Llanos-Cuentas Alejandro, Tulliano Gianfranco, Araujo-Castillo Roger, Miranda-Verastegui Cesar, Santamaria-Castrellon Giovanna, Ramirez Luis, Lazo Marcela, De Doncker Simonne, Boelaert Marleen, Robays Jo, Dujardin Jean-Claude, Arevalo Jorge, Chappuis Francois
Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.
Clin Infect Dis. 2008 Jan 15;46(2):223-31. doi: 10.1086/524042.
Treatment for cutaneous leishmaniasis (CL) with standard pentavalent antimonial therapy is hampered by cumbersome administration, toxicity, and potential failure. Knowledge of factors influencing treatment outcome is essential for successful management.
A case-control study of incident cases was performed with patients experiencing their first CL episode. The standard treatment for CL for these patients was 20 mg/kg/day of sodium stibogluconate for 20 days. Clinical and epidemiological data were recorded, and parasite isolates were species typed. Patients were followed up for 6 months to assess treatment outcome. Clinical cure was defined as complete wound closure and re-epithelization without inflammation or infiltration; new lesions, wound reopening, or signs of activity were classified as treatment failure. Descriptive, bivariate, and logistic regression analyses were performed.
One hundred twenty-seven patients were recruited; 63 (49.6%) were infected with Leishmania (Viannia) peruviana, 29 (22.8%) were infected with Leishmania (Viannia) braziliensis, 27 (21.3%) were infected with Leishmania (Viannia) guyanensis, and 8 (6.3%) were infected with other species. Only patients infected with the 3 most common species were selected for risk-factor analysis (n=119). Final failure rate at 6 months was 24.4% (95% confidence interval [CI], 16.5%-32.1%), with 96% of failures occurring within the first 3 months of follow-up assessment. Risk factors for treatment failure identified in the final multivariate model were age (per year, odds ratio [OR], 0.95; 95% CI, 0.92-0.99; P=.017), stay of <72 months in area of disease acquisition (OR, 30.45; 95% CI, 2.38-389.25; P=.009), duration of disease <5 weeks (OR, 4.39; 95% CI, 1.12-17.23; P=.034), additional lesion (per lesion, OR, 2.06; 95% CI, 1.3-3.28; P=.002), infection with L. (V.) peruviana (OR, 9.85; 95% CI, 1.01-95.65; P=.049), and infection with L. (V.) braziliensis (OR, 22.36; 95% CI, 1.89-263.96; P=.014).
The identification of parasite species and clinical risk factors for antimonial treatment failure should lead to an improved management of CL in patients in Peru.
标准五价锑疗法治疗皮肤利什曼病（CL）存在给药繁琐、毒性大及可能治疗失败等问题。了解影响治疗结果的因素对于成功治疗至关重要。
对首次发生CL的患者进行病例对照研究。这些患者CL的标准治疗方案为葡萄糖酸锑钠20mg/kg/天，共20天。记录临床和流行病学数据，并对寄生虫分离株进行种型鉴定。对患者随访6个月以评估治疗结果。临床治愈定义为伤口完全闭合且重新上皮化，无炎症或浸润；新病灶、伤口重新开放或活动迹象均分类为治疗失败。进行描述性、双变量和逻辑回归分析。
共招募127例患者；63例（49.6%）感染秘鲁利什曼原虫（维扬亚利什曼原虫），29例（22.8%）感染巴西利什曼原虫（维扬亚利什曼原虫），27例（21.3%）感染圭亚那利什曼原虫（维扬亚利什曼原虫），8例（6.3%）感染其他种。仅选择感染3种最常见种的患者进行危险因素分析（n = 119）。6个月时的最终失败率为24.4%（95%置信区间[CI]，16.5% - 32.1%），96%的失败发生在随访评估的前3个月内。最终多变量模型中确定的治疗失败危险因素为年龄（每年，比值比[OR]，0.95；95% CI，0.92 - 0.99；P = 0.017）、在疾病感染地区停留<72个月（OR，30.45；95% CI，2.38 - 389.25；P = 0.009）、病程<5周（OR，4.39；95% CI，1.12 - 17.23；P = 0.034）、额外病灶（每个病灶，OR，2.06；95% CI，1.3 - 3.28；P = 0.002）、感染秘鲁利什曼原虫（维扬亚利什曼原虫）（OR，9.85；95% CI，1.01 - 95.65；P = 0.049）以及感染巴西利什曼原虫（维扬亚利什曼原虫）（OR，22.36；95% CI，1.89 - 263.96；P = 0.014）。
确定寄生虫种类及锑剂治疗失败的临床危险因素应能改善秘鲁患者CL的治疗管理。
