Llanos-Cuentas et al evaluated the effectiveness of pentavalent antimony to treat cutaneous leishmaniasis in Peru. They identified factors associated with treatment failure. The authors are from Universidad Peruana Cayetano Heredia in Lima, Hospital Dr Luis Fabrega in Santiago City, Institute of Tropical Medicine in Antwerp and Geneva University in Switzerland.
Standard therapy for cutaneous leishmaniasis: 20 mg/kg per day of sodium stibogluconate for 20 days
Parameters:
(1) age of the patient
(2) number of skin lesions
(3) length of stay in area of disease acquisition
(4) duration of disease at time of treatment
(5) species involved
|
Parameter |
Finding |
Points |
Odds Ratio |
|
age of the patient |
young (<= 21 years) |
1 |
|
|
|
older |
0 |
|
|
number of skin lesions |
1 (or 2) |
0 |
1 |
|
|
2 or more |
1 |
2 per lesion |
|
length of stay |
< 6 years (72 months) |
1 |
30 |
|
|
>= 72 months |
0 |
1 |
|
duration of disease |
< 5 weeks |
1 |
4.4 |
|
|
>= 5 weeks |
0 |
1 |
|
species involved |
L. peruviana |
1 |
10 |
|
|
L. braziliensis |
1 |
22 |
|
|
L. guyanensis |
0 |
1 |
total number of risk factors for treatment failure =
= SUM(points for all 5 parameters)
Interpretation:
• minimum number of risk factors: 0
• maximum number of risk factors: 5
• The presence of multiple risk factors or the presence of significant risk factors (infection with L. braziliensis or duration of stay) is associated with a greater risk of treatment failure.
• The risk factors reflect a limited immune response, high number of organisms (more lesions) and more virulent species (page 229)
Specialty: Infectious Diseases
