title: Clinical and Parasitological Features of Patients with American Cutaneous Leishmaniasis that Did Not Respond to Treatment with Meglumine Antimoniate.
abstract: American cutaneous leishmaniasis (ACL) is a complicated disease producing about 67.000 new cases per year. The severity of the disease depends on the parasite species; however in the vast majority of cases species confirmation is not feasible. WHO suggestion for ACL produced by Leishmania braziliensis, as first line treatment, are pentavalent antimonial derivatives (Glucantime or Sodium Stibogluconate) under systemic administration. According to different authors, pentavalent antimonial derivatives as treatment for ACL show a healing rate of about 75% and reasons for treatment failure are not well known.
  
  
  
  In order to characterise the clinical and parasitological features of patients with ACL that did not respond to Glucantime, a cross-sectional observational study was carried out in a cohort of 43 patients recruited in three of the Colombian Army National reference centers for complicated ACL. Clinical and paraclinical examination, and epidemiological and geographic information were recorded for each patient. Parasitological, histopathological and PCR infection confirmation were performed. Glucantime IC50 and in vitro infectivity for the isolated parasites were estimated.
  
  
  
  Predominant infecting Leishmania species corresponds to L. braziliensis (95.4%) and 35% of the parasites isolated showed a significant decrease in in vitro Glucanatime susceptibility associated with previous administration of the medicament. Lesion size and in vitro infectivity of the parasite are negatively correlated with decline in Glucantime susceptibility (Spearman: r = (-)0,548 and r = (-)0,726; respectively).
  
  
  
  A negative correlation between lesion size and parasite resistance is documented. L. braziliensis was found as the main parasite species associated to lesion of patients that underwent treatment failure or relapse. The indication of a second round of treatment in therapeutic failure of ACL, produced by L. braziliensis, with pentavalent antimonial derivatives is discussable.
authors.affiliation: Departamento de Medicina Interna, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia.|Unidad de infectología Hospital Militar Central, Bogotá, Colombia.
authors.forename: Jairo E
authors.initials: JE
authors.lastname: Perez-Franco
authors.affiliation: Departamento de Salud Publica, Facultad de Medicina Universidad Nacional de Colombia, Bogotá, Colombia.
authors.forename: Mónica L
authors.initials: ML
authors.lastname: Cruz-Barrera
authors.affiliation: Unidad de Dermatología, Hospital Militar Central, Bogotá, Colombia.|Facultad de Medicina Universidad Militar Nueva Granada, Bogotá, Colombia.
authors.forename: Marta L
authors.initials: ML
authors.lastname: Robayo
authors.affiliation: Departamento de Salud Publica, Facultad de Medicina Universidad Nacional de Colombia, Bogotá, Colombia.
authors.forename: Myriam C
authors.initials: MC
authors.lastname: Lopez
authors.affiliation: Facultad de Medicina Universidad Militar Nueva Granada, Bogotá, Colombia.
authors.forename: Carlos D
authors.initials: CD
authors.lastname: Daza
authors.affiliation: Unidad de Dermatología, Hospital Militar Central, Bogotá, Colombia.
authors.forename: Angela
authors.initials: A
authors.lastname: Bedoya
authors.affiliation: Unidad de Dermatología, Hospital Militar Central, Bogotá, Colombia.
authors.forename: Maria L
authors.initials: ML
authors.lastname: Mariño
authors.affiliation: Departamento de Medicina Interna, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia.
authors.forename: Carlos H
authors.initials: CH
authors.lastname: Saavedra
authors.affiliation: Departamento de Salud Publica, Facultad de Medicina Universidad Nacional de Colombia, Bogotá, Colombia.
authors.forename: Maria C
authors.identifier: 0000-0002-5590-6470
authors.initials: MC
authors.lastname: Echeverry
mesh_terms: D000328:Adult; D000981:Antiprotozoal Agents / Q000494:pharmacology / Q000627:therapeutic use*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D006801:Humans; D020128:Inhibitory Concentration 50; D007892:Leishmania braziliensis / Q000187:drug effects* / Q000502:physiology; D016773:Leishmaniasis, Cutaneous / Q000188:drug therapy*; D008297:Male; D008536:Meglumine / Q000494:pharmacology / Q000627:therapeutic use*; D000077485:Meglumine Antimoniate; D009942:Organometallic Compounds / Q000494:pharmacology / Q000627:therapeutic use*; D012008:Recurrence; D017211:Treatment Failure; D020298:U937 Cells; D055815:Young Adult
chemical_list: D000981:Antiprotozoal Agents; D009942:Organometallic Compounds; D008536:Meglumine; D000077485:Meglumine Antimoniate