Jacques-Robert Christen1, Eliane Bourreau2, Magalie Demar3, Edward Lightburn4, Pierre Couppié5, Marine Ginouvès6, Ghislaine Prévot6, Jean-Pierre Gangneux7, Hélène Savini4, Frank de Laval8, Vincent Pommier de Santi8, Sébastien Briolant9. 1. Laveran Military Teaching Hospital, Department of Infectious Diseases and Tropical Medicine, Marseille, France. Electronic address: jako.christen@gmail.com. 2. Immunology Laboratory for Leishmaniasis, Institut Pasteur in French Guiana, Cayenne, French Guiana. 3. Amazonian Ecosystems and Tropical Pathologies-EA 3593-Labex CEBA-Department of Medicine, University of French Guiana, Cayenne, French Guiana; Laboratory of Parasitology-Mycology, Andrée Rosemon Hospital, Cayenne, French Guiana. 4. Laveran Military Teaching Hospital, Department of Infectious Diseases and Tropical Medicine, Marseille, France. 5. Amazonian Ecosystems and Tropical Pathologies-EA 3593-Labex CEBA-Department of Medicine, University of French Guiana, Cayenne, French Guiana; Department of Dermatology, Andrée Rosemon Hospital, Cayenne, French Guiana. 6. Amazonian Ecosystems and Tropical Pathologies-EA 3593-Labex CEBA-Department of Medicine, University of French Guiana, Cayenne, French Guiana. 7. Rennes University Hospital, Parasitology-Mycology Laboratory, Inserm U1085-Research Institute for Environmental and Occupational Health (IRSET), 35000 Rennes, France. 8. French Armed Forces Medical Health Service, French Guiana, France; French Armed Forces Center for Epidemiology and Public Health, Marseille, France. 9. French Armed Forces Medical Health Service, French Guiana, France; Armed Forces Biomedical Research Institute, Brétigny-sur-Orge, France; URMITE, Aix-Marseille University, UM63, CNRS 7278, IRD 198, INSERM 1095, IHU - Méditerranée Infection, Marseille, France.
Abstract
BACKGROUND: New world cutaneous leishmaniasis (NWCL) can be found in French Guiana as well as in several other parts of Central and South America. Leishmania guyanensis accounts for nearly 90% of cases in French Guiana and is treated with pentamidine isethionate, given by either intramuscular or intravenous injection. The military population is particularly exposed due to repeated missions in the rainforest. The purpose of the present study was to identify the factors associated with pentamidine isethionate treatment failure in a series of service members with L. guyanensis NWCL acquired in French Guiana. METHOD: All the French service members reported as having acquired leishmaniasis in French Guiana from December 2013 to June 2016 were included. RESULTS: Seventy-three patients infected with L. guyanensis were included in the final analysis. Patients treated with IV pentamidine isethionate had better response rates than those treated with IM pentamidine isethionate (p = 0.002, adjusted odds ratio (AOR) = 0.15, 95% CI [0.04-0.50]). The rate of treatment success was 85.3% (95% CI [68.9-95.0]) for IV pentamidine isethionate and 51.3% (95% CI [34.8-67.6]) for IM pentamidine isethionate. CONCLUSIONS: The use of intramuscular pentamidine isethionate in the treatment of Leishmania guyanensis cutaneous leishmaniasis is associated with more treatment failures than intravenous pentamidine isethionate.
BACKGROUND: New world cutaneous leishmaniasis (NWCL) can be found in French Guiana as well as in several other parts of Central and South America. Leishmania guyanensis accounts for nearly 90% of cases in French Guiana and is treated with pentamidine isethionate, given by either intramuscular or intravenous injection. The military population is particularly exposed due to repeated missions in the rainforest. The purpose of the present study was to identify the factors associated with pentamidine isethionate treatment failure in a series of service members with L. guyanensis NWCL acquired in French Guiana. METHOD: All the French service members reported as having acquired leishmaniasis in French Guiana from December 2013 to June 2016 were included. RESULTS: Seventy-three patients infected with L. guyanensis were included in the final analysis. Patients treated with IV pentamidine isethionate had better response rates than those treated with IM pentamidine isethionate (p = 0.002, adjusted odds ratio (AOR) = 0.15, 95% CI [0.04-0.50]). The rate of treatment success was 85.3% (95% CI [68.9-95.0]) for IV pentamidine isethionate and 51.3% (95% CI [34.8-67.6]) for IM pentamidine isethionate. CONCLUSIONS: The use of intramuscular pentamidine isethionate in the treatment of Leishmania guyanensis cutaneous leishmaniasis is associated with more treatment failures than intravenous pentamidine isethionate.