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Clinical and parasite species risk factors for pentavalent antimonial treatment failure in cutaneous leishmaniasis in Peru

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dc.contributor.author Llanos-Cuentas, A. en_US
dc.contributor.author Tulliano, G. en_US
dc.contributor.author Araujo-Castillo, R. en_US
dc.contributor.author Miranda-Verastegui, C. en_US
dc.contributor.author Santamaria-Castrellon, G. en_US
dc.contributor.author Ramirez, L. en_US
dc.contributor.author Lazo, M. en_US
dc.contributor.author De Doncker, S. en_US
dc.contributor.author Boelaert, M. en_US
dc.contributor.author Robays, J. en_US
dc.contributor.author Dujardin, J. C. en_US
dc.contributor.author Arevalo, J. en_US
dc.contributor.author Chappuis, F. en_US
dc.date.accessioned 2008-03-13T12:05:36Z
dc.date.available 2008-03-13T12:05:36Z
dc.date.issued 2008
dc.identifier.issn 1058-4838
dc.identifier.doi http://dx.doi.org/10.1086/524042
dc.identifier.other ITG-P8B en_US
dc.identifier.other ITG-H9A en_US
dc.identifier.other ITG-H10A en_US
dc.identifier.other ITG-P11A en_US
dc.identifier.other PARAS en_US
dc.identifier.other U-PROTO en_US
dc.identifier.other HEALTH en_US
dc.identifier.other U-EPID en_US
dc.identifier.other JIF en_US
dc.identifier.other UPD1 en_US
dc.identifier.other FTA en_US
dc.identifier.other ABSTRACT en_US
dc.identifier.other MULTI en_US
dc.identifier.uri http://hdl.handle.net/10390/2167
dc.description.abstract BACKGROUND: Treatment for cutaneous leishmaniasis (CL) with standard pentavalent antimonial therapy is hampered by cumbersome administration, toxicity, and potential failure. Knowledge of factors influencing treatment outcome is essential for successful management. METHODS: A case-control study of incident cases was performed with patients experiencing their first CL episode. The standard treatment for CL for these patients was 20 mg/kg/day of sodium stibogluconate for 20 days. Clinical and epidemiological data were recorded, and parasite isolates were species typed. Patients were followed up for 6 months to assess treatment outcome. Clinical cure was defined as complete wound closure and re-epithelization without inflammation or infiltration; new lesions, wound reopening, or signs of activity were classified as treatment failure. Descriptive, bivariate, and logistic regression analyses were performed. RESULTS: One hundred twenty-seven patients were recruited; 63 (49.6%) were infected with Leishmania (Viannia) peruviana, 29 (22.8%) were infected with Leishmania (Viannia) braziliensis, 27 (21.3%) were infected with Leishmania (Viannia) guyanensis, and 8 (6.3%) were infected with other species. Only patients infected with the 3 most common species were selected for risk-factor analysis (n=119). Final failure rate at 6 months was 24.4% (95% confidence interval [CI], 16.5%-32.1%), with 96% of failures occurring within the first 3 months of follow-up assessment. Risk factors for treatment failure identified in the final multivariate model were age (per year, odds ratio [OR], 0.95; 95% CI, 0.92-0.99; P=.017), stay of <72 months in area of disease acquisition (OR, 30.45; 95% CI, 2.38-389.25; P=.009), duration of disease <5 weeks (OR, 4.39; 95% CI, 1.12-17.23; P=.034), additional lesion (per lesion, OR, 2.06; 95% CI, 1.3-3.28; P=.002), infection with L. (V.) peruviana (OR, 9.85; 95% CI, 1.01-95.65; P=.049), and infection with L. (V.) braziliensis (OR, 22.36; 95% CI, 1.89-263.96; P=.014). CONCLUSIONS: The identification of parasite species and clinical risk factors for antimonial treatment failure should lead to an improved management of CL in patients in Peru. en_US
dc.language English en_US
dc.publisher University of Chicago Press en_US
dc.subject Protozoal diseases en_US
dc.subject Leishmaniasis en_US
dc.subject Cutaneous en_US
dc.subject Drug therapy en_US
dc.subject Antimonials en_US
dc.subject Treatment failure en_US
dc.subject Risk factors en_US
dc.subject Species en_US
dc.subject Peru en_US
dc.subject America, Latin en_US
dc.title Clinical and parasite species risk factors for pentavalent antimonial treatment failure in cutaneous leishmaniasis in Peru en_US
dc.type Article en_US
dc.citation.issue 2 en_US
dc.citation.jtitle Clinical Infectious Diseases en_US
dc.citation.volume 46 en_US
dc.citation.pages 223-231 en_US
dc.publisher.place Chicago en_US
dc.identifier.pmid http://www.ncbi.nlm.nih.gov/pubmed/18171254
dc.citation.jabbreviation Clin Infect Dis en_US


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