Liposomal amphotericin B in travelers with cutaneous and muco-cutaneous leishmaniasis: Not a panacea.
Complex cutaneous and muco-cutaneous leishmaniasis (CL and MCL) often requires systemic therapy. Liposomal amphotericin B (L-AmB) has a strong potential for a solid clinical benefit in this indication.We conducted a retrospective analysis of data from a French centralized referral treatment program...
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ftdoajarticles:oai:doaj.org/article:db3f303a03924347b5ef20a387c6d066 2023-05-15T15:14:12+02:00 Liposomal amphotericin B in travelers with cutaneous and muco-cutaneous leishmaniasis: Not a panacea. Romain Guery Benoit Henry Guillaume Martin-Blondel Claire Rouzaud Florence Cordoliani Gundel Harms Jean-Pierre Gangneux Françoise Foulet Emmanuelle Bourrat Michel Baccard Gloria Morizot Paul-Henri Consigny Antoine Berry Johannes Blum Olivier Lortholary Pierre Buffet French Cutaneous Leishmaniasis Study group & the LeishMan network 2017-11-01T00:00:00Z https://doi.org/10.1371/journal.pntd.0006094 https://doaj.org/article/db3f303a03924347b5ef20a387c6d066 EN eng Public Library of Science (PLoS) http://europepmc.org/articles/PMC5714383?pdf=render https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0006094 https://doaj.org/article/db3f303a03924347b5ef20a387c6d066 PLoS Neglected Tropical Diseases, Vol 11, Iss 11, p e0006094 (2017) Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 article 2017 ftdoajarticles https://doi.org/10.1371/journal.pntd.0006094 2022-12-31T00:34:17Z Complex cutaneous and muco-cutaneous leishmaniasis (CL and MCL) often requires systemic therapy. Liposomal amphotericin B (L-AmB) has a strong potential for a solid clinical benefit in this indication.We conducted a retrospective analysis of data from a French centralized referral treatment program and from the "LeishMan" European consortium database. All patients with parasitologically proven CL or MCL who received at least one dose of L-AmB were included. Positive outcome was based on ulcer closure as per recent WHO workshop guidelines.From 2008 through 2016, 43 travelers returning from 18 countries (Old World n = 28; New World n = 15) were analyzed with a median follow-up duration of 79 days [range 28-803]. Main clinical forms were: localized CL with one or multiple lesions (n = 32; 74%) and MCL (n = 8; 19%). As per published criteria 19 of 41 patients (46%) were cured 90 days after one course of L-AmB. When the following items -improvement before day 90 but no subsequent follow-up, delayed healing (>3 months) and healing after a second course of L-AmB- were included in the definition of cure, 27 of 43 patients (63%) had a positive outcome. Five patients (MCL = 1; CL = 4) experienced a relapse after a median duration of 6 months [range 3-27] post treatment and 53% of patients (23/43) experienced at least one adverse event including severe hypokalaemia and acute cardiac failure (one patient each). In multivariate analysis, tegumentary infection with L. infantum was associated with complete healing after L-AmB therapy (OR 5.8 IC 95% [1.03-32]) while infection with other species had no impact on outcome.In conditions close to current medical practice, the therapeutic window of L-AmB was narrow in travellers with CL or MCL, with the possible exception of those infected with L. infantum. Strict follow-up is warranted when using L-AmB in patients with mild disease. Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic PLOS Neglected Tropical Diseases 11 11 e0006094 |
institution |
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Directory of Open Access Journals: DOAJ Articles |
op_collection_id |
ftdoajarticles |
language |
English |
topic |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
spellingShingle |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Romain Guery Benoit Henry Guillaume Martin-Blondel Claire Rouzaud Florence Cordoliani Gundel Harms Jean-Pierre Gangneux Françoise Foulet Emmanuelle Bourrat Michel Baccard Gloria Morizot Paul-Henri Consigny Antoine Berry Johannes Blum Olivier Lortholary Pierre Buffet French Cutaneous Leishmaniasis Study group & the LeishMan network Liposomal amphotericin B in travelers with cutaneous and muco-cutaneous leishmaniasis: Not a panacea. |
topic_facet |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
description |
Complex cutaneous and muco-cutaneous leishmaniasis (CL and MCL) often requires systemic therapy. Liposomal amphotericin B (L-AmB) has a strong potential for a solid clinical benefit in this indication.We conducted a retrospective analysis of data from a French centralized referral treatment program and from the "LeishMan" European consortium database. All patients with parasitologically proven CL or MCL who received at least one dose of L-AmB were included. Positive outcome was based on ulcer closure as per recent WHO workshop guidelines.From 2008 through 2016, 43 travelers returning from 18 countries (Old World n = 28; New World n = 15) were analyzed with a median follow-up duration of 79 days [range 28-803]. Main clinical forms were: localized CL with one or multiple lesions (n = 32; 74%) and MCL (n = 8; 19%). As per published criteria 19 of 41 patients (46%) were cured 90 days after one course of L-AmB. When the following items -improvement before day 90 but no subsequent follow-up, delayed healing (>3 months) and healing after a second course of L-AmB- were included in the definition of cure, 27 of 43 patients (63%) had a positive outcome. Five patients (MCL = 1; CL = 4) experienced a relapse after a median duration of 6 months [range 3-27] post treatment and 53% of patients (23/43) experienced at least one adverse event including severe hypokalaemia and acute cardiac failure (one patient each). In multivariate analysis, tegumentary infection with L. infantum was associated with complete healing after L-AmB therapy (OR 5.8 IC 95% [1.03-32]) while infection with other species had no impact on outcome.In conditions close to current medical practice, the therapeutic window of L-AmB was narrow in travellers with CL or MCL, with the possible exception of those infected with L. infantum. Strict follow-up is warranted when using L-AmB in patients with mild disease. |
format |
Article in Journal/Newspaper |
author |
Romain Guery Benoit Henry Guillaume Martin-Blondel Claire Rouzaud Florence Cordoliani Gundel Harms Jean-Pierre Gangneux Françoise Foulet Emmanuelle Bourrat Michel Baccard Gloria Morizot Paul-Henri Consigny Antoine Berry Johannes Blum Olivier Lortholary Pierre Buffet French Cutaneous Leishmaniasis Study group & the LeishMan network |
author_facet |
Romain Guery Benoit Henry Guillaume Martin-Blondel Claire Rouzaud Florence Cordoliani Gundel Harms Jean-Pierre Gangneux Françoise Foulet Emmanuelle Bourrat Michel Baccard Gloria Morizot Paul-Henri Consigny Antoine Berry Johannes Blum Olivier Lortholary Pierre Buffet French Cutaneous Leishmaniasis Study group & the LeishMan network |
author_sort |
Romain Guery |
title |
Liposomal amphotericin B in travelers with cutaneous and muco-cutaneous leishmaniasis: Not a panacea. |
title_short |
Liposomal amphotericin B in travelers with cutaneous and muco-cutaneous leishmaniasis: Not a panacea. |
title_full |
Liposomal amphotericin B in travelers with cutaneous and muco-cutaneous leishmaniasis: Not a panacea. |
title_fullStr |
Liposomal amphotericin B in travelers with cutaneous and muco-cutaneous leishmaniasis: Not a panacea. |
title_full_unstemmed |
Liposomal amphotericin B in travelers with cutaneous and muco-cutaneous leishmaniasis: Not a panacea. |
title_sort |
liposomal amphotericin b in travelers with cutaneous and muco-cutaneous leishmaniasis: not a panacea. |
publisher |
Public Library of Science (PLoS) |
publishDate |
2017 |
url |
https://doi.org/10.1371/journal.pntd.0006094 https://doaj.org/article/db3f303a03924347b5ef20a387c6d066 |
geographic |
Arctic |
geographic_facet |
Arctic |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
PLoS Neglected Tropical Diseases, Vol 11, Iss 11, p e0006094 (2017) |
op_relation |
http://europepmc.org/articles/PMC5714383?pdf=render https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0006094 https://doaj.org/article/db3f303a03924347b5ef20a387c6d066 |
op_doi |
https://doi.org/10.1371/journal.pntd.0006094 |
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PLOS Neglected Tropical Diseases |
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11 |
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11 |
container_start_page |
e0006094 |
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