Gomes C M, Cesetti M V, de Morais O O, Mendes M S T, Roselino A M, Sampaio R N R
Department of Dermatology, Universidade de Brasília, Brasília, Brazil; Laboratório de Dermatomicologia, Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília, Brasília Brazil.
J Eur Acad Dermatol Venereol. 2015 Jan;29(1):109-14. doi: 10.1111/jdv.12473. Epub 2014 Mar 21.
The recurrence of American cutaneous leishmaniasis (ACL) in patients experiencing a long-term cure is often called leishmaniasis recidiva cutis (LRC). LRC is considered an unusual form of ACL.
This study aims to estimate the incidence of LRC in ACL patients evaluated at a tertiary dermatologic centre in Midwestern Brazil. We also aim to evaluate the association between various treatment regimens and the development of LRC using multivariate analysis in a case-control study.
We performed a 17-year epidemiological study using data from patients treated at our dermatologic centre from July 1994 to December 2011. A retrospective analysis was then performed to estimate risk and protective factors related to clinical presentation. We also assessed the influence of treatment regimens in the development of LRC.
The incidence of LRC among ACL patients was 1.34%. The analysis included 105 patients; 82 patients (78%) were in the control group, and 23 patients (22%) were in the LRC case group. The data analysis indicated that the standard treatment N-methylglucamine antimoniate (N-MA) reduced the development of LRC in bivariate (odds ratio (OR) = 0.34; 95% CI = 0.13-0.91) and multivariate analyses (OR = 0.16; 95% CI = 0.03-0.86; P = 0.03). However, no differences in LRC incidence were observed when the standard treatment N-MA and alternative drugs, such as pentamidine and amphotericin B, were considered (OR = 0.47; 95% CI = 0.16-1.35) CONCLUSION: We conclude that the standard treatment N-MA, as proposed by the Brazilian Ministry of Health, is effective in the prevention of LRC. Although other drugs have shown promising results in LRC, more scientific evidence is needed to assess their efficacy compared with N-MA.
美国皮肤利什曼病（ACL）患者长期治愈后复发通常称为皮肤利什曼病复发（LRC）。LRC被认为是ACL的一种不寻常形式。
本研究旨在估计在巴西中西部一家三级皮肤病中心接受评估的ACL患者中LRC的发病率。我们还旨在通过病例对照研究中的多变量分析评估各种治疗方案与LRC发生之间的关联。
我们利用1994年7月至2011年12月在我们皮肤病中心接受治疗的患者数据进行了一项为期17年的流行病学研究。然后进行回顾性分析以估计与临床表现相关的风险和保护因素。我们还评估了治疗方案对LRC发生的影响。
ACL患者中LRC的发病率为1.34%。分析包括105名患者；82名患者（78%）在对照组，23名患者（22%）在LRC病例组。数据分析表明，标准治疗药物N - 甲基葡糖胺锑酸盐（N - MA）在二元分析（比值比（OR）= 0.34；95%置信区间 = 0.13 - 0.91）和多变量分析（OR = 0.16；95%置信区间 = 0.03 - 0.86；P = 0.03）中降低了LRC的发生。然而，当考虑标准治疗药物N - MA和其他替代药物，如喷他脒和两性霉素B时，未观察到LRC发病率的差异（OR = 0.47；95%置信区间 = 0.16 - 1.35）。结论：我们得出结论，巴西卫生部提议的标准治疗药物N - MA在预防LRC方面是有效的。尽管其他药物在LRC方面已显示出有前景的结果，但与N - MA相比，需要更多科学证据来评估它们的疗效。
