Mucosal leishmaniasis: description of case management approaches and analysis of risk factors for treatment failure in a cohort of 140 patients in Brazil.
BACKGROUND
Mucosal leishmaniasis is caused mainly by Leishmania braziliensis and it occurs months or years after cutaneous lesions. This progressive disease destroys cartilages and osseous structures from face, pharynx and larynx.


OBJECTIVE
The aim of this study was to analyse the significance of clinical and epidemiological findings, diagnosis and treatment with the outcome and recurrence of mucosal leishmaniasis through binary logistic regression model from 140 patients with mucosal leishmaniasis from a Brazilian centre.


RESULTS
The median age of patients was 57.5 and systemic arterial hypertension was the most prevalent secondary disease found in patients with mucosal leishmaniasis (43%). Diabetes, chronic nephropathy and viral hepatitis, allergy and coagulopathy were found in less than 10% of patients. Human immunodeficiency virus (HIV) infection was found in 7 of 140 patients (5%). Rhinorrhea (47%) and epistaxis (75%) were the most common symptoms. N-methyl-glucamine showed a cure rate of 91% and recurrence of 22%. Pentamidine showed a similar rate of cure (91%) and recurrence (25%). Fifteen patients received itraconazole with a cure rate of 73% and recurrence of 18%. Amphotericin B was the drug used in 30 patients with 82% of response with a recurrence rate of 7%. The binary logistic regression analysis demonstrated that systemic arterial hypertension and HIV infection were associated with failure of the treatment (P < 0.05).


CONCLUSIONS
The current first-line mucosal leishmaniasis therapy shows an adequate cure but later recurrence. HIV infection and systemic arterial hypertension should be investigated before start the treatment of mucosal leishmaniasis. Conflicts of interest The authors are not part of any associations or commercial relationships that might represent conflicts of interest in the writing of this study (e.g. pharmaceutical stock ownership, consultancy, advisory board membership, relevant patents, or research funding).
Amato
V S
VS
Infectious and Parasitic Diseases Clinic, Hospital das Clinicas, Medical School, University of Sao Paulo, Sao Paulo, Brazil. valdirsa@netpoint.com.br
Tuon
F F
FF
Imamura
R
R
Abegão de Camargo
R
R
Duarte
M I
MI
Neto
V A
VA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D000981:Antiprotozoal Agents / Q000627:therapeutic use*; D001938:Brazil; D019090:Case Management / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology; D017964:Itraconazole / Q000627:therapeutic use; D007892:Leishmania braziliensis / Q000472:pathogenicity*; D007897:Leishmaniasis, Mucocutaneous / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D008536:Meglumine / Q000627:therapeutic use; D008875:Middle Aged; D010419:Pentamidine / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D012867:Skin / Q000469:parasitology*; D017211:Treatment Failure; D055815:Young Adult
D000981:Antiprotozoal Agents; D017964:Itraconazole; D010419:Pentamidine; D008536:Meglumine