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Association of Treatment of American Cutaneous Leishmaniasis Prior to Ulcer Development with High Rate of Failure in Northeastern Brazil

Cure rates for American cutaneous leishmaniasis (ACL) range between 60% and 90%. Early evidence suggests lower cure rates for early ACL before the development of the ulceration. We evaluated risk factors for treatment failure in patients with early and classic ulcerative ACL. Patients (n = 136) were 13–60 years of age and had lesions with a duration of 15–90-days. Patients were treated with antimony (20 mg/kg/day for 20 days). The primary outcome was lesion cure by 90 days without recurrence. Patients with early ACL (n = 16) had papules, nodules, plaques, or superficial ulcerations with less than 30 days of illness. Patients with classic ulcerative ACL (n = 120) had ulcerated classic lesions, longer duration, larger lesions, and higher levels of interferon- and tumor necrosis factor- (P 0.01 for all comparisons). Ulcerated lesions were associated with a lower treatment failure rate compared with early ACL (25.8% versus 75.0%; P < 0.001). Early treatment of ACL does not prevent lesion ulceration and is associated with higher rates of treatment failure.

Received August 5, 2008. Accepted for publication December 20, 2008.

Acknowledgments: We thank Elbe Silva for secretarial assistance in the preparation of the manuscript.

Financial support: This study was supported by the National Institutes of Health (NIH) grant T32 AI-07613, NIH/Fogarty International Center grant D43 TW007127, a Fogarty/Ellison fellowship to Alon Unger, and Fundação de Amparo à Pesquisa do Estado da Bahia.

^* Address correspondence to Edgar M. Carvalho, Serviço de Imunologia, 5° Andar, Hospital Universitário Professor Edgard Santos, Rua João das Botas, s/n 40110160 Canela, Salvador, Bahia, Brazil. E-mail: edgar{at}ufba.br

Authors’ addresses: Alon Unger, Departments of Medicine and Pediatrics, University of California, 10833 Le Conte Avenue, 12-335 MDCC, Mailcode 175217, Los Angeles, CA 90095, E-mail: AUnger{at}mednet.ucla.edu. Seth O’Neal, Department of Public Health and Preventive Medicine, Oregon Health and Sciences University, 3181 SW Sam Jackson Park Road, CCB 669, Portland OR 97239, E-mail: oneals{at}ohsu.edu. Paulo R. L. Machado, Luiz H. Guimarães, Albert Schriefer, Olívia Bacellar, and Edgar M. Carvalho, Serviço de Imunologia, 5° Andar, Hospital Universitário Professor Edgard Santos, Rua João das Botas, s/n 40110160 Canela, Salvador, Bahia, Brazil, E-mails: prlmachado{at}uol.com.br, aschriefer{at}globo.com, olivinha{at}ufba.br, and edgar{at}ufba.br. Daniel J. Morgan, Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, 100 North Greene Street, Lower Level, Baltimore, MD 21201, E-mail: danieljosiahmorgan{at}yahoo.com. Marshall J. Glesby, Department of Medicine, Weill Cornell Medical College 525 East 68th Street, Box 566, New York, NY 10021, E-mail: mag2005{at}med.cornell.edu.