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A Species-Specific Approach to the Use of Non-Antimony Treatments for Cutaneous Leishmaniasis

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  • Clinical Parasitology Unit and Helminth Immunology Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland; Center for Immunization Research, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Laboratory Medicine, National Institutes of Health, Bethesda, Maryland; Gastrointestinal Parasites Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
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We used a species-specific approach to treat 10 patients with cutaneous leishmaniasis diagnosed using polymerase chain reaction. Non-antimony treatments (oral miltefosine, ketoconazole, and liposomal amphotericin B) were chosen as an alternative to pentavalent antimony drugs based on likely or proven drug efficacy against the infecting species. Leishmania Viannia panamensis was diagnosed in three patients and treated successfully with oral ketoconazole. Miltefosine treatment cured two patients with L. infantum chagasi. A wide variety of Leishmania responded to liposomal amphotericin B administered for 5–7 days. Three patients with L. V. braziliensis, one patient with L. tropica, and two patients with L. infantum chagasi were treated successfully. One person with L. V. braziliensis healed slowly because of a resistant bacterial superinfection, and a second patient with L. infantum chagasi relapsed and was retreated with miltefosine. These drugs were reasonably well-tolerated. In this limited case series, alternative non-antimony–based regimens were convenient, safe, and effective.

Author Notes

*Address correspondence to Roshan Ramanathan, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, 4 Center Drive, Building 4, Room B-105, National Institutes of Health, Bethesda, MD 20902. E-mail: ramanathanr@niaid.nih.gov

Authors' addresses: Roshan Ramanathan, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, E-mail: ramanathanr@niaid.nih.gov. Kawsar R. Talaat, International Health Center for Immunization Research, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, E-mail: ktalaat@jhsph.edu. Daniel P. Fedorko, Department of Laboratory Medicine, National Institutes of Health, Bethesda, MD, E-mail: dfedorko@mail.nih.gov. Siddhartha Mahanty, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, E-mail: smahanty@niaid.nih.gov. Theodore E. Nash, Gastrointestinal Parasites Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, E-mail: tnash@niaid.nih.gov.

Reprint requests: Roshan Ramanathan, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, 4 Center Drive, Room 4/B1-05, Bethesda, MD 20892, E-mail: ramanathanr@niaid.nih.gov.

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