[Treatment of mucocutaneous leishmaniasis with pentamidine isothionate]

Abstract

Background: The mucocutaneous form of New World cutaneous leishmaniasis is caused, theoretically, by Leishmania (viannia) braziliensis. Pentad valency antimonic compounds are widely used for treatment of New World cutaneous leishmaniasis. The rate of recurrence is often high when these drugs are used for mucocutaneous forms. Pentamidine has been considered as a second line treatment although little data is available.

Patients and methods: Seventeen patients with mucocutaneous leishmaniasis were treated with pentamidine isothionate, 4 mg/kg every 48 hours. A complete oto-rhino-laryngological examination was performed once a week to determine the course of the lesions. Treatment was discontinued when the lesions healed. A follow-up oto-rhinolaryngological examination was also performed after treatment withdrawal and every three months thereafter for an undetermined period.

Results: Lesions healed with pentamidine isothionate in 16 patients (94%). Mean dosage required was 2872 mg (2025-4320 mg) for a mean treatment duration of 22 days (12-32 days). Mean follow-up was 13.3 months (3-37 months). Leishmaniasis relapsed in one patient 4 months after treatment withdrawal.

Discussion: Pentamidine isothionate is an effective treatment for mucocutaneous leishmaniasis, providing cure with a low rate of recurrence.