Tainã Lago1,2, Lucas P Carvalho1,2,3, Mauricio Nascimento2,3, Luiz H Guimarães4, Jamile Lago1,2, Léa Castellucci1,2, Augusto M Carvalho3, Alex Lago1,2, Edgar M Carvalho1,2,3. 1. Immunology Service, Professor Edgard Santos University Hospital Complex, Federal University of Bahia, Salvador, Brazil. 2. Postgraduate Course in Health Sciences, Federal University of Bahia Medical School, Salvador, Brazil. 3. Gonçalo Moniz Institute (IGM), Fiocruz, Salvador, Brazil. 4. Federal University of Southern Bahia, Teixeira de Freitas, Brazil.
Abstract
BACKGROUND: Cutaneous leishmaniasis (CL) caused by Leishmania braziliensis is characterized by a single ulcer or multiple cutaneous lesions with raised borders. Cure rates <60% are observed in response to meglumine antimoniate therapy. We investigated the impact of obesity on CL clinical presentation and therapeutic response. METHODS: A total of 90 age-matched patients with CL were included (30 obese, 30 overweight, and 30 with normal body mass index [BMI]). CL was diagnosed through documentation of L. braziliensis DNA by polymerase chain reaction or identification of amastigotes in biopsied skin-lesion samples. Serum cytokine levels were determined by chemiluminescence. Antimony therapy with Glucantime (Sanofi-Aventis; 20 mg/kg/day) was administered for 20 days. RESULTS: Obese CL patients may present hypertrophic ulcers rather than typical oval, ulcerated lesions. A direct correlation between BMI and healing time was noted. After 1 course of antimony, cure was achieved in 73% of patients with normal BMI, 37% of overweight subjects, yet just 18% of obese CL patients (P < .01). Obese CL cases additionally presented higher leptin levels than overweight patients or those with normal BMI (P < .05). CONCLUSIONS: Obesity modifies the clinical presentation of CL and host immune response and is associated with greater failure to therapy.
BACKGROUND: Cutaneous leishmaniasis (CL) caused by Leishmania braziliensis is characterized by a single ulcer or multiple cutaneous lesions with raised borders. Cure rates <60% are observed in response to meglumine antimoniate therapy. We investigated the impact of obesity on CL clinical presentation and therapeutic response. METHODS: A total of 90 age-matched patients with CL were included (30 obese, 30 overweight, and 30 with normal body mass index [BMI]). CL was diagnosed through documentation of L. braziliensis DNA by polymerase chain reaction or identification of amastigotes in biopsied skin-lesion samples. Serum cytokine levels were determined by chemiluminescence. Antimony therapy with Glucantime (Sanofi-Aventis; 20 mg/kg/day) was administered for 20 days. RESULTS: Obese CL patients may present hypertrophic ulcers rather than typical oval, ulcerated lesions. A direct correlation between BMI and healing time was noted. After 1 course of antimony, cure was achieved in 73% of patients with normal BMI, 37% of overweight subjects, yet just 18% of obese CL patients (P < .01). Obese CL cases additionally presented higher leptin levels than overweight patients or those with normal BMI (P < .05). CONCLUSIONS: Obesity modifies the clinical presentation of CL and host immune response and is associated with greater failure to therapy.
Authors: Lara Jirmanus; Marshall J Glesby; Luiz H Guimarães; Ednaldo Lago; Maria Elisa Rosa; Paulo R Machado; Edgar M Carvalho Journal: Am J Trop Med Hyg Date: 2012-03 Impact factor: 2.345
Authors: Luiz Henrique Guimarães; Adriano Queiroz; Juliana A Silva; Silvana C Silva; Viviane Magalhães; Ednaldo L Lago; Paulo Roberto L Machado; Olívia Bacellar; Mary E Wilson; Stephen M Beverley; Edgar M Carvalho; Albert Schriefer Journal: PLoS Negl Trop Dis Date: 2016-12-01