Antihelminthic Therapy and Antimony in Cutaneous Leishmaniasis: A Randomized, Double-Blind, Placebo-Controlled Trial in Patients Co-Infected with Helminths and Leishmania braziliensis

AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE - Tập 84 Số 4 - Trang 551-555 - 2011
Tracey Newlove1, Luiz Henrique Guimarães, Daniel J. Morgan, Luíz Carlos Júnior Alcântara, Marshall J. Glesby, Edgar M. Carvalho, Paulo Roberto Lima Machado2
1College of Medicine, University of Arizona, Tucson, AZ, USA
2Serviço de Imu-nologia, Complexo Hospitalar Universitário Prof. Edgard Santos, UFBA, Rua João das Botas s/n, Canela, 40110-160, BA, Brazil.

Tóm tắt

Helminth infections influence the clinical response to certain diseases and are associated with delayed healing time of patients with cutaneous leishmaniasis (CL) caused by Leishmania braziliensis. We conducted a randomized, double-blind, placebo-controlled clinical trial to examine the role of early versus deferred treatment of intestinal helminth infection on the clinical course of patients with CL treated with pentavalent antimony. (Clinicaltrials.gov number NCT00469495). A total of 90 patients were enrolled, 51.1% (N = 23) of control patients had persistent lesions at Day 90, compared with 62.2% (N = 28) in the treatment group (difference 11.1%, 95% confidence interval = −9.1–30.0%). There was no statistically significant difference in overall time to cure between groups, although there was a tendency for shorter cure times in the control group. This study shows that early introduction of antihelminthic therapy does not improve clinical outcome in patients co-infected with helminths and L. braziliensis.

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Tài liệu tham khảo

Jones, 1987, Epidemiology of American cutaneous leishmaniasis due to Leishmania braziliensis, 156, 73

Correia, 1996, Comparative study of meglumine antimonate, pentamidine isethionate and aminosidine sulfate in the treatment of primary skin lesions caused by Leishmania (Vianna) braziliensis, 29, 447

Romero, 2001, Comparison of cutaneous leishmaniasis due to Leishmania (Viannia) braziliensis and L. (V.) guyanensis in Brazil: therapeutic response to meglumine antimoniate, 65, 456

Bacellar, 2002, Up-regulation of Th1-type responses in mucosal leishmaniasis patients, 70, 6734

Ribeiro-de-Jesus, 1998, Cytokine profile and pathology in human leishmaniasis, 31, 143

Bittencourt, 1991, Evaluation of the histopathological classifications of American cutaneous and mucocutaneous leishmaniasis, 86, 51

Machado, 2002, Failure of early treatment of cutaneous leishmaniasis in preventing the development of an ulcer, 34, e69

DaCruz, 1996, Tumor necrosis factor-alpha in human American tegumentary leishmaniasis, 91, 225

Almeida, 1999, Randomized, double-blind study of stibogluconate plus human granulocyte macrophage colony-stimulating factor versus stibogluconate alone in the treatment of cutaneous leishmaniasis, 180, 1735

Lessa, 2001, Successful treatment of refractory mucosal leishmaniasis with pentoxifylline plus antimony, 65, 87

Medeiros, 2003, Schistosoma mansoni infection is associated with a reduced course of asthma, 111, 947

Summers, 2003, Trichuris suis seems to be safe and possibly effective in the treatment of inflammatory bowel disease, 98, 2034

Maizels, 2005, Infections and allergy–helminths, hygiene and host immune regulation, 17, 656

Araujo, 2004, Impaired T helper 2 response to aeroallergen in helminth-infected patients with asthma, 190, 1797

O'Neal, 2007, Influence of helminth infections on the clinical course of and immune response to Leishmania braziliensis cutaneous leishmaniasis, 195, 142

Schriefer, 2004, Multiclonal Leishmania braziliensis population structure and its clinical implication in a region of endemicity for American tegumentary leishmaniasis, 72, 508

Reed, 1986, Selection of a skin test antigen for American visceral leishmaniasis, 35, 79

NIAID Division of AIDS Toxicity Grading Scale, 2007

Rocha, 1971, Prolonged Salmonella bacteremia in patients with Schistosoma mansoni infection, 128, 254