Influence of Leishmania (Viannia) Species on the Response to Antimonial Treatment in Patients with American Tegumentary Leishmaniasis

Background. Pentavalent antimonials (SbV) are the first-line chemotherapy for American tegumentary leishmaniasis (ATL). There are, however, reports of the occurrence of treatment failure with these drugs. Few studies in Latin America have compared the response to SbV treatment in ATL caused by different Leishmania species. Methods. Clinical parameters and response to SbV chemotherapy were studied in 103 patients with cutaneous leishmaniasis (CL) in Peru. Leishmania isolates were collected before treatment and typed by multilocus polymerasechain-reaction restriction fragment—length polymorphism analysis. Results. The 103 isolates were identified as L. (Viannia) peruviana (47.6%), L. (V.) guyanensis (23.3%), L. (V.) braziliensis (22.3%), L. (V.) lainsoni (4.9%), L. (Leishmania) mexicana (1%), and a putative hybrid, L. (V.) braziliensis/L. (V.) peruviana (1%). L. (V.) guyanensis was most abundant in central Peru. Of patients infected with the 3 former species, 21 (21.9%) did not respond to SbV chemotherapy. The proportions of treatment failure (after 12 months of follow-up) were 30.4%, 24.5%, and 8.3% in patients infected with L. (V.) braziliensis, L. (V.) peruviana, and L. (V.) guyanensis, respectively. Infection with L. (V.) guyanensis was associated with significantly less treatment failure than L. (V.) braziliensis, as determined by multiple logistic regression analysis (odds ratio, 0.07 [95% confidence interval, 0.007-0.8]; P = .03). Conclusions. Leishmania species can influence SbV treatment outcome in patients with CL. Therefore, parasite identification is of utmost clinical importance, because it should lead to a species-oriented treatmen

New world cutaneous leishmaniasis : new paradigms for novel therapies

Leishmaniasis is a serious public health problem throughout the developing world; 350 million people are at risk of infection in 88 countries. It is caused by a protozoa parasite called leishmania. The current therapy for leishmaniasis is limited. Pentavalent antimonials (SbV) have been the recommended drugs for the treatment of leishmaniasis for over 50 years, but long courses, and toxicity limits their use. New approaches for new therapies, including combination therapies, are urgently needed. Imiquimod is a novel compound that activates macrophages to kill leishmania amastigotes in vitro and could reduce disease severity in a mouse model of cutaneous leishmaniasis (CL). It is an agonist for the Toll like receptor 7 (TLR7) on macrophages directing the development of Th1-type immune response required for resolution of leishmaniasis.A new combined model therapy for CL, was investigated in order to confirm that it was superior to SbV alone in the treatment of CL. A randomized, double-blind, placebo-controlled trial was carried out using Sb V in combination with topical imiquimod (5%) or a placebo cream for the treatment of CL in Peru. The study shows that, when used in combination with SbV, imiquimod significantly shortens the time required for complete cure of CL and may reduce the severity of scarring.High costs and drug resistance to SbV are a big problem in endemic areas; therefore alternative drugs for SbV are necessary to possibly be used in combination with imiquimod. The findings of these studies represent a significant advance for leishmaniasis, demonstrating that it is possible to translate the rationale for combined therapy based in basic immunological concepts into action in the developing world

Atendiendo la salud mental de las personas con enfermedades crónicas no transmisibles en el Perú: Retos y oportunidades para la integración de cuidados en el primer nivel de atención

En este artículo se discute la relación entre la salud mental y las enfermedades crónicas no transmisibles; así como la posibilidad de atenderlas de manera integral en el sistema de salud peruano. En primer lugar se revisan los estimados de prevalencia y carga de enfermedad de enfermedades crónicas no transmisibles y desórdenes mentales a nivel mundial y en el Perú. Luego, se describe el impacto perjudicial de la depresión en la etiología así como en la progresión de la diabetes y las enfermedades cardiovasculares. Posteriormente, se analiza la brecha en el acceso a la atención de la salud mental en el Perú y, finalmente, se exploran las alternativas para reducirla. De estas alternativas se enfatiza la integración de la salud mental en servicios de atención primaria como una forma viable de responder a las necesidades de atención de la población en general, y de las personas con enfermedades crónicas, en particular, en el contexto peruan

Atendiendo la salud mental de las personas con enfermedades crónicas no transmisibles en el Perú: retos y oportunidades para la integración de cuidados en el primer nivel de atención

In this article, the relationship between mental health and chronic non-communicable diseases is discussed as well as the possibility to address them in a comprehensive manner in the Peruvian health system. First, the prevalence estimates and the burden of chronic non-communicable diseases and mental disorders worldwide and in Peru are reviewed. Then, the detrimental impact of depression in the early stages as well as the progress of diabetes and cardiovascular diseases is described. Additionally, the gap between access to mental health care in Peru is analyzed. Lastly, the alternatives to reduce the gap are explored. Of these alternatives, the integration of mental health into primary care services is emphasized; as a feasible way to meet the care needs of the general population, and people with chronic diseases in particular, in the Peruvian context.En este artículo se discute la relación entre la salud mental y las enfermedades crónicas no transmisibles; así como la posibilidad de atenderlas de manera integral en el sistema de salud peruano. En primer lugar se revisan los estimados de prevalencia y carga de enfermedad de enfermedades crónicas no transmisibles y desórdenes mentales a nivel mundial y en el Perú. Luego, se describe el impacto perjudicial de la depresión en la etiología así como en la progresión de la diabetes y las enfermedades cardiovasculares. Posteriormente, se analiza la brecha en el acceso a la atención de la salud mental en el Perú y, finalmente, se exploran las alternativas para reducirla. De estas alternativas se enfatiza la integración de la salud mental en servicios de atención primaria como una forma viable de responder a las necesidades de atención de la población en general, y de las personas con enfermedades crónicas, en particular, en el contexto peruano

Atendiendo la salud mental de las personas con enfermedades crónicas no transmisibles en el Perú: Retos y oportunidades para la integración de cuidados en el primer nivel de atención

En este artículo se discute la relación entre la salud mental y las enfermedades crónicas no transmisibles; así como la posibilidad de atenderlas de manera integral en el sistema de salud peruano. En primer lugar se revisan los estimados de prevalencia y carga de enfermedad de enfermedades crónicas no transmisibles y desórdenes mentales a nivel mundial y en el Perú. Luego, se describe el impacto perjudicial de la depresión en la etiología así como en la progresión de la diabetes y las enfermedades cardiovasculares. Posteriormente, se analiza la brecha en el acceso a la atención de la salud mental en el Perú y, finalmente, se exploran las alternativas para reducirla. De estas alternativas se enfatiza la integración de la salud mental en servicios de atención primaria como una forma viable de responder a las necesidades de atención de la población en general, y de las personas con enfermedades crónicas, en particular, en el contexto peruan

Leishmania OligoC-TesT as a Simple, Rapid, and Standardized Tool for Molecular Diagnosis of Cutaneous Leishmaniasis in Peru▿

Molecular methods such as PCR have become attractive tools for diagnosis of cutaneous leishmaniasis (CL), both for their high sensitivity and for their specificity. However, their practical use in routine diagnosis is limited due to the infrastructural requirements and the lack of any standardization. Recently, a simplified and standardized PCR format for molecular detection of Leishmania was developed. The Leishmania OligoC-TesT is based on simple and rapid detection using a dipstick with PCR-amplified Leishmania DNA. In this study, we estimated the diagnostic accuracy of the Leishmania OligoC-TesT for 61 specimens from 44 CL-suspected patients presenting at the leishmaniasis clinic of the Instituto de Medicina Tropical Alexander von Humboldt, Peru. On the basis of parasitological detection and the leishmanin skin test (LST), patients were classified as (i) confirmed CL cases, (ii) LST-positive cases, and (iii) LST-negative cases. The sensitivities of the Leishmania OligoC-TesT was 74% (95% confidence interval (CI), 60.5% to 84.1%) for lesion aspirates and 92% (95% CI, 81.2% to 96.9%) for scrapings. A significantly higher sensitivity was observed with a conventional PCR targeting the kinetoplast DNA on the aspirates (94%) (P = 0.001), while there was no significant difference in sensitivity for the lesion scrapings (88%) (P = 0.317). In addition, the Leishmania OligoC-TesT was evaluated for 13 CL-suspected patients in two different peripheral health centers in the central jungle of Peru. Our findings clearly indicate the high accuracy of the Leishmania OligoC-TesT for lesion scrapings for simple and rapid molecular diagnosis of CL in Peru