Article Category:
Research Article

Treatment of Bolivian Leishmania braziliensis Cutaneous and Mucosal Leishmaniasis

Jaime Soto FUNDERMA (Fundación Nacional de Dermatología) and Hospital Dermatológico de Jorochito, Santa Cruz, Bolivia;

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Patricia Gutiérrez FUNDERMA (Fundación Nacional de Dermatología) and Hospital Dermatológico de Jorochito, Santa Cruz, Bolivia;

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Paula Soto FUNDERMA (Fundación Nacional de Dermatología), Santa Cruz, Bolivia;

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David Paz Hospital Dermatológico de Jorochito, Santa Cruz, Bolivia;

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Eduardo Cayhuara Programa Nacional de Leishmaniasis, Ministerio de Salud del Estado Plurinacional de, La Paz, Bolivia;

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Carmen Molina Programa Nacional de Leishmaniasis, Ministerio de Salud del Estado Plurinacional de, La Paz, Bolivia;

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Mia Sánchez FUNDERMA (Fundación Nacional de Dermatología), Santa Cruz, Bolivia;

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Jonathan Berman AB Foundation, North Bethesda, Maryland;
Fast-Track Drugs, Potomac, Maryland

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DOI:
https://doi.org/10.4269/ajtmh.21-0928
Volume/Issue:
Volume 106: Issue 4
Page(s):
1182–1190
Restricted access
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ABSTRACT.

Although infection with Leishmania braziliensis is perhaps the key reason to treat New World cutaneous leishmaniasis (CL) and mucosal leishmaniasis (ML), the total literature contains relatively few reported cases. With the aim of supplementing the meager clinical information available, we searched the records of Jorochito (Dermatology) Hospital, Bolivia, for the years 1999–2020 and identified treatment records for 1,696 naive CL patients and 355 naive ML patients. Because follow-up was poor for this real-world treatment experience in the developing world, only 255 CL patients (15%) and 114 ML patients (32%) attended follow-up at Hospital. We therefore engaged in an Active Search for “lost” patients, located a further 542 CL patients (32%) and 142 ML patients (44%), thus eventually accomplished follow up on 697 CL patients (41%) and 256 ML patients (72%). Granular adverse event data derived from hospital records is listed for the 902 CL and 86 ML patients administered Glucantime intramuscularly, the 401 CL and 202 ML patients administered Glucantime intravenously, and the 163 CL and 89 ML patients administered miltefosine orally. Efficacy was obtained from hospital records for patients seen at hospital and from patient recall communicated by telephone for the patients found in the Active Search. The overall CL cure rate was 508 of 697 CL patients (73%) with follow-up: intramuscular Glucantime—196/293 (67%); intravenous Glucantime—90/126 (71%); intralesional Glucantime—34/54 (63%); oral miltefosine—52/69 (75%). The overall ML cure rate was 161 of 256 ML patients (63%) with follow-up: intramuscular Glucantime—26/48 (54%); intravenous Glucantime—66/104 (63%); intravenous amphotericin B deoxycholate—19/35 (54%); oral miltefosine—50/71 (70%). We offer this extensive adverse event and efficacy experience as useful guides for clinicians presented with a L. braziliensis infection. The cure rates also illustrate the quandary of New World CL and ML chemotherapy: sufficiently high to be useful but nevertheless needing augmentation with new agents.

Author Notes

Address correspondence to Jaime Soto, FUNDERMA (Fundación Nacional de Dermatología) and Hospital Dermatológico de Jorochito, Santa Cruz, Bolivia. E-mail: jaime.soto@infoleis.com.

Financial support: Grant from the AB Foundation to Dr. Jaime Soto.

Disclosure: J. D. B. is an employee of Fast-Track Drugs and Biologics, which has a contractual relationship with Knight Therapeutics, the NDA sponsor of Impavido (miltefosine).

Authors’ addresses: Jaime Soto and Patricia Gutiérrez, FUNDERMA (Fundación Nacional de Dermatología) and Hospital Dermatológico de Jorochito, Santa Cruz, Bolivia, E-mails: jaime.soto@infoleis.com and pgutierrezduenas@gmail.com. Paula Soto and Mia Sánchez, FUNDERMA (Fundación Nacional Dermatología), Santa Cruz, Bolivia, E-mails: dra.paula.dermalaser@gmail.com and sanchezmia1404@gmail.com. David Paz, Hospital Dermatológico de Jorochito, Santa Cruz, Bolivia, E-mail: davidpazmendoza@hotmail.com. Eduardo Cayhuara and Carmen Molina, Programa Nacional de Leishmaniasis, Ministerio de Salud del Estado Plurinacional de, Bolivia, E-mails: eduardocayhuara@gmail.com and carmen_molina123@hotmail.com. Jonathan Berman, AB Foundation, North Bethesda, MD, and Fast-Track Drugs, Potomac, MD, E-mail: jberman@fasttrackresearch.com.

Copyright:
© The American Society of Tropical Medicine and Hygiene 2022
Received:
25 Aug 2021
|
Accepted:
08 Nov 2021
|
Published Online:
24 Jan 2022
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
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