Treatment Failure in Cutaneous Leishmaniasis Patients Referred to the School of Public Health, Tehran University of Medical Sciences During 2008–2017
-
Zahra Kakooei
,
Homa Hajjaran
,
Behnaz Akhoundi
,
Sorour Charehdar
,
Samira Elikaee
,
Zahra Shafeghat
,
Hamid Hassanpour
,
Mohammad Taghi Satvat
,
Elham Kazemi-Rad
,
Mehdi Mohebali
Abstract
Background: Cutaneous leishmaniasis (CL) is a vector borne disease predominantly found in tropical and subtropical countries, including Iran. For more than 6 decades, pentavalent antimonials have been used successfully worldwide for the treatment of leishmaniasis, but over the past few years, clinical resistance to these medications has increased. In this study, we evaluated CL patients who did not show any desirable responses to the anti-leishmanial treatment within a 10-year period (2008 to 2017).
Methods: All patients from different parts of Iran suspected of having cutaneous leishmaniasis, who were referred to the laboratory of leishmaniosis in Tehran University of Medical Sciences from 2008–2017 were parasitological examined.
Results: During this period, a total of 1480 suspected CL patients were referred to the laboratory of leishmaniosis. Samples from 655 patients (70.8%) suspected of having CL were positive microscopically. The failure rate in patients treated with anti-leishmaniasis medications for a minimum of three complete treatment periods was 1.83% (12 cases). There was no association between the number and size of skin lesions and patient characteristics. Also, the route of drug administration had no significant effect on the number and size of lesions.
Conclusion: In the present study, treatment failure was found in some confirmed CL patients treated with meglumine antimoniate. Over the past few years, it seems that had been increased in resistance to these medications. So, a review of the correct implementation of the treatment protocol and/or a combination therapy may be helpful in preventing an increase in the rate of treatment failure.
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2. World Health Organization (2002) An in-creasing risk factor for leishmaniasis (Week¬ly Epidemiological Record. WHO Press. 77(44): 365–370.
3. Nadim A, Javadian E, Mohebali M, Zamen Moemeni A (2008) Leishmania and Leish¬maniasis in Iran, Second edition. Academic Publication Center, Tehran (In Per¬sian).
4. Ferreira FM, Castro RA, Batista MA, Rossi FMO, Silveria-Lemos D, Fre¬zard F, A.L.Moura S, Rezende SA (2014) As-sociation of water extract of green prop-olis and liposomal meglu¬mine an¬timoni-ate in the treatment of exper¬i¬mental vis-ceral leishmaniasis. Parasitol Res. 113 (2): 533–543.
5. Treatment and medical education of Iran (2002–2003) Diseases Management Cen¬ter, Ministry of Health, Treatment and Med¬ical Education. Annual Com-muni¬cable Diseases Report. Ministry of Health, Treatment and Medical Educa-tion Press, Iran.
6. Firdous R, Yasunzai M, Ranja K (2009) Efficacy of Glucantime® in the treat-ment of old world cutaneous leish¬mani-asis. Int J Dermatol. 48(7): 758–762.
7. Soleimanifard S, Arjmand R, Saberi S, Salehi M, Hejazi SH (2017) Treatment outcome of the drug-resistant zoonotic cutaneous leishmaniasis by Glucan-time®. Adv Bi¬omed Res. 6: 17.
8. Croft SL (2001) Monitoring drug re-sistance in leishmaniasis. Trop Med Int Health. 6(11): 899–905.
9. Croft SL, Sundar S, Fairlamb AH (2006) Drug resistance in leishmaniasis. Clin Microbiol Rev. 19(1): 111–126.
10. Hadighi R, Mohebali M, Boucher P, Haj-jaran H, Khamesipour A, Ouellette M (2006) Unresponsiveness to Glucan-time® treatment in Iranian Cutaneous leishman¬iasis due to drug resistant Leishmania tropica parasites. PLOS Medicine. 3(5): 162: 0659–0667.
11. Rodrigues AM, Hueb M, Santos TA, Fer-nandes CJ (2006) Factors associated with treatment failure of cutaneous leishmaniasis with meglumine anti¬mo-niate. Rev Soc Bras Med Trop. 39(2): 139–145.
12. Samady JA, Janniger CK, Schwartz RA (1996) Cutaneous and mucocutaneous leishmaniasis. Cutis. 57: 13–20.
13. Mohammadzadeh M, Behnaz F, Golshan Z (2013) Efficacy of Glucantime® for treatment of cutaneous leishmaniasis in central Iran. J Infect Public Health. 6(2): 120–124.
14. Hajjaran H, Mohebali H, Teimouri A, Oshaghi MA, Mirjalali H, Kazemi-Rad E, Shiee MR, Naddaf SR (2014) Identi-fication and phylogenetic rela¬tionship of Iranian strains of various and visceral cases of leishmaniasis based on N-acetyl¬glucosamin-1-phos¬phate transfer-ase gene. Infect Genet Evol. 26: 203–212.
15. Shirzadi MR (2012) Handbook of Cuta-neous Leishmaniasis Care in Iran. Ra¬zi Nahan Publication. (In Persian).
16. Magill AJ (2005) cutaneous leishmaniasis in the returning traveler. Infect Dis Clin North Am. 19(1): 241–266.
17. Holakouie-Naieni K, Mostafavi E, Dar-vishi Boloorani A, Mohebali M, Pakzad R (2017) Reprint of “Spatial modeling of cutaneous leishmaniasis in Iran from 1983 to 2013”. Acta Trop. 65: 90–95.
18. Killick-Kendrick R (1999) the biology and control of Phlebotominae sand flies. Clin Dermatol.17(3): 279–289.
19. Grogl M, Thomason TN, Franke ED (1992) Drug resistance in leishmania¬sis: its implication in systemic chem¬other¬apy of cutaneous and mucocuta¬neus diseas-es. Am J Trop Med Hyg. 47(1): 117–260.
20. Lira R, Sundar S, Makharia A, Kenney R, Gam A, Saraiva E, Sacks D (1999) Evi-dence that the high incidence of treat-ment failures in Indian kala-azar is due to the emergence of antimony-resistant strains of Leishmania do¬novani. J Infect Dis. 180(2): 546–547.
21. Gramiccia M, Gradoni L, Orsini S (1992) Decreased sensitivity to meglumine an-timoniate (Glucantime®) of Leish¬mania infantum isolated from Dogs after sev-eral courses of drug treat¬ment. Ann Trop Med Parasit. 86(6): 613–620.
22. Rojas R, Valderrama L, Valderrama M, Va¬rona MX, Ouellette M, Saravia NG (2006) Resistance to antimony and treatment fail¬ure in human Leishmania viannia infection. J Infect Dis. 193(10): 1375–1383.
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| Files | ||
| Issue | Vol 14 No 4 (2020) | |
| Section | Original Article | |
| DOI | https://doi.org/10.18502/jad.v14i4.5274 | |
| Keywords | ||
| Cutaneous leishmaniasis; Anti-Leishmania drug; Treatment failure; Iran | ||
| Rights and permissions | |
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Kakooei Z, Hajjaran H, Akhoundi B, Charehdar S, Elikaee S, Shafeghat Z, Hassanpour H, Satvat MT, Kazemi-Rad E, Mohebali M. Treatment Failure in Cutaneous Leishmaniasis Patients Referred to the School of Public Health, Tehran University of Medical Sciences During 2008–2017. J Arthropod Borne Dis. 2021;14(4):363–375.
