High continuous antimony therapy in two patients with unresponsive mucosal leishmaniasis

Area of Science:

• Infectious Diseases
• Parasitology
• Tropical Medicine

Background:

• Mucosal leishmaniasis caused by Leishmania braziliensis braziliensis is a challenging infection.
• Standard chemotherapy, including antimonials and Amphotericin B, can be ineffective in some patients.
• Treatment resistance and relapse are significant concerns in managing this disease.

Observation:

• Two patients with severe mucosal leishmaniasis, previously treated extensively with antimonials and one with Amphotericin B, were studied.
• Both patients exhibited resistance or relapse to prior standard therapies.
• The patients received prolonged continuous Pentostam (a pentavalent antimonial) therapy.

Findings:

• Both patients demonstrated a positive response to the extended Pentostam treatment.
• Therapy duration was 62 days for one patient and 85 days for the other, at a daily dose of 20 mg Sbv/kg/day.
• Pentavalent antimonials, administered over protracted courses, proved curative in these selected non-responsive patients.

Implications:

• Prolonged continuous Pentostam therapy is a viable and potentially curative option for severe mucosal leishmaniasis unresponsive to standard treatments.
• This highlights the importance of considering extended treatment regimens for refractory cases.
• Further research into optimizing pentavalent antimonial therapy for leishmaniasis is warranted.