Leishmaniasis Tegumentaria Americana: Implicancia del Parasito en la Falla terapéutica

BARRIO, ALEJANDRA; GONZALEZ PRIETO, GABRIELA; MARTINEZ, NURIA; SAJAMA , JESÚS; MORA, MARIA CELIA; RAMOS, FEDERICO; BECKAR, JOSEFINA; TAPIA, EMILCE; SANCHEZ NEGRETTE, OLGA; HASHIGUCHI, Y.

Anales de la Fundacion Alberto J. Rommers

Ediciones Medicas del Sur S.R.L.

Lugar: Buenos Aires; Año: 2019; p. 64 - 70

In Argentina, the American Tegumentary Leishmaniasis (ATL) is endemic in 9 provinces of the northwest, with the highest incidence in Salta. In the absence of a vaccine, the control lies in the rapid diagnosis and early treatment. The first line therapy corresponds to the meglumine antimonate (Glu).There are no previous publications about the effectiveness of Glu in patients from Argentina, particularly Yungas and Chaco Seco ecoregions, where ATLis transmitted. In order to study the frequency of therapeutic failure (TF) and the possible factors involved, we investigated the results of Glu therapy in Salta and the possible contribution of parasites resistance. Ninety patients attended in the period 2000-2014, were included. Epidemiological and treatment data were obtained from a detailed questionnaire and from patients? medical records. To check if the clinical response to the treatment was consistent with the parasite?s phenotype against Glu, in vitro tests were performed with parasites isolated from lesions (n = 33).A rate of 51.67% TF was observed, with a greater probability of occurrence of TF in Yungas than in Dry Chaco (p = 0.04). There were no differencesin treatment with respect to the clinical form or to the species involved. A significantassociation between therapeutic failure and Glu resistant phenotypeof promastigotes has also been observed (p = 0.001).These results show a considerable rate of TF and a possible associationwith the circulation of resistant strains. This should be seriously considered.Given that the Glu is the first treatment option for ATL in Argentina, it would berelevant to evaluate the implementation of alternative treatments. A nationalpolicy based on drug combinations seems to be the best strategy to avoidresistance.