title: Monitoring the response of patients with cutaneous leishmaniasis to treatment with pentamidine isethionate by quantitative real-time PCR, and identification of Leishmania parasites not responding to therapy.
abstract: BACKGROUND
  Leishmania (Viannia) guyanensis is believed to be the principal cause of cutaneous leishmaniasis (CL) in Suriname. This disease is treated with pentamidine isethionate (PI), but treatment failure has increasingly been reported.
  
  
  OBJECTIVE
  To evaluate PI for its clinical efficacy, to compare parasite load, and to assess the possibility of treatment failure due to other infecting Leishmania species.
  
  
  METHODS
  Parasite load of patients with CL was determined in skin biopsies using real-time quantitative PCR before treatment and 6 and 12 weeks after treatment. Clinical responses were evaluated at week 12 and compared with parasite load. In parallel, molecular species differentiation was performed.
  
  
  RESULTS
  L. (V.) guyanensis was the main infecting species in 129 of 143 patients (about 90%). PI treatment led to a significant decrease (P < 0.001) in parasite counts, and cured about 75% of these patients. Treatment failure was attributable to infections with Leishmania (Viannia) braziliensis, Leishmania (Leishmania) amazonensis and L. (V.) guyanensis (1/92, 1/92 and 22/92 evaluable cases, respectively). There was substantial agreement beyond chance between the parasite load at week 6 and the clinical outcome at week 12, as indicated by the κ value of 0.61.
  
  
  CONCLUSIONS
  L. (V.) guyanensis is the main infecting species of CL in Suriname, followed by L. (V.) braziliensis and L. (L.) amazonensis. Furthermore, patient response to PI can be better anticipated based on the parasite load 6 weeks after the treatment rather than on parasite load before treatment.
authors.affiliation: Anton de Kom University of Suriname, Paramaribo, Suriname.
authors.forename: D R A
authors.initials: DR
authors.lastname: Mans
authors.affiliation: Anton de Kom University of Suriname, Paramaribo, Suriname.
authors.forename: A D
authors.initials: AD
authors.lastname: Kent
authors.affiliation: Dermatological Service, Ministry of Health, Paramaribo, Suriname.
authors.forename: R V
authors.initials: RV
authors.lastname: Hu
authors.affiliation: Department of Dermatology, Academic Hospital Paramaribo, Paramaribo, Suriname.
authors.forename: E J
authors.initials: EJ
authors.lastname: Lai A Fat
authors.affiliation: Royal Tropical Institute, Amsterdam, The Netherlands.
authors.forename: G J
authors.initials: GJ
authors.lastname: Schoone
authors.affiliation: Royal Tropical Institute, Amsterdam, The Netherlands.
authors.forename: E R
authors.initials: ER
authors.lastname: Adams
authors.affiliation: Royal Tropical Institute, Amsterdam, The Netherlands.
authors.forename: E J
authors.initials: EJ
authors.lastname: Rood
authors.affiliation: Royal Tropical Institute, Amsterdam, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Alba
authors.affiliation: Dermatological Service, Ministry of Health, Paramaribo, Suriname.
authors.forename: L O A
authors.initials: LO
authors.lastname: Sabajo
authors.affiliation: Department of Dermatology, Academic Hospital Paramaribo, Paramaribo, Suriname.
authors.forename: R F
authors.initials: RF
authors.lastname: Lai A Fat
authors.affiliation: Department of Dermatology, Academic Medical Center, Amsterdam, The Netherlands.|Center for Infection and Immunology Amsterdam (CINIMA), University of Amsterdam, Amsterdam, The Netherlands.|STI Outpatient Clinic, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands.
authors.forename: H J C
authors.initials: HJ
authors.lastname: de Vries
authors.affiliation: Royal Tropical Institute, Amsterdam, The Netherlands.
authors.forename: H D F H
authors.initials: HD
authors.lastname: Schallig
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D007891:Leishmania / Q000187:drug effects / Q000254:growth & development / Q000302:isolation & purification*; D007892:Leishmania braziliensis / Q000187:drug effects / Q000254:growth & development / Q000302:isolation & purification; D018334:Leishmania guyanensis / Q000187:drug effects / Q000254:growth & development / Q000302:isolation & purification; D016773:Leishmaniasis, Cutaneous / Q000188:drug therapy* / Q000453:epidemiology / Q000469:parasitology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D059208:Parasite Load / Q000379:methods; D010419:Pentamidine / Q000008:administration & dosage / Q000494:pharmacology*; D015995:Prevalence; D060888:Real-Time Polymerase Chain Reaction / Q000379:methods*; D012867:Skin / Q000187:drug effects / Q000469:parasitology* / Q000473:pathology; D013532:Suriname / Q000453:epidemiology; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000981:Antiprotozoal Agents; D010419:Pentamidine