Prediction score for antimony treatment failure in patients with ulcerative leishmaniasis lesions.

BACKGROUND: Increased rates for failure in leishmaniasis antimony treatment have been recently recognized worldwide. Although several risk factors have been identified there is no clinical score to predict antimony therapy failure of cutaneous leishmaniasis. METHODS: A case control study was conduct...

Full description

Bibliographic Details
Published in:PLoS Neglected Tropical Diseases
Main Authors: Cristian Valencia, Jorge Arévalo, Jean Claude Dujardin, Alejandro Llanos-Cuentas, François Chappuis, Mirko Zimic
Format: Article in Journal/Newspaper
Language:English
Published: Public Library of Science (PLoS) 2012
Subjects:
Online Access:https://doi.org/10.1371/journal.pntd.0001656
https://doaj.org/article/d6acec308d1748bcbb4e56fd665ffb1d
Description
Summary:BACKGROUND: Increased rates for failure in leishmaniasis antimony treatment have been recently recognized worldwide. Although several risk factors have been identified there is no clinical score to predict antimony therapy failure of cutaneous leishmaniasis. METHODS: A case control study was conducted in Peru from 2001 to 2004. 171 patients were treated with pentavalent antimony and followed up to at least 6 months to determine cure or failure. Only patients with ulcerative cutaneous leishmaniasis (N=87) were considered for data analysis. Epidemiological, demographical, clinical and laboratory data were analyzed to identify risk factors for treatment failure. Two prognostic scores for antimonial treatment failure were tested for sensitivity and specificity to predict antimony therapy failure by comparison with treatment outcome. RESULTS: Among 87 antimony-treated patients, 18 (21%) failed the treatment and 69 (79%) were cured. A novel risk factor for treatment failure was identified: presence of concomitant distant lesions. Patients presenting concomitant-distant lesions showed a 30.5-fold increase in the risk of treatment failure compared to other patients. The best prognostic score for antimonial treatment failure showed a sensitivity of 77.78% and specificity of 95.52% to predict antimony therapy failure. CONCLUSIONS: A prognostic score including a novel risk factor was able to predict antimonial treatment failure in cutaneous leishmaniasis with high specificity and sensitivity. This prognostic score presents practical advantages as it relies on clinical and epidemiological characteristics, easily obtained by physicians or health workers, and makes it a promising clinical tool that needs to be validated before their use for developing countries.