这种重要热带疾病的疗法尚未进行系统评价。本研究的目的是根据医学文献提供的最佳研究，确定拉丁美洲治疗ML的最佳药物管理方案。检索了MEDLINE、LILACS、EMBASE、科学网和考克兰图书馆数据库，以识别与ML和治疗相关的文章。这些研究由两位作者独立挑选。纳入的文章需有足够的治愈和治疗失败数据、内部和外部有效性信息，且每种治疗方法的患者数>4例。本系统评价的验证基于保证质量的指南；22篇文章符合我们的纳入标准。葡糖酸锑钠的治愈率为51%（150例患者中的76例），接受葡甲胺治疗的患者中有88%（121例患者）治愈。喷他脒和两性霉素与葡甲胺的疗效相当。伊曲康唑和其他疗法（己酮可可碱、别嘌醇或干扰素-γ）的使用存在争议，一些研究中的患者数量不足以进行统计分析。葡甲胺可能是治疗ML的首选药物，因为与两性霉素B和喷他脒相比，其治愈率相似。在确定这种疾病的最佳管理方案之前，尤其是在发展中国家，治疗ML的药物成本、不良反应、当地经验和可及性都是需要考虑的重要因素。
