First report of treatment failure in a patient with cutaneous leishmaniasis infected by Leishmania (Viannia) naiffi carrying Leishmania RNA virus: a fortuitous combination?

Abstract We report the case of a 32-year-old man from Rio de Janeiro, who was infected in the Amazon region of Brazil by Leishmania (Viannia) naiffi. Generally, patients with L. naiffi cutaneous leishmaniasis exhibit a good therapeutic response to either pentavalent antimonials or pentamidine. However, after pentamidine treatment, this patient's infection evolved to therapeutic failure. To understand this clinical outcome, we investigated the presence of the Leishmania RNA virus (LRV) in parasites isolated from the cutaneous lesion; herein, we discuss the possible association between a poor response to pentamidine therapy and the presence of the LRV.

Tratamento da leishmaniose tegumentar americana, com lesäo em mucosa, por meio do isotionato de pentamidina / Treatment of mucocutaneous leishmaniasis, with mucosal lesion, with pentamidine isothianate

Ten patients with mucosal lesions caused by American tegumental leishmaniasis were treated with pentamidine isethionate at the dose 4 mg/kg on alternate days by the intravenous route. The mean posology was 2,140 mg. Healing of the lesions occurred in 9 (90 per cent) of the patients who completed treatment. There was no recurrence during a follow-up time of 1 to 24 months (mean, 7,7 months). One patient discontinued treatment before healing of the lesion because be developed diabetes mellitus. In 3 (30 per cent) patients, blood exams showed increased urea and creatinine levels and leucopenia, which were corrected by increasing the interval between administrations of the drug. Pentamidine isethionate is efficient in bringing about cicatrization of the lesions but needs further evaluation in terms of its value in preventing recurrence.

Diabetes mellitus associated with pentamidine isethionate in diffuse cutaneous leishmaniasis

The authors report a case of a male patient from Bacabal, MA with diffuse cutaneous leishmaniasis (DCL), for at least nine years, with 168 lesions on his body. These were tumour-like nodules with some ulceration. He used pentavalent antimonial (glucantime) and an association of gamma interferon plus glucantime with improvement of the lesions but relapsed later. Recently, pentamidine isethionate (pentacarinat) was given a dosage of 4mg/kg/weight/day on alternate days for 20 applications. After 3 months a similar course of 10 application was given 2 times. Later he developed diabetic signs with weight loss of 10kg, polydypsia, polyuria and xerostomia. The lower limbs lesions showed signs of activity. Blood glucose levels normalised and remain like this at moment. Attention is drawn to the fact that pentamidine isethionate should be used as a therapy option with care, obeying rigorous laboratory controls including a glucose tolerance test.

Tratamento da leishmaniose tegumentar americana com a pentamidina, esquema em dose única endovenosa / Treatment of american cutaneous Leishmaniasis with pentamidine: scheme in single endovenous dosis

Os autores relatam os resultados obtidos no tratamento de 63 casos de leishmaniose tegumentar americana empregando o metanossulfonato de pentamidina (Lomidine) em dose única e endovenosa. Na dose de 120 a 480 mg em 100 a 250 ml de soro glicosado a 5%, a eficâcia foi de 76%. Considerando as reaçöes colaterais e as contra-indicaçöes da pentamidina, recomendam a sua utilizaçäo somente em alguns casos de recidiva ou rebeldes ao tratamento antimonial

Persistent hyperglycaemia requiring insulin therapy following the use of pentamidine in the treatment of kala-azar.

Five cases of persistent hyperglycaemia requiring insulin therapy following pentamidine treatment for Indian kala-azar are being reported.

Tratamento com pentamidina de seis casos da forma mucosa de leishmaniase tegumentar / Treatment with pentamidine of 6 cases with mucus form of tegumentary leishmaniasis

As principais razöes para a escolha da pentamidina no presente ensaio terapêutico foram a alta taxa de recidiva de casos de forma mucosa de leishmaniose tegumentar com o tratamento pelos antimoniais pentavalentes e o fato deste medicamento ter sido usado com sucesso na forma cutânea da doença. Seis pacientes com forma mucosa de leishmaniose tegumentar diagnosticados clinicamente por exame dermato-otorrinolaringológico, reaçäo intradérmica de Montenegro, cultura inoculaçäo em hamster e esfregaço de material obtido das lesöes, exame histopatológico e pesquisa de anticorpos circulantes, foram tratados com pentamidina na dose de 200 mg em dias alternados, com dose total entre 2,3 a 5,9g, de acordo com a clínica. Houve cura clínica e parasitológica de cinco casos, com acompanhamento variando de 12 a 24 meses após o tratamento. No único caso de falha, tratava-se de um paciente que também näo respondeu ao tratamento com Glucantime. Entre os efeitos colaterais estäo um caso de diabetes mellitus, alteraçöes transitórias de glicemia em dois casos e abscesso glúteo em um, concluindo-se ser boa a resposta terapêutica à pentamidina dos casos da forma mucosa de leishmaniose tegumentar