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1.
Cincurá C, de Lima CMF, Machado PRL, Oliveira-Filho J, Glesby MJ, Lessa MM, Carvalho EM, 2017. Mucosal leishmaniasis: A retrospective study of 327 cases from an endemic area of Leishmania (Viannia) braziliensis. Am J Trop Med Hyg 97: 761–766.
-
2.
Carvalho EM, Johnson WD, Barreto E, Marsden PD, Costa JL, Reed S, Rocha H, 1985. Cell mediated immunity in American cutaneous and mucosal leishmaniasis. J Immunol 135: 4144–4148.
-
3.
Marsden PD, Badaró R, Netto EM, Casler JD, 1991. Spontaneous clinical resolution without specific treatment in mucosal leishmaniasis. Trans R Soc Trop Med Hyg 85: 221.
-
4.
Soto J, Gutiérrez P, Soto P, Paz D, Cayhuara E, Molina C, Sánchez M, Berman J, 2022. Treatment of Bolivian Leishmania braziliensis cutaneous and mucosal leishmaniasis. Am J Trop Med Hyg 106: 1182–1190.
-
5.
PAHO, 2022. Guidelines for the Treatment of Leishmaniasis in the Americas. Available at: https://iris.paho.org/bitstream/handle/10665.2/56120/9789275125038_eng.pdf?sequence=13&isAllowed=y. Accessed February 2, 2025.
-
6.
Carvalho JP, Silva SN, Freire ML, Alves LL, Souza CSA, Cota G, 2022. The cure rate after different treatments for mucosal leishmaniasis in the Americas: A systematic review. PLoS Negl Trop Dis 16: e0010931.
-
7.
Aronson N, Herwaldt BL, Libman M, Pearson R, Lopez-Velez R, Weina P, Carvalho E, Ephros M, Jeronimo S, Magill A, 2017. Diagnosis and treatment of leishmaniasis: Clinical practice guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH). Am J Trop Med Hyg 96: 24–45.
-
8.
Schneider MM, Hoepelman AI, Eeftinck Schattenkerk JK, Nielsen TL, van der Graaf Y, Frissen JP, van der Ende IM, Kolsters AF, Borleffs JC, 1992. A controlled trial of aerosolized pentamidine or trimethoprim-sulfamethoxazole as primary prophylaxis against Pneumocystis carinii pneumonia in patients with human immunodeficiency virus infection. The Dutch AIDS Treatment Group. N Engl J Med 327: 1836–1841.
-
9.
Food and Drug Administration, 2010. Nebupent Respirgard Label. Available at: www.accessdata.fda.gov/drugsatfda_docs/label/2011/019887s014lbl.pdf. Accessed February 2, 2025.
-
10.
Monk J, Benfield P, 1990. Inhaled pentamidine. An overview of its pharmacological properties and a review of its therapeutic use in Pneumocystis carinii pneumonia. Drugs 39: 741–756.
-
11.
Rizzardi GP, Lazzarin A, Musicco M, Frigerio D, Maillard M, Lucchini M, Moroni M, 1995. Better efficacy of twice-monthly than monthly aerosolised pentamidine for secondary prophylaxis of Pneumocystis carinii pneumonia in patients with AIDS. An Italian multicentric randomised controlled trial. The Italian PCP Study Group. J Infect 31: 99–105.
-
12.
Soto J et al., 2007. Treatment of Bolivian mucosal leishmaniasis with miltefosine. Clin Infect Dis 44: 350–356.
-
13.
Franke ED, Wignall FS, Cruz ME, Rosales E, Tovar AA, Lucas CM, Llanos-Cuentas A, Berman JD, 1990. Efficacy and toxicity of sodium stibogluconate for mucosal leishmaniasis. Ann Intern Med 113: 934–940.
-
14.
Llanos-Cuentas A, Echevarría J, Cruz M, La Rosa A, Campos P, Campos M, Franke E, Berman J, Modabber F, Marr J, 1997. Efficacy of sodium stibogluconate alone and in combination with allopurinol for treatment of mucocutaneous leishmaniasis. Clin Infect Dis 25: 677–684.
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Inhaled Pentamidine for Bolivian Mucosal Leishmaniasis
Jaime Soto
jasm.dlb@gmail.com
Jaime Soto
Fundación Nacional de Dermatología, Santa Cruz, Bolivia;
Hospital Dermatológico de Jorochito, Santa Cruz, Bolivia;
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Hospital Dermatológico de Jorochito, Santa Cruz, Bolivia;
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Patricia Gutiérrez
Patricia Gutiérrez
Fundación Nacional de Dermatología, Santa Cruz, Bolivia;
Hospital Dermatológico de Jorochito, Santa Cruz, Bolivia;
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Hospital Dermatológico de Jorochito, Santa Cruz, Bolivia;
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Paula Soto
Paula Soto
Fundación Nacional de Dermatología, Santa Cruz, Bolivia;
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Julio Escobar
Julio Escobar
ENT Service, Clínica Foianini, Santa Cruz, Bolivia;
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David Paz
David Paz
Hospital Dermatológico de Jorochito, Santa Cruz, Bolivia;
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Daniela Rivero
Daniela Rivero
Hospital Dermatológico de Jorochito, Santa Cruz, Bolivia;
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Aracely Villalba
Aracely Villalba
Hospital Dermatológico de Jorochito, Santa Cruz, Bolivia;
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Jonathan Berman
Jonathan Berman
AB Foundation, North Bethesda, Maryland;
Fast-Track Drugs, Potomac, Maryland
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Fast-Track Drugs, Potomac, Maryland
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ABSTRACT.
Aerosolized pentamidine is Food and Drug Administration approved to treat Pneumocystis pneumonia via a route that does not lead to systemic absorption or toxicity. Because Leishmania is also susceptible to pentamidine and mucosal leishmaniasis is also an infection of the respiratory tract, we performed a pilot study of aerosolized pentamidine (300 mg for 10 days over approximately 4 weeks) for mucosal leishmaniasis caused by Bolivian Leishmania braziliensis with a 2-year follow-up. Of 15 patients, 6 of 7 patients with initially mild disease were cured, 3 of 4 patients with initially moderate disease relapsed at the 18- to 24-month follow-up visits, and 3 of 4 patients with initially severe disease failed early after treatment. This study suggests that inhaled pentamidine may be useful as a well-tolerated treatment of mild mucosal leishmaniasis and that to rule out relapse, mucosal leishmaniasis follow-up should extend to 2 years.
Author Notes
Financial support: This work was supported by a grant from the
Disclosures: J. Berman is an officer of the AB Foundation, the granting agency for this work. The protocol was approved by the Comite de Bioetica de la Facultad de Medicina, Universidad Mayor de San Simon, Cochabamba, Bolivia.
Current contact information: Jaime Soto and Patricia Gutiérrez, Fundación Nacional de Dermatología y Hospital Dermatológico de Jorochito, Santa Cruz, Bolivia, E-mails: jaime.soto@infoleis.com and pgutierrezduenas@gmail.com. Paula Soto, Fundación Nacional Dermatología, Santa Cruz, Bolivia, E-mail: dra.paula.dermalaser@gmail.com. Julio Escobar, ENT Service, Clínica Foianini, Santa Cruz, Bolivia. David Paz, Daniela Rivero, and Aracely Villalba, Hospital Dermatológico de Jorochito, Santa Cruz, Bolivia, E-mails: davidpazmendoza@hotmail.com, p_d_rivero@hotmail.com, and chelycita83@gmail.com. Jonathan Berman, AB Foundation, North Bethesda, MD, E-mail: jberman@fasttrackresearch.com.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Cincurá C, de Lima CMF, Machado PRL, Oliveira-Filho J, Glesby MJ, Lessa MM, Carvalho EM, 2017. Mucosal leishmaniasis: A retrospective study of 327 cases from an endemic area of Leishmania (Viannia) braziliensis. Am J Trop Med Hyg 97: 761–766.
-
2.
Carvalho EM, Johnson WD, Barreto E, Marsden PD, Costa JL, Reed S, Rocha H, 1985. Cell mediated immunity in American cutaneous and mucosal leishmaniasis. J Immunol 135: 4144–4148.
-
3.
Marsden PD, Badaró R, Netto EM, Casler JD, 1991. Spontaneous clinical resolution without specific treatment in mucosal leishmaniasis. Trans R Soc Trop Med Hyg 85: 221.
-
4.
Soto J, Gutiérrez P, Soto P, Paz D, Cayhuara E, Molina C, Sánchez M, Berman J, 2022. Treatment of Bolivian Leishmania braziliensis cutaneous and mucosal leishmaniasis. Am J Trop Med Hyg 106: 1182–1190.
-
5.
PAHO, 2022. Guidelines for the Treatment of Leishmaniasis in the Americas. Available at: https://iris.paho.org/bitstream/handle/10665.2/56120/9789275125038_eng.pdf?sequence=13&isAllowed=y. Accessed February 2, 2025.
-
6.
Carvalho JP, Silva SN, Freire ML, Alves LL, Souza CSA, Cota G, 2022. The cure rate after different treatments for mucosal leishmaniasis in the Americas: A systematic review. PLoS Negl Trop Dis 16: e0010931.
-
7.
Aronson N, Herwaldt BL, Libman M, Pearson R, Lopez-Velez R, Weina P, Carvalho E, Ephros M, Jeronimo S, Magill A, 2017. Diagnosis and treatment of leishmaniasis: Clinical practice guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH). Am J Trop Med Hyg 96: 24–45.
-
8.
Schneider MM, Hoepelman AI, Eeftinck Schattenkerk JK, Nielsen TL, van der Graaf Y, Frissen JP, van der Ende IM, Kolsters AF, Borleffs JC, 1992. A controlled trial of aerosolized pentamidine or trimethoprim-sulfamethoxazole as primary prophylaxis against Pneumocystis carinii pneumonia in patients with human immunodeficiency virus infection. The Dutch AIDS Treatment Group. N Engl J Med 327: 1836–1841.
-
9.
Food and Drug Administration, 2010. Nebupent Respirgard Label. Available at: www.accessdata.fda.gov/drugsatfda_docs/label/2011/019887s014lbl.pdf. Accessed February 2, 2025.
-
10.
Monk J, Benfield P, 1990. Inhaled pentamidine. An overview of its pharmacological properties and a review of its therapeutic use in Pneumocystis carinii pneumonia. Drugs 39: 741–756.
-
11.
Rizzardi GP, Lazzarin A, Musicco M, Frigerio D, Maillard M, Lucchini M, Moroni M, 1995. Better efficacy of twice-monthly than monthly aerosolised pentamidine for secondary prophylaxis of Pneumocystis carinii pneumonia in patients with AIDS. An Italian multicentric randomised controlled trial. The Italian PCP Study Group. J Infect 31: 99–105.
-
12.
Soto J et al., 2007. Treatment of Bolivian mucosal leishmaniasis with miltefosine. Clin Infect Dis 44: 350–356.
-
13.
Franke ED, Wignall FS, Cruz ME, Rosales E, Tovar AA, Lucas CM, Llanos-Cuentas A, Berman JD, 1990. Efficacy and toxicity of sodium stibogluconate for mucosal leishmaniasis. Ann Intern Med 113: 934–940.
-
14.
Llanos-Cuentas A, Echevarría J, Cruz M, La Rosa A, Campos P, Campos M, Franke E, Berman J, Modabber F, Marr J, 1997. Efficacy of sodium stibogluconate alone and in combination with allopurinol for treatment of mucocutaneous leishmaniasis. Clin Infect Dis 25: 677–684.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 496 | 496 | 156 |
| Full Text Views | 13 | 13 | 4 |
| PDF Downloads | 16 | 16 | 7 |