Intralesional Meglumine Antimoniate for Treatment of Cutaneous Leishmaniasis Patients with Contraindication to Systemic Therapy from Rio de Janeiro (2000 to 2006)

We report a case of a 42 year-old female, who came to a leishmaniasis reference center in Rio de Janeiro, Brazil, presenting a cutaneous leishmaniasis lesion in the right forearm. Treatment with low-dose intramuscular meglumine antimoniate (MA) (5 mg Sb5+/kg/day) was initiated, with improvement after 28 days, although with the development of generalized eczema. After 87 days, the lesion worsened. Patient refused treatment with amphotericin B. MA was then infiltrated in the lesion, in two sessions, resulting in local eczema, with bullae formation; however, twenty days after, both the ulcer and eczema receded. Intralesional administration of MA should be used carefully when previous cutaneous hypersensitivity is detected.

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An old drug and different ways to treat cutaneous leishmaniasis: Intralesional and intramuscular meglumine antimoniate in a reference center, Rio de Janeiro, Brazil

PLoS Neglected Tropical Diseases ◽

10.1371/journal.pntd.0009734 ◽

2021 ◽

Vol 15 (9) ◽

pp. e0009734

Author(s):

Carla Oliveira-Ribeiro ◽

Maria Inês Fernandes Pimentel ◽

Liliane de Fátima Antonio Oliveira ◽

Érica de Camargo Ferreira e Vasconcellos ◽

Fatima Conceição-Silva ◽

...

Keyword(s):

Cutaneous Leishmaniasis ◽

Rio De Janeiro ◽

Treatment Interruption ◽

Complete Healing ◽

Cutaneous Lesions ◽

Chi Square ◽

Standard Regimen ◽

Historical Cohort ◽

Reference Center ◽

Meglumine Antimoniate

Background Treatment of cutaneous leishmaniasis (CL) remains challenging since the drugs currently used are quite toxic, thus contributing to lethality unrelated to the disease itself but to adverse events (AE). The main objective was to evaluate different treatment regimens with meglumine antimoniate (MA), in a reference center in Rio de Janeiro, Brazil. Methodology A historical cohort of 592 patients that underwent physical and laboratory examination were enrolled between 2000 and 2017. The outcome measures of effectiveness were epithelialization and complete healing of cutaneous lesions. AE were graded using a standardized scale. Three groups were evaluated: Standard regimen (SR): intramuscular (IM) MA 10–20 mg Sb5+/kg/day during 20 days (n = 46); Alternative regimen (AR): IM MA 5 mg Sb5+/kg/day during 30 days (n = 456); Intralesional route (IL): MA infiltration in the lesion(s) through subcutaneous injections (n = 90). Statistical analysis was performed through Fisher exact and Pearson Chi-square tests, Kruskal-Wallis, Kaplan-Meier and log-rank tests. Results SR, AR and IL showed efficacy of 95.3%, 84.3% and 75.9%, with abandonment rate of 6.5%, 2.4% and 3.4%, respectively. IL patients had more comorbidities (58.9%; p = 0.001), were mostly over 50 years of age (55.6%), and had an evolution time longer than 2 months (65.6%; p = 0.02). Time for epithelialization and complete healing were similar in IL and IM MA groups (p = 0.9 and p = 0.5; respectively). Total AE and moderate to severe AE that frequently led to treatment interruption were more common in SR group, while AR and IL showed less toxicity. Conclusions/Significance AR and IL showed less toxicity and may be good options especially in CL cases with comorbidities, although SR treatment was more effective. IL treatment was an effective and safe strategy, and it may be used as first therapy option as well as a rescue scheme in patients initially treated with other drugs.

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FACTORS ASSOCIATED TO ADHERENCE TO DIFFERENT TREATMENT SCHEMES WITH MEGLUMINE ANTIMONIATE IN A CLINICAL TRIAL FOR CUTANEOUS LEISHMANIASIS

Revista do Instituto de Medicina Tropical de São Paulo ◽

10.1590/s0036-46652014000400004 ◽

2014 ◽

Vol 56 (4) ◽

pp. 291-296 ◽

Cited By ~ 6

Author(s):

Madelon Novato Ribeiro ◽

Maria Inês Fernandes Pimentel ◽

Armando de Oliveira Schubach ◽

Raquel de Vasconcellos Carvalhães de Oliveira ◽

José Liporage Teixeira ◽

...

Keyword(s):

Clinical Trial ◽

Cutaneous Leishmaniasis ◽

Low Dose ◽

Lower Number ◽

Adherence To Treatment ◽

Simple Method ◽

Meglumine Antimoniate ◽

Factors Associated ◽

Adherence Monitoring ◽

Socioeconomic Data

The favorable outcome of the treatment of a disease is influenced by the adherence to therapy. Our objective was to assess factors associated with adherence to treatment of patients included in a clinical trial of equivalence between the standard and alternative treatment schemes with meglumine antimoniate (MA) in the treatment of cutaneous leishmaniasis (CL), in the state of Rio de Janeiro. Between 2008 and 2011, 57 patients with CL were interviewed using a questionnaire to collect socioeconomic data. The following methods were used for adherence monitoring: counting of vial surplus, monitoring card, Morisky test and modified Morisky test (without the question regarding the schedule); we observed 82.1% (vial return), 86.0% (monitoring card), 66.7% (Morisky test) and 86.0% (modified Morisky test) adherence. There was a strong correlation between the method of vial counting and the monitoring card and modified Morisky test. A significant association was observed between greater adherence to treatment and low dose of MA, as well as with a lower number of people sleeping in the same room. We recommend the use of the modified Morisky test to assess adherence to treatment of CL with MA, because it is a simple method and with a good performance, when compared to other methods.

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Intralesional meglumine antimoniate for the treatment of localised cutaneous leishmaniasis: a retrospective review of a Brazilian referral centre

Memórias do Instituto Oswaldo Cruz ◽

10.1590/0074-02760160183 ◽

2016 ◽

Vol 111 (8) ◽

pp. 512-516 ◽

Cited By ~ 17

Author(s):

Rosiana Estéfane da Silva ◽

Antonio Toledo Júnior ◽

Maria Camilo Senna ◽

Ana Rabello ◽

Gláucia Cota

Keyword(s):

Cutaneous Leishmaniasis ◽

Retrospective Review ◽

Referral Centre ◽

Meglumine Antimoniate

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Comparison of Oral Zinc Sulfate with Systemic Meglumine Antimoniate in the Treatment of Cutaneous Leishmaniasis

Dermatology Research and Practice ◽

10.1155/2011/269515 ◽

2011 ◽

Vol 2011 ◽

pp. 1-4 ◽

Cited By ~ 9

Author(s):

Mohamad Javad Yazdanpanah ◽

Mahnaz Banihashemi ◽

Fakhrozaman Pezeshkpoor ◽

Mohammad Khajedaluee ◽

Sororozaman Famili ◽

...

Keyword(s):

Side Effects ◽

Cutaneous Leishmaniasis ◽

Side Effect ◽

Zinc Sulfate ◽

Cure Rate ◽

Meglumine Antimoniate ◽

Treatment Groups ◽

Significant Difference

The purpose of this study was to investigate comparison between oral zinc sulfate and meglumine antimoniate in the treatment of cutaneous leishmaniasis (CL). So 100 patients with CL were included and randomly divided into two groups. The first group was treated with oral zinc sulfate (10 mg/kg/day during 45 days period), and the second group was treated with systemic meglumine antimoniate (20 mg/kg/day intramuscularly for 20 days). Acceptable cure after completing 45 days of followup occurred in 30.2% of lesions in first group, while this was 35.5% for the second group. There is not any significant difference between the two treatment groups (P=0.42). Serious side effects resulting in treatment discounting occurred in only meglumine antimoniate group. Although cure rate of systemic meglumine antimoniate group was better the treatment with zinc sulfate is much easier, cheaper, more convenient in consumption, safer, and nearly close cure percentage to systemic meglumine antimoniate injections without serious side effect.

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American cutaneous leishmaniasis in two cats from Rio de Janeiro, Brazil: first report of natural infection with Leishmania (Viannia) braziliensis

Transactions of the Royal Society of Tropical Medicine and Hygiene ◽

10.1016/s0035-9203(03)00040-3 ◽

2004 ◽

Vol 98 (3) ◽

pp. 165-167 ◽

Cited By ~ 29

Author(s):

T.M.P Schubach ◽

F.B Figueiredo ◽

S.A Pereira ◽

M.F Madeira ◽

I.B Santos ◽

...

Keyword(s):

Cutaneous Leishmaniasis ◽

Rio De Janeiro ◽

Natural Infection ◽

First Report ◽

American Cutaneous Leishmaniasis

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Zoonotic cutaneous leishmaniasis due to Leishmania (Viannia) braziliensis associated with domestic animals in Venezuela and Brazil

Memórias do Instituto Oswaldo Cruz ◽

10.1590/s0074-02761989000100005 ◽

1989 ◽

Vol 84 (1) ◽

pp. 19-28 ◽

Cited By ~ 42

Author(s):

Cruz Manuel Aguilar ◽

Elizabeth F. Rangel ◽

Leonardo Garcia ◽

Elio Fernandez ◽

Hooman Momen ◽

...

Keyword(s):

Cutaneous Leishmaniasis ◽

Rio De Janeiro ◽

Domestic Animals ◽

Source Of Infection ◽

Zoonotic Cutaneous Leishmaniasis ◽

Significant Difference ◽

Janeiro State ◽

Enzootic Cycle

After outbreaks of cutaneous leishmaniasis in Solano State, Venezuela, 5% of the population had parasitized ulcers while after similar outbreaks in Mesquita, Rio de Janeiro State, Brazil, 9% had the disease. In these foci children, including some under six years of age, wre affected. There was no significant difference in the occurence of the disease according to sex or type of employment. In Solano, 3% of dogs and 28% of donkeys had parasitized lesions, while in Mesquita these indices were 19.8% and 30.8% respectively. The parasite from man, dogs and equines was identified as Leishmania (Viannia) braziliensis, by zymodeme and serodeme characterization. In these foci there is evidence suggesting that leishmaniasis is a zoonosis, possibly with equine and dogs as reservoirs, although both a wild enzootic cycle and the role of man as a source of infection can not be ruled out. Transmission is assumed to occur peridomestically by sandfly vectors such as Lutzomyia panamensis in Venezuela and Lutzomyia intermedia in Brazil. Information about the origin of these foci suggests that infected equines may be an important factor in the dissemination of the parasite in a peridomestic situation where these sandflies are abundant.

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