Liposomal amphotericin B in travelers with cutaneous and muco-cutaneous leishmaniasis: Not a panacea

• Published in: PLoS neglected tropical diseases 2017-11, Vol.11 (11), p.e0006094-e0006094
• Main Authors: Guery, Romain, Henry, Benoit, Martin-Blondel, Guillaume, Rouzaud, Claire, Cordoliani, Florence, Harms, Gundel, Gangneux, Jean-Pierre, Foulet, Françoise, Bourrat, Emmanuelle, Baccard, Michel, Morizot, Gloria, Consigny, Paul-Henri, Berry, Antoine, Blum, Johannes, Lortholary, Olivier, Buffet, Pierre
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Amphotericin B; Amphotericin B - administration & dosage; Amphotericin B - adverse effects; Amphotericin B - therapeutic use; Analysis; Antifungal agents; Antiprotozoal Agents; Antiprotozoal Agents - administration & dosage; Antiprotozoal Agents - adverse effects; Antiprotozoal Agents - therapeutic use; Biology and Life Sciences; Care and treatment; Child; Child, Preschool; Consortia; Countries; Cutaneous leishmaniasis; Data processing; Dosage and administration; Duration; Ecology, environment; Failure analysis; Female; Healing; Health; Health aspects; Health risk assessment; Heart diseases; Humans; Infant; Infections; Leishmania; Leishmania - classification; Leishmania - drug effects; Leishmania braziliensis; Leishmaniasis, Cutaneous; Leishmaniasis, Cutaneous - drug therapy; Leishmaniasis, Cutaneous - parasitology; Leishmaniasis, Mucocutaneous; Leishmaniasis, Mucocutaneous - drug therapy; Leishmaniasis, Mucocutaneous - parasitology; Lesions; Life Sciences; Male; Medicine and Health Sciences; Middle Aged; Multivariate analysis; Parasitic diseases; Patients; Physical Sciences; Research and Analysis Methods; Retrospective Studies; Therapy; Travel; Travelers; Travellers; Treatment Outcome; Tropical diseases; Vector-borne diseases
• ISSN: 1935-2735; 1935-2727; 1935-2735
• DOI: 10.1371/journal.pntd.0006094

Complex cutaneous and muco-cutaneous leishmaniasis (CL and MCL) often requires systemic therapy. Liposomal amphotericin B (L-AmB) has a strong potential for a solid clinical benefit in this indication. We conducted a retrospective analysis of data from a French centralized referral treatment program and from the "LeishMan" European consortium database. All patients with parasitologically proven CL or MCL who received at least one dose of L-AmB were included. Positive outcome was based on ulcer closure as per recent WHO workshop guidelines. From 2008 through 2016, 43 travelers returning from 18 countries (Old World n = 28; New World n = 15) were analyzed with a median follow-up duration of 79 days [range 28-803]. Main clinical forms were: localized CL with one or multiple lesions (n = 32; 74%) and MCL (n = 8; 19%). As per published criteria 19 of 41 patients (46%) were cured 90 days after one course of L-AmB. When the following items -improvement before day 90 but no subsequent follow-up, delayed healing (>3 months) and healing after a second course of L-AmB- were included in the definition of cure, 27 of 43 patients (63%) had a positive outcome. Five patients (MCL = 1; CL = 4) experienced a relapse after a median duration of 6 months [range 3-27] post treatment and 53% of patients (23/43) experienced at least one adverse event including severe hypokalaemia and acute cardiac failure (one patient each). In multivariate analysis, tegumentary infection with L. infantum was associated with complete healing after L-AmB therapy (OR 5.8 IC 95% [1.03-32]) while infection with other species had no impact on outcome. In conditions close to current medical practice, the therapeutic window of L-AmB was narrow in travellers with CL or MCL, with the possible exception of those infected with L. infantum. Strict follow-up is warranted when using L-AmB in patients with mild disease.