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Am. J. Trop. Med. Hyg., 73(1), 2005, pp. 79-81
Copyright © 2005 by The American Society of Tropical Medicine and Hygiene

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SUCCESSFUL TREATMENT OF REFRACTORY CUTANEOUS LEISHMANIASIS WITH GM-CSF AND ANTIMONIALS

ROQUE P. ALMEIDA, JUSSAMARA BRITO, PAULO L. MACHADO, AMÉLIA R. DE JESUS, ALBERT SCHRIEFER, LUIZ HENRIQUE GUIMARÃES, AND EDGAR M. CARVALHO*
Serviço de Imunologia, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil; Instituto de Investigação em Imunologia (iii)/CNPq, São Paulo, Brazil

Therapeutic failure in the treatment of cutaneous leishmaniasis (CL) occurs in 5% of patients infected by Leishmania braziliensis. This study evaluates the use of topically applied granulocyte macrophage colony-stimulating factor (GM-CSF) combined with the standard dose of antimony to treat refractory cases of CL. Five patients who had received three courses or more of antimony were enrolled in an open-label clinical trial. One to 2 mL of the GM-CSF solution (10 µg/mL in 0.9% saline) was reapplied topically, and dressings were changed three times per week for 3 weeks, associated with standard parenteral antimony (20 mg kg–1 day–1 for 20 days). All the patients healed their CL ulcers; 3 healed within 50 days (21, 27, and 44 days) and 2 in 118 and 120 days after beginning therapy. There were no side effects. This study shows that combined topically applied GM-CSF and antimony can be effective and well tolerated in the treatment of relapsed CL.

Received September 2, 2004. Accepted for publication February 26, 2005.

Acknowledgments: The authors thank the patients included in this study. The authors thank Maria Neuza S. Souza, health post assistant, who applied the medication. We also thank Ednaldo Lago and the personnel from Corte de Pedra Health Post for their assistance and Mrs. Elbe M. S. Silva for preparing the manuscript.

Financial support This study was supported by the Brazilian Research Council (CNPq) and Fundação de Apoio à Pesquisa do Estado da Bahia (FAPESB). Dr. Edgar M. Carvalho is a senior investigator of CNPq.

* Address correspondence to Edgar M. Carvalho, Serviço de Imunologia, Hospital Universitário Prof. Edgard Santos, UFBA, Rua João das Botas s/n, Canela, 40110-160, BA, Brazil. E-mail: edgar{at}ufba.br; imuno{at}ufba.br

Authors’ addresses: Roque P. Almeida (E-mail: roque{at}ufba.br), Jussamara Brito (E-mail: imuno{at}ufba.br), Paulo L. Machado (E-mail: imuno{at}ufba.br), Amélia R. de Jesus (E-mail: amelia{at}ufba.br), Albert Schriefer (E-mail: imuno{at}ufba.br), Luiz Henrique Guimarães (E-mail: umuno{at}ufba.br), Edgar M. Carvalho (E-mail: edgar{at}ufba.br), Serviço de Imunologia, Hospital Universitário Prof. Edgar Santos, UFBA, Rua João das Botas s/n, Canela, 40110-160, BA, Brazil.

Reprint requests: Edgar M. Carvalho, Serviço de Imunologia, Hospital Universitário Prof. Edgard Santos, UFBA, Rua João das Botas s/n, Canela, 40110-160, BA, Brazil, Telephone: (55.71) 237-7353, Fax: (55.71) 245-7110, E-mail: edgar{at}ufba.br; imuno{at}ufba.br.






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Copyright © 2005 by the American Society of Tropical Medicine and Hygiene.