<html><head><style type='text/css'>p { margin: 0; }</style></head><body><div style='font-family: times new roman,new york,times,serif; font-size: 12pt; color: #000000'>De: <<a href="mailto:promed@promedmail.org" target="_blank">promed@promedmail.org</a>><br><blockquote style="border-left:2px solid rgb(16, 16, 255);margin-left:5px;padding-left:5px;color:#000;font-weight:normal;font-style:normal;text-decoration:none;font-family:Helvetica,Arial,sans-serif;font-size:12pt;"><div dir="ltr"><div>Data: domingo, 25 de outubro de 2015<br>Assunto: PRO/EDR> Leishmaniasis - India: miltefosine resistance<br>Para: <a href="mailto:promed-post@promedmail.org" target="_blank">promed-post@promedmail.org</a>, <a href="mailto:promed-edr-post@promedmail.org" target="_blank">promed-edr-post@promedmail.org</a><br><br><br><br>
LEISHMANIASIS - INDIA: MILTEFOSINE RESISTANCE<br>
*********************************************<br>
A ProMED-mail post<br>
<<a href="http://www.promedmail.org" target="_blank">http://www.promedmail.org</a>><br>
ProMED-mail is a program of the<br>
International Society for Infectious Diseases<br>
<<a href="http://www.isid.org" target="_blank">http://www.isid.org</a>><br>
<br>
Date: Thu 22 Oct 2015<br>
Source: Medical Xpress [edited]<br>
<<a href="http://medicalxpress.com/news/2015-10-resistance-drug-treatment-tropical-skin.html" target="_blank">http://medicalxpress.com/news/2015-10-resistance-drug-treatment-tropical-skin.html</a>><br>
<br>
<br>
Cutaneous leishmaniasis [CL] is an ulcerous skin disease caused by a<br>
tropical parasite [_Leishmania_ spp.], all forms of which can be<br>
treated with the drug miltefosine.<br>
<br>
Researchers from the National Institute of Pathology, Indian Council<br>
of Medical Research and Safdarjung Hospital in Delhi studied the<br>
responses of 86 patients treated with miltefosine over 18 months,<br>
which indicated a developing parasitic resistance to the drug,<br>
supporting a growing evidence base showing the rise of miltefosine<br>
resistance.<br>
<br>
The researchers studied 86 patients, all confirmed to have post<br>
kala-azar dermal leishmaniasis. Patients were initially treated with<br>
50 mg 3 times daily for 60 days; however, some patients suffered<br>
gastrointestinal side-effects and were changed to a dose of 50 mg of<br>
miltefosine twice daily for 90 days. Due to the side effects, all<br>
patients from 2011 onwards were initiated onto this 2nd regime. The<br>
patients were followed for 18 months post-treatment and assessed<br>
monthly via a clinical and histopathological examination.<br>
<br>
73 patients successfully completed the treatment and were cured. Four<br>
percent of patients suffered relapse in the 1st 12 months after<br>
treatment, while 15 percent relapsed in the 18 months following<br>
treatment, with a higher relapse rate seen in patients on the 60-day<br>
treatment regimen compared with the 90-day regimen. The number of<br>
parasites pre-treatment was found to be higher in the patients who<br>
later suffered a relapse.<br>
<br>
In 6 of the relapsed cases, the researchers tested the susceptibility<br>
of the parasites to miltefosine post-relapse and compared this with<br>
susceptibility of parasites pre-treatment. Following the relapse,<br>
parasites were shown to have significantly reduced sensitivity to the<br>
treatment, suggesting the development of resistance.<br>
<br>
Although all the patients in the study were cured through the use of<br>
miltefosine, the rate of relapse, along with the reduced drug<br>
susceptibility of the parasites following relapse, indicates that the<br>
development of drug resistance is a major concern. This indicates a<br>
pressing need for the development of new therapies or co-therapies to<br>
ensure the continued effective treatment of all forms of<br>
leishmaniasis.<br>
<br>
--<br>
Communicated by:<br>
ProMED-mail<br>
<<a target="_blank">promed@promedmail.org</a>><br>
<br>
[The study referred to in the text is: Ramesh V et al. Decline in<br>
Clinical Efficacy of Oral Miltefosine in Treatment of Post Kala-azar<br>
Dermal Leishmaniasis (PKDL) in India. PLoS Negl Trop Dis.<br>
2015;9(10):e0004093.<br>
<br>
PKDL develops up to several years after treatment of visceral<br>
leishmaniasis and leishmania parasites can be found in the cutaneous<br>
lesions in PKDL. PKDL develops in 5-15 percent of treated kala-azar<br>
case-patients in India (Salotra & Singh. Challenges in the diagnosis<br>
of post kala-azar dermal leishmaniasis. Indian J Med Res.<br>
2006;123:295-310), and in up to 50 percent of cases in the Sudan<br>
(Zijlstra & el-Hassan. Leishmaniasis in Sudan. Post kala-azar dermal<br>
leishmaniasis. Trans R Soc Trop Med Hyg. 2001;95(Suppl 1):S59-76).<br>
<br>
Miltefosine is usually used for treatment of cutaneous leishmaniasis<br>
and has recently been reported to be less effective against visceral<br>
leishmaniasis (Monge-Maillo & Lopez-Velez; Miltefosine for visceral<br>
and cutaneous leishmaniasis: drug characteristics and evidence-based<br>
treatment recommendations. Clin Infect Dis. 2015;60:1398-404). This is<br>
certainly a concern, as miltefosine is the only oral drug available<br>
for treatment of leishmaniasis. If resistance against miltefosine is<br>
developing as suggested in these studies, a rational strategy to<br>
prevent it could be not to use miltefosine as single drug but combine<br>
it with at least one other anti-leishmania drug. - Mod.EP<br>
<br>
A HealthMap/ProMED-mail map can be accessed at:<br>
<<a href="http://healthmap.org/promed/p/142" target="_blank">http://healthmap.org/promed/p/142</a>>.]<br>
<br>
[See Also:<br>
2013<br>
----<br>
Leishmaniasis - India (02): (JK): 20130910.1935488<br>
Leishmaniasis - India: (KL): 20130303.1568442<br>
2012<br>
----<br>
Leishmaniasis, visceral - India: (BR): 20120725.1214743<br>
2011<br>
----<br>
Leishmaniasis, visceral - India 20111007.3015<br>
2008<br>
----<br>
Leishmaniasis, visceral - India: RFI 20080928.3075<br>
Leishmaniasis, visceral - India: (Assam), susp., RFI 20080223.0736<br>
2007<br>
----<br>
Leishmaniasis, visceral - India (Mumbai) 20070430.1400<br>
2004<br>
----<br>
Leishmaniasis - India (Bihar) (02) 20040526.1418<br>
Leishmaniasis - Pakistan & India: background 20040201.0392<br>
Leishmaniasis - India (Andhra Pradesh) 20040124.0288<br>
Leishmaniasis - India (Bihar) (02): vectors 20040115.0167<br>
Leishmaniasis - India (Bihar) 20040114.0156<br>
2000<br>
----<br>
Leishmaniasis - India (Calcutta) (02) 20001026.1858<br>
Leishmaniasis - India (Calcutta) 20001022.1830]<br>
.................................................sb/ep/msp/dk<br>
*##########################################################*<br>
************************************************************<br>
ProMED-mail makes every effort to verify the reports that<br>
are posted, but the accuracy and completeness of the<br>
information, and of any statements or opinions based<br>
thereon, are not guaranteed. The reader assumes all risks in<br>
using information posted or archived by ProMED-mail. ISID<br>
and its associated service providers shall not be held<br>
responsible for errors or omissions or held liable for any<br>
damages incurred as a result of use or reliance upon posted<br>
or archived material.<br>
************************************************************<br>
Donate to ProMED-mail. Details available at:<br>
<<a href="http://www.isid.org/donate/" target="_blank">http://www.isid.org/donate/</a>><br>
************************************************************<br>
Visit ProMED-mail's web site at <<a href="http://www.promedmail.org" target="_blank">http://www.promedmail.org</a>>.<br>
Send all items for posting to: <a target="_blank">promed@promedmail.org</a> (NOT to<br>
an individual moderator). If you do not give your full name<br>
name and affiliation, it may not be posted. You may unsub-<br>
scribe at <<a href="http://ww4.isid.org/promedmail/subscribe.php" target="_blank">http://ww4.isid.org/promedmail/subscribe.php</a>>.<br>
For assistance from a human being, send mail to:<br>
<<a target="_blank">postmaster@promedmail.org</a>>.<br>
############################################################<br>
############################################################<br>
<br>
List-Unsubscribe: <a href="http://ww4.isid.org/promedmail/subscribe.php" target="_blank">http://ww4.isid.org/promedmail/subscribe.php</a><br>
<br></div> </div>
</blockquote><br></div></body></html>