LEISHMANIASIS TEGUMENTARIA AMERICANA: IMPLICANCIA DEL PARÁSITO EN LA FALLA TERAPEÚTICA

BARRIO, ALEJANDRA; GONZÁLEZ PRIETO, ANA GABRIELA; MARTINEZ, NURIA; SAJAMA, JESÚS; MORA, MARÍA CELIA; RAMOS, FEDERICO; MONROIG, SIVILA; BECKAR, JOSEFINA; TAPIA, EMILCE; SÁNCHEZ NEGRETTE, OLGA; HASHIGUCHI, Y

Anales de la Fundación Alberto J Roemmers

Ediciones Medicas del Sur

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

In Argentina, the AmericanTegumentary Leishmaniasis (ATL) is endemic in 9 provinces of the northwest, with the highest incedence in Salta. In the absence of a vaccine, the controlies in rapid diagnosis and early trestment. the first line therapy corresponds to the meglumine antimonate (Glu). There are no previous publications about the affectivencess of Glu in patients from Argentina, particulary Yungas and Chaco Seco ecoregions, where ATL is transmitted. In order to study the therapeuticfailure (TF) and the possible factors involved, we investigate the results of Glu therapy in Salta and 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 patient´s medical records. To check if the clinical response to the treatment was consistentwith the parasite´s phenotype against Glu, in vitro test were performed with parasites isolate from lesions (n=33). A rate of 51,67% TF was oberved, with a greater probability of occurrence of TF in Yungas than in Dry Chaco (p=0.04). There were no differences in treatment with respect to the clinical form or to the species involved. A significant association between therapeutic failure and Glu resistan phenotype of promastigoteshas also been observed(p=0.001). The results show a considerable rate od TF and a possible association with the circulation of resistant strains .This should be seriously considered. Given that the Glu is the first treatment option for ATL in Argentina, it woud be relevant to evaluate the implementation of alternative treatments. A national policy based on drug combinations seems to be the best strategyto avoid resistance.