Ezatkhah F, Sharifi I, Babaei Z, Baneshi M R, Zolala F, Kermanizadeh A, Keyhani A, Sharifi M, Dezaki E S, Aflatoonian M R, Aflatoonian B, Khatami M, Bamorovat M
Leishmaniasis Research Center; Department of Parasitology and Mycology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran.
Research Center for Modeling in Health, Kerman University of Medical Sciences, Kerman, Iran.
J Vector Borne Dis. 2019 Oct-Dec;56(4):351-359. doi: 10.4103/0972-9062.302039.
BACKGROUND & OBJECTIVES: Insufficient treatment of cutaneous leishmaniasis (CL) by conventional drugs is a major barrier in control strategies. This study was aimed to evaluate Glucantime efficacy and the susceptibility of Glucantime unresponsive and responsive CL isolates in the field and laboratory.
Chi-square test (x) was used to determine the significance of difference between proportions in Glucantime-treated patients. The inhibitory activity of various concentrations of Glucantime against Leishmenia tropica stages was evaluated by a colorimetric cell viability MTT and macrophage assays. Mixed model, t-test and ANOVA were performed to determine the significance of difference between various concentrations of Glucantime unresponsive or responsive isolates and untreated control group and p <0.05 was defined as significant level. Altogether, 89.8% of the patients were cured by Glucantime, whilst 10.2% remained non-cured.
The overall Glucantime efficacy in different age groups and genders was similar. The IC values of promastigotes and amastigotes for Glucanime unresponsive isolates were 2.1 and 2.6 times higher than the equivalent rates obtained for responsive cases, respectively. The overall mean number of amastigotes within macrophages in unresponsive isolates was significantly higher (32.68 ± 1.24) than that in responsive ones (18.68 ± 1.52, p <0.001). Glucantime unresponsive and responsive field isolates of anthroponotic CL (ACL) caused by L. tropica strongly correlated to in vitro assays.
INTERPRETATION & CONCLUSION: Monitoring of Glucantime unresponsiveness by the health surveillance system is extremely important, where anthroponotic transmission occurs in humans. Hence, physicians should be aware of such clinical unresponsive presentations with ACL for antimonial therapeutic failure to improve management of disease in endemic regions.
传统药物对皮肤利什曼病（CL）治疗不充分是控制策略中的主要障碍。本研究旨在评估葡糖酸锑钠的疗效以及在现场和实验室中对葡糖酸锑钠无反应和有反应的CL分离株的敏感性。
采用卡方检验（x）来确定接受葡糖酸锑钠治疗的患者比例之间差异的显著性。通过比色细胞活力MTT和巨噬细胞试验评估不同浓度的葡糖酸锑钠对热带利什曼原虫各阶段的抑制活性。进行混合模型、t检验和方差分析以确定不同浓度的对葡糖酸锑钠无反应或有反应的分离株与未治疗对照组之间差异的显著性，p<0.05被定义为显著水平。总共，89.8%的患者通过葡糖酸锑钠治愈，而10.2%仍未治愈。
葡糖酸锑钠在不同年龄组和性别的总体疗效相似。对葡糖酸锑钠无反应的分离株的前鞭毛体和无鞭毛体的IC值分别比有反应病例的等效率高2.1倍和2.6倍。无反应分离株中巨噬细胞内无鞭毛体的总体平均数量显著高于有反应分离株（32.68±1.24）（18.68±1.52，p<0.001）。由热带利什曼原虫引起的人源性CL（ACL）的对葡糖酸锑钠无反应和有反应的现场分离株与体外试验密切相关。
在人类发生人源性传播的地方，通过健康监测系统监测对葡糖酸锑钠的无反应性极其重要。因此，医生应了解ACL这种对锑剂治疗失败的临床无反应表现，以改善流行地区疾病的管理。
