Indian Journal of Dermatology
  Publication of IADVL, WB
  Official organ of AADV
Indexed with Science Citation Index (E) , Web of Science and PubMed
 
Users online: 1345  
Home About  Editorial Board  Current Issue Archives Online Early Coming Soon Guidelines Subscriptions  e-Alerts    Login  
    Small font sizeDefault font sizeIncrease font size Print this page Email this page


 
Table of Contents 
THERAPEUTIC ROUND
Year : 2011  |  Volume : 56  |  Issue : 1  |  Page : 37-39
Decreased effect of glucantime in cutaneous leishmaniasis complicated with secondary bacterial infection


1 Skin Disease and Leishmaniasis Research Center, Isfahan, Iran
2 Medical school, Isfahan University of Medical Sciences, Isfahan, Iran

Date of Web Publication10-Mar-2011

Correspondence Address:
G Sadeghian
Skin Disease and Leishmaniasis Research Center, Sedigheh Tahereh Research and Training Organization, Khoram Street, Jomhoori Sq., Isfahan
Iran
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.77549

Rights and Permissions

   Abstract 

Background: Glucantime is regarded as the first-line treatment of cutaneous leishmaniasis (CL); however, failure to treatment is a problem in many cases. Aim: The aim was to evaluate the therapeutic effect of glucantime in CL complicated with secondary bacterial infection compared to uncomplicated lesions. Methods: This experimental study was performed in Skin Diseases and Leishmaniasis Research Center, Isfahan, Iran. A total of 161 patients enrolled in the study had CL confirmed by positive smear of lesions. All the patients were treated with systemic glucantime for 3 weeks and followed for 2 months. Response to treatment was defined as loss of infiltration, reepithelization, and negative smear. Depending on the results of bacterial cultures, the lesions were divided into two groups and the efficacy of glucantime was compared. Results: A total of 123 patients (76.4%) were negative, and 38 patients (23.6%) were positive for secondary bacterial infection. In groups with negative bacterial culture response to treatment was 65% (80 patients) and in the other positive group, it was 31.6% (12 patients), with a difference (χ2 = 13.77, P < 0.01). Conclusion: Therapeutic effect of glucantime showed a decrease in CL lesions with secondary bacterial infection. Therefore, in the cases of unresponsiveness to treatment, the lesions should be evaluated for bacterial infection, before repeating the treatment.


Keywords: Bacterial infection, cutaneous leishmaniasis, glucantime


How to cite this article:
Sadeghian G, Ziaei H, Bidabadi L S, Baghbaderani A Z. Decreased effect of glucantime in cutaneous leishmaniasis complicated with secondary bacterial infection. Indian J Dermatol 2011;56:37-9

How to cite this URL:
Sadeghian G, Ziaei H, Bidabadi L S, Baghbaderani A Z. Decreased effect of glucantime in cutaneous leishmaniasis complicated with secondary bacterial infection. Indian J Dermatol [serial online] 2011 [cited 2019 Aug 23];56:37-9. Available from: http://www.e-ijd.org/text.asp?2011/56/1/37/77549



   Background Top


Cutaneous leishmaniasis (CL) is an endemic parasitic disease in Iran. It is so prevalent that in some villages up to 70% of the population have at least one leishmaniasis scar. [1] Pentavalent antimony compounds including meglumine antimoniate (glucantime) and sodium stibogluconate (Pentostam) are regarded as the first-line treatment of this condition. [2] They are normally effective in 70-85% of cases when given in an adequate dose and duration. [3] Antimonial unresponsiveness in human leishmaniasis has long been recognized as a serious clinical problem, and its prevalence appears to be increasing. [4] In such cases, repeating the treatment for several courses leads to increasing the resistance to these drugs. [4]

In this study, anti-leishmanial activity of glucantime was evaluated in CL lesions complicated with secondary bacterial infection and non-complicated lesions.


   Methods Top


This experimental study was carried out in Skin Diseases and Leishmaniasis Research Center, Isfahan, Iran. The participants enrolled in the study had CL confirmed by positive smear of their lesions. They were of both sex and different age groups. The patients or their guardians signed a consent form after being informed about the study. Those with underlying disease, pregnant women, children under 5 years old, previous treatment with glucantime, and those with more than one lesion or lesions lasting for more than 6 months were excluded from the study. For bacteriological examination, the center of lesions were scraped using a sterile swab and the samples were cultured on a blood agar medium inside a disposable plastic plate. The inoccula were spread on the blood agar and incubated at 37C for 24 h. Smears from each of the morphologically different colonies were observed on the blood agar, then heat fixed, treated with Gram stain, and examined microscopically. Bacteria were identified from their form, size, reaction to Gram stain, and colony characteristics on the culture medium.

The patients were treated with glucantime at 20 mg/kg/day dosage for 20 days and followed for a period of 2 months. Good response to treatment was defined as the loss of infiltration, reepithelization, and negative smear. Poor response was defined as unchanging size of the lesions without reepithelization and positive smear at the end of the study. Regarding the results of cultures, the patients were divided into positive and negative groups. Glucantime activity was compared between two groups by Chi-square test using SPSS software (Chicago, USA).


   Results Top


A total of 161 patients (101 male and 60 female) completed the study. The mean age was 23.6 ± 17.3, and the mean of disease duration was 5.6 ± 5.3 weeks. The mean size of lesions was 23 ± 0.9 mm. Characteristics of patients in two groups are shown in [Table 1].
Table 1: Demographic data of patients in the two study groups


Click here to view


Results of bacterial culture were negative in 123 patients (76.4%) and positive in 38 patients (23.6%). In the group with negative culture, good response to glucantime was observed in 80 patients (65%) and poor response observed in 43 patients (35%). In the group with positive culture, 12 patients (31.6%) had good response and 26 patients (68.4%) had poor response (χ2 = 13.36, P < 0.05). The results of isolated bacterial species are shown in [Table 2].
Table 2: Bacterial species isolated from lesions


Click here to view



   Discussion Top


This study showed that there was a significant difference between therapeutic effect of glucantime in the lesions of CL complicated with secondary bacterial infection and uncomplicated lesions in a way that in lesions with secondary bacterial infection the efficacy of glucantime was decreased [Figure 1] and [Figure 2].
Figure 1: Cutaneous leishmaniasis lesion infected with secondary bacterial infection before treatment with glucantime

Click here to view
Figure 2: Cutaneous leishmaniasis lesion infected with secondary bacterial infection after treatment with glucantime

Click here to view


Pentavalent antimonial in the form of sodium stibogluconate (Pentostam) and meglumine antimoniate (glucantime) has been recommended as a first-line treatment of CL. These drugs are administrated parenterally at dosage of 10-20 mg/kg/day for 10-30 days, depending on the clinical form of the disease. [5] Unfortunately, failure to treatment in kala azar, mucosal leishmaniasis, and some forms of CL is becoming a problem in many endemic areas, occurring in 5-70% of the patients. In some instances, this could be attributed to reinfection or immunologic, physiologic, and pharmacokinetic deficiencies in the host. [5] In a previous study, the futility and dangers of repeating antimonial treatments were emphasized. [4] In a study from Mexico, the pathogenic role of bacteria in skin lesions of patients with chiclero's ulcer (one of the forms of CL due to Leishmania Mexicana), reluctant to antimonial treatment was determined which suggested the need of elimination of bacterial infection before starting treatment. [6] In another study from Iran, resistance to glucantime was reported in 20 out of 185 patients (10.8%) in a region where anthroponotic CL is endemic [7] and one study reported 8.1% resistance in a region of zoonotic CL. [8] Another study showed that patients infected with L. tropica have more drug resistance and those infected with L. major have more drug sensitivity to glucantime. [9]

The prevalence of superimposed bacterial infection in CL in two other studies done in Iran was 26.5% and 21.8%. Staphylococcus aureus was the most prevalent organism in these lesions. [10],[11] This study showed decreased activity of glucantime in lesions of CL infected with secondary bacterial infection with the prevalence of 23.6%. The most prevalent-isolated organism was Staphylococcus aureus confirming the results of previous studies.

Regarding the prevalence of secondary bacterial infection and decreasing the glucantime efficacy, in the cases of unresponsiveness to treatment with antimonial compounds, evaluation of secondary bacterial infection is recommended, and antibiotic therapy before repeating the treatment is suggested.


   Acknowledgments Top


We are very grateful to Professor Klas Nordlind for his suggestions during writing this article.

 
   References Top

1.Hatman GR, Riyad M, Bichichi M, Hejazi SH, Guessous Idrissi N, Ardehali S, et al. Isoenzyme characterization of Iranian Leishmania Isolates from cutaneous leishmaniasis. Iran J Sci Technol 2005;29:65-70.  Back to cited text no. 1
    
2.Croft SL, Sundar S, Fairlamb AH. Drug Resistance in Leishmaniasis. Clin Microbiol Rev 2006;19:111-26.  Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.Momeni Ali Z, Aminjavaheri M. Successful treatment of non-healing cases of cutaneous leishmaniasis, using Combination of meglumine antimoniate plus alloporinol. Eur J Dermatol 2003;13:40-3.  Back to cited text no. 3
    
4.Gramiccia M, Gradoni L, Orisini S. Decreased Sensitivity to meglomine antimoniate (Glucantime) of Leishmania infantum isolated from dogs after several courses of drug treatment. Ann Trop Med Parasitol 1992;86:613-20.  Back to cited text no. 4
    
5.Grogi M, Thomason TN, Franke ED. Drug resistance in leishmaniasis: its implications in systemic chemotherapy of cutaneous and mucocutaneous disease. Am J Trop Med Hyg 1991;47:117-26.  Back to cited text no. 5
    
6.Isaae-Marquez AP, Lezoma-Davila CM. Detection of pathogenic bacteria in skin lesions patients with chiclero's ulcer, Relactant response to antimonial treatment. Mem Inst Oswaldo Cruz 2003;98:1993-5.  Back to cited text no. 6
    
7.Hadighi R, Mohebali M, Boucher P, Hajjaran H, Khamesipour A, Ouellette M. Unresponsiveness to Glucantime treatment in iranian cutaneous leishmaniasis due to drug-resistant leishmania tropica parasites. PLoS Med 2006;3:e162.   Back to cited text no. 7
[PUBMED]  [FULLTEXT]  
8.Nilfroushzadeh MA, Ansari N, Derakhshan R. Frequency of resistance to systemically administered meglumin antimoniate (Glucantime) in patients with acute cutaneuse leishmaniasis: A cross-sectional study. Iran J Dermatol 2006;8:457-61.  Back to cited text no. 8
    
9.Motazedian M. Study of glucantime resistance in cutaneous leishmaniasis by PCR-RFLP method in Shiraz, Iran. Available from: http://www.blackwellpublishing.com/eccmid14/abstract.asp?id=14270#top [last cited on 2004 May].  Back to cited text no. 9
    
10.Edrissian GH, Mohammadi M, Kanani A, Afshar A, Hafezi R, Ghorbani M, et al. Bacterial infections in suspected cutaneous leishaniasis lesions. Bull World Health Organ 1990;88:473-7.  Back to cited text no. 10
    
11.Ziaei H, Sadeghian G, Hejazi SH. Distribution frequency of pathogenic bacteria isolated from cutaneous leishmaniasis lesions. Korean J Parasitol 2008;46:191-3.  Back to cited text no. 11
[PUBMED]  [FULLTEXT]  


    Figures

  [Table 2], [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1]



 

Top
Print this article  Email this article
 
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Article in PDF (693 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    Abstract
    Background
    Methods
    Results
    Discussion
    Acknowledgments
    References
    Article Figures
    Article Tables

 Article Access Statistics
    Viewed3232    
    Printed94    
    Emailed0    
    PDF Downloaded51    
    Comments [Add]    

Recommend this journal