Intralesional Infiltration with Meglumine Antimoniate for the Treatment of Leishmaniasis Recidiva Cutis in Ecuador

Manuel Calvopiña Escuela de Medicina, Facultad de Ciencias de la Salud, Universidad De Las Américas (UDLA), Quito, Ecuador;

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William Cevallos Carrera de Medicina, Facultad de Ciencias Médicas, Universidad Central del Ecuador, Quito, Ecuador;

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Yolanda Paredes Laboratorio de Patología Clínica, Carrera de Laboratorio Clínico, Universidad Central del Ecuador, Quito, Ecuador;

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Edison Puebla Carrera de Medicina, Facultad de Ciencias Médicas, Universidad Central del Ecuador, Quito, Ecuador;

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Jessica Flores Carrera de Medicina, Facultad de Ciencias Médicas, Universidad Central del Ecuador, Quito, Ecuador;

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Richard Loor Carrera de Medicina, Facultad de Ciencias Médicas, Universidad Central del Ecuador, Quito, Ecuador;

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José Padilla Epidemiología, Distrito de Salud 17 D-12, Ministerio de Salud Pública del Ecuador, Quito, Ecuador

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Meglumine Antimoniate (MA), administered intramuscularly for 21 continuous days is the recommended treatment of leishmaniases in Ecuador. However, because of its toxicity and requirement for intramuscular injections, treatment is frequently abandoned before completion. In addition, therapeutic failure and reactivation are not uncommon. Here we evaluate the efficacy and safety of MA administered intralesionally (IL) in leishmaniasis recidiva cutis (LRC). LRC is a special clinical variant of cutaneous leishmaniasis, characterized by reactivation at the edges of a primary cured lesion, presenting with active papules around the scar. Twenty-one patients were included in the study. All were diagnosed parasitologically by one of three diagnostic methods (smear, culture, and Leishmanin skin test). Each patient received MA intralesionally weekly for 4 weeks. Each papule was infiltrated until complete saturation. On average, patients received 1 mL of MA per administration. The criterion of cure was the complete resolution of the papules. Follow up was performed at 30, 90, and 180 days after treatment. At day 30 after treatment, 19 (90.5%) of 21 patients were clinically cured. The two patients, who did not heal by the fourth application, were cured on the seventh and eighth dose, achieving a clinical cure of 100% without subsequent reactivation. Mild to moderate local pain during infiltration was the only adverse reaction experienced by 81% of patients. In one case, subsequent infiltrations were discontinued because of a local allergic reaction. Complete compliance of patients to treatment and the small volume of drug administered make this method of administering MA an effective, safe, and inexpensive alternative. Consequently, IL could replace intramuscular administration in the treatment of LRC in Ecuador.

Author Notes

Address correspondence to Manuel Calvopiña, Universidad De Las Américas (UDLA), Av. Granados E11-41 y Colimíes, P.O. Box 17-17-9788, Quito 170137, Ecuador. E-mail: manuel.calvopina@udla.edu.ec

Financial support: Proyectos Semilla, Comisión de Investigación Formativa, Universidad Central del Ecuador (cif-cv-fcm-16). In part by the Fundação de Assistência Médica Internacional (AMI) by Fernando Nobre, President of AMI, Lisboa, Portugal under the Project “Integrated Control of Leishmaniasis in Ecuador” (ICLE).

Authors’ addresses: Manuel Calvopiña, Escuela de Medicina, Universidad De Las Américas (UDLA) Quito, Ecuador, E-mail: manuel.calvopina@udla.edu.ec. William Cevallos, Edison Puebla, Jessica Flores, and Richard Loor, Carrera de Medicina, Universidad Central del Ecuador, Quito, Ecuador, E-mails: wcevallos@uce.edu.ec, puebla.edison@gmail.com, jessicaflores.uce.felsocem@outlook.es, and rieduard-09@hotmail.com. Yolanda Paredes, Laboratorio de Patología Clínica, Carrera de Laboratorio Clínico, Universidad Central del Ecuador, Quito, Ecuador, E-mail: paredesyolanda@yahoo.com. José Padilla, Epidemiología, Distrito de Salud 17 D-12, Ministerio de Salud Pública del Ecuador, Quito, Ecuador, E-mail: jose.padilla@17d12.mspz2.gob.ec.

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