LEISHMANIASIS TEGUMENTARIA AMERICANA: IMPLICANCIA DEL PARÁSITO EN LA FALLA TERAPEÚTICA

ALEJANDRA BARRIO; SAJAMA, JESUS; MONROIG, SIBILA; SANCHEZ NEGRETTE, OLGA; MARTÍNEZ, NURIA; RAMOS FEDERICO; TAPIA, EMILCE; GONZALEZ PRIETO GABRIELA; MORA, MARIA CELIA; BECKAR, JOSEFINA; HASHIGUCHI, Y

Anales de la Fundación Alberto J Roemmers

Ediciones Medicas del Sur SRL

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 theabsence 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 patientsfrom Argentina, particularly Yungas and Chaco Seco ecoregions, where ATLis transmitted. In order to study the frequency of therapeutic failure (TF) andthe possible factors involved, we investigated the results of Glu therapy inSalta 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 questionnaireand from patients? medical records.To check if the clinical response to the treatment was consistent with theparasite?s phenotype against Glu, in vitro tests were performed with parasitesisolated 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 significant association 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.