ABSTRACT
Azithromycin was compared with meglumine antimoniate for treatment of patients with cutaneous leishmaniasis. Patients were randomized to receive oral azithromycin, 500 mg/day (22 patients) or intramuscular meglumine antimoniate, 10 mg Sb/kg/day (23 patients), both for 28 days, with a second cycle of 15 days if necessary, and followed-up for one year after completion of treatment. Efficacy, defined as complete re-epithelization without relapse for 12 months after completing therapy, was 82.6% (95% confidence interval [CI] = 67-98%) for meglumine antimoniate and 45.5% (95% CI = 25-66%) for azithromycin. All patients who failed treatment with azithromycin were treated with meglumine antimoniate and clinically cured. Azithromycin was well tolerated; meglumine antimoniate caused arthralgias and local symptoms in 78% of the patients. In 17 cases, species identification was obtained; Leishmania (Viannia) braziliensis was identified in all of them. For the treatment of American cutaneous leishmaniasis caused by L. (V.) braziliensis, meglumine antimoniate is significatively more efficacious than azithromycin, which was clinically curative in almost half of the patients and well-tolerated.
Subject(s)
Azithromycin/administration & dosage , Leishmania braziliensis/growth & development , Leishmaniasis, Cutaneous/drug therapy , Meglumine/administration & dosage , Organometallic Compounds/administration & dosage , Administration, Oral , Adult , Animals , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/adverse effects , Antiprotozoal Agents/administration & dosage , Antiprotozoal Agents/adverse effects , Argentina/epidemiology , Azithromycin/adverse effects , Endemic Diseases , Female , Humans , Leishmaniasis, Cutaneous/epidemiology , Leishmaniasis, Cutaneous/parasitology , Male , Meglumine/adverse effects , Meglumine Antimoniate , Middle Aged , Organometallic Compounds/adverse effectsABSTRACT
Migration of HIV infected individuals from cities to small towns and rural areas spreads AIDS among non urban population, superimposing HIV with other endemic or epidemic infections as parasitoses. This situation is a big challenge to public health because in most cases the association between these infections worsens both prognoses. We present here the first case in Argentina of AIDS associated to a mucocutaneous form of American tegumentary leishmaniasis. The patient was from Orán, an area where in the middle eighties, an epidemic outbreak took place. By now more than 2000 cases have been parasitologically confirmed in our Institute and the causing species were identified as Leishmania (V.) braziliensis and L. (L.) amasonensis. Considering the existence of co-infection of HIV and Leishmania, it is recommended that in patients from endemic areas with records of cutaneous or mucocutaneous ulcers, even healed, leishmaniasis must be investigated, among other diseases.
Subject(s)
AIDS-Related Opportunistic Infections/parasitology , Acquired Immunodeficiency Syndrome/parasitology , Leishmaniasis, Cutaneous/complications , AIDS-Related Opportunistic Infections/diagnosis , Acquired Immunodeficiency Syndrome/diagnosis , Animals , Argentina , Enzyme-Linked Immunosorbent Assay , Humans , Leishmania/isolation & purification , Leishmaniasis, Cutaneous/diagnosis , Male , Middle AgedABSTRACT
Las migraciones a pequeños municipios y áreas rurales de personas infectadas con HIV contribuye a la diseminación progresiva del sida y a la asociación con otras infecciones prevalentes en áreas endémicas, como las parasitosis. Esta asociación significa un importante desafío para la salud pública, ya que frecuentemente ambas infecciones se potencian. En este trabajo presentamos el primer paciente autóctono con sida asociado a leishmaniosis mucocutánea procedente de la zona de Orán, donde a mediados de los 80 se desarrolló un brote epidémico de leishmaniosis que a la fecha supera más de 2000 casos confirmados parasitológicamente en nuestro Instituto. Recientemente informamos la existencia de 2 especies (Leishmania (V.) braziliensis y L. (L.) amasonensis) como las causantes de leishmaniosis tegumentaria americana en la zona. Queremos llamar la atención de los profesionales de la salud sobre la posibilidad de coinfección HIV-Leishmania, recomendando que en pacientes de áreas endémicas con antecedentes de úlceras cutáneas indoloras o incluso cicatrizales, se investigue, entre otras enfermedades, la leishmaniosis.
Subject(s)
Humans , Animals , Male , Middle Aged , AIDS-Related Opportunistic Infections/parasitology , Acquired Immunodeficiency Syndrome/parasitology , Leishmaniasis, Cutaneous/complications , AIDS-Related Opportunistic Infections/diagnosis , Argentina , Acquired Immunodeficiency Syndrome/diagnosis , Enzyme-Linked Immunosorbent Assay , Leishmania/isolation & purification , Leishmaniasis, Cutaneous/diagnosisABSTRACT
Las migraciones a pequeños municipios y áreas rurales de personas infectadas con HIV contribuye a la diseminación progresiva del sida y a la asociación con otras infecciones prevalentes en áreas endémicas, como las parasitosis. Esta asociación significa un importante desafío para la salud pública, ya que frecuentemente ambas infecciones se potencian. En este trabajo presentamos el primer paciente autóctono con sida asociado a leishmaniosis mucocutánea procedente de la zona de Orán, donde a mediados de los 80 se desarrolló un brote epidémico de leishmaniosis que a la fecha supera más de 2000 casos confirmados parasitológicamente en nuestro Instituto. Recientemente informamos la existencia de 2 especies (Leishmania (V.) braziliensis y L. (L.) amasonensis) como las causantes de leishmaniosis tegumentaria americana en la zona. Queremos llamar la atención de los profesionales de la salud sobre la posibilidad de coinfección HIV-Leishmania, recomendando que en pacientes de áreas endémicas con antecedentes de úlceras cutáneas indoloras o incluso cicatrizales, se investigue, entre otras enfermedades, la leishmaniosis.(AU)
Subject(s)
Humans , Animals , Male , Middle Aged , RESEARCH SUPPORT, NON-U.S. GOVT , AIDS-Related Opportunistic Infections/parasitology , Acquired Immunodeficiency Syndrome/parasitology , Leishmaniasis, Cutaneous/complications , AIDS-Related Opportunistic Infections/diagnosis , Acquired Immunodeficiency Syndrome/diagnosis , Argentina , Leishmania/isolation & purification , Enzyme-Linked Immunosorbent Assay , Leishmaniasis, Cutaneous/diagnosisABSTRACT
Migration of HIV infected individuals from cities to small towns and rural areas spreads AIDS among non urban population, superimposing HIV with other endemic or epidemic infections as parasitoses. This situation is a big challenge to public health because in most cases the association between these infections worsens both prognoses. We present here the first case in Argentina of AIDS associated to a mucocutaneous form of American tegumentary leishmaniasis. The patient was from Orán, an area where in the middle eighties, an epidemic outbreak took place. By now more than 2000 cases have been parasitologically confirmed in our Institute and the causing species were identified as Leishmania (V.) braziliensis and L. (L.) amasonensis. Considering the existence of co-infection of HIV and Leishmania, it is recommended that in patients from endemic areas with records of cutaneous or mucocutaneous ulcers, even healed, leishmaniasis must be investigated, among other diseases.
