Background

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.

Methods

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.

Results

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.

Conclusion

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.

中文翻译：

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患有皮肤和粘膜皮肤利什曼病的旅行者中的脂质体两性霉素B：不是万能药

背景

复杂的皮肤和粘膜皮肤利什曼病（CL和MCL）通常需要全身治疗。脂质体两性霉素B（L-AmB）具有很强的潜力，可在此适应症中获得可靠的临床益处。

方法

我们对法国集中转诊治疗计划和“ LeishMan”欧洲联盟数据库的数据进行了回顾性分析。包括所有接受至少一剂L-AmB的寄生虫学证实的CL或MCL的患者。根据最近的世界卫生组织讲习班指南，积极的结果是基于溃疡的闭合。

结果

从2008年到2016年，对来自18个国家（旧世界n = 28；新世界n = 15）返回的43位旅行者进行了分析，中位随访时间为79天[范围28-803]。主要临床形式为：具有一个或多个病变的局部CL（n = 32； 74％）和MCL（n = 8； 19％）。根据公布的标准，一疗程的L-AmB治疗90天后，有41位患者中的19位（46％）治愈了。如果以下定义-在第90天之前有所改善，但没有随后的随访，延迟的愈合（> 3个月）和第二个L-AmB疗程后的愈合被包括在治愈的定义中，则43例患者中有27例（63％）取得了积极的成果。五名患者（MCL = 1; CL = 4）治疗后中位时间6个月[范围3–27]后经历了复发，并且53％的患者（23/43）经历了至少一种不良事件，包括严重的低钾血症和急性心力衰竭（每例一名患者） 。在多变量分析中，大号。L-AmB治疗后婴儿与完全愈合相关（OR 5.8 IC 95％[1.03-32]），而其他物种的感染对结局没有影响。

结论

在接近当前医学实践的情况下，CL或MCL旅行者的L-AmB的治疗范围较窄，可能感染L的患者除外。婴儿的。在轻度疾病患者中使用L-AmB时，应严格随访。