Association of treatment of American cutaneous leishmaniasis prior to ulcer development with high rate of failure in Northeastern Brazil

Alon Unger, Seth O'Neal, Paulo R L Machado, Luiz H. Guimarães, Daniel J. Morgan, Albert Schriefer, Olívia Bacellar, Marshall J. Glesby, Edgar M. Carvalho

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Abstract

Cure rates for American cutaneous leishmaniasis (ACL) range between 60% and 90%. Early evidence suggests lower cure rates for early ACL before the development of the ulceration. We evaluated risk factors for treatment failure in patients with early and classic ulcerative ACL. Patients (n = 136) were 13-60 years of age and had lesions with a duration of 15-90-days. Patients were treated with antimony (20 mg/kg/day for 20 days). The primary outcome was lesion cure by 90 days without recurrence. Patients with early ACL (n = 16) had papules, nodules, plaques, or superficial ulcerations with less than 30 days of illness. Patients with classic ulcerative ACL (n = 120) had ulcerated classic lesions, longer duration, larger lesions, and higher levels of interferon-γ and tumor necrosis factor-α (P <0.01 for all comparisons). Ulcerated lesions were associated with a lower treatment failure rate compared with early ACL (25.8% versus 75.0%; P <0.001). Early treatment of ACL does not prevent lesion ulceration and is associated with higher rates of treatment failure.

Original languageEnglish (US)
Pages (from-to)574-579
Number of pages6
JournalAmerican Journal of Tropical Medicine and Hygiene
Volume80
Issue number4
StatePublished - Apr 2009

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Cutaneous Leishmaniasis
Ulcer
Brazil
Therapeutics
Treatment Failure
Antimony
Sick Leave
Interferons

ASJC Scopus subject areas

  • Parasitology
  • Infectious Diseases
  • Virology
  • Medicine(all)

Cite this

Association of treatment of American cutaneous leishmaniasis prior to ulcer development with high rate of failure in Northeastern Brazil. / Unger, Alon; O'Neal, Seth; Machado, Paulo R L; Guimarães, Luiz H.; Morgan, Daniel J.; Schriefer, Albert; Bacellar, Olívia; Glesby, Marshall J.; Carvalho, Edgar M.

In: American Journal of Tropical Medicine and Hygiene, Vol. 80, No. 4, 04.2009, p. 574-579.

Research output: Contribution to journalArticle

Unger, A, O'Neal, S, Machado, PRL, Guimarães, LH, Morgan, DJ, Schriefer, A, Bacellar, O, Glesby, MJ & Carvalho, EM 2009, 'Association of treatment of American cutaneous leishmaniasis prior to ulcer development with high rate of failure in Northeastern Brazil', American Journal of Tropical Medicine and Hygiene, vol. 80, no. 4, pp. 574-579.
Unger, Alon ; O'Neal, Seth ; Machado, Paulo R L ; Guimarães, Luiz H. ; Morgan, Daniel J. ; Schriefer, Albert ; Bacellar, Olívia ; Glesby, Marshall J. ; Carvalho, Edgar M. / Association of treatment of American cutaneous leishmaniasis prior to ulcer development with high rate of failure in Northeastern Brazil. In: American Journal of Tropical Medicine and Hygiene. 2009 ; Vol. 80, No. 4. pp. 574-579.
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