Antihelminthic Therapy Combined With Antimony in the Treatment of Cutaneous Leishmaniasis
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The purpose of this project is to investigate the efficacy of early, empiric anti-helminthic therapy combined with standard pentavalent antimony in the treatment of subjects co-infected with helminths and cutaneous leishmaniasis caused by L. brasiliensis. The study hypothesis is that early intervention with antihelminthic therapy will improve response rates to antimony in subjects with cutaneous leishmaniasis.
Condition or disease
Drug: Anti-helminthicDrug: meglumine antimony
Leishmaniases are a group of diseases caused by a parasite and transmitted by the sand fly. There are a number of diseases associated with infection ranging from simple skin lesions to a severe, fatal form. The standard treatment of cutaneous leishmaniasis (CL) is a 20 day course of antimony which, although fairly effective, has multiple side effects and is difficult to administer. The populations that are affected by leishmaniasis are usually also affected by intestinal helminths (worms). It is unknown what effect these two diseases have on each other and the immune system. As pathology in CL is mediated by an inflammatory reaction and helminths down regulate inflammation, helminthic infection may be beneficial for leishmaniasis. However, a recent study by our research group suggested that subjects infected with both leishmania and helminths have longer healing times and are less likely to respond to antimony. Since failure of initial therapy often results in repeat courses of the drug or development of more severe disease, we propose a study to investigate the role of early treatment for co-existing helminth infections in improving response rates to antimony in subjects with CL.
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Ages Eligible for Study:
13 Years to 50 Years (Child, Adult)
Sexes Eligible for Study:
Accepts Healthy Volunteers:
Subjects with a diagnosis of CL based on the presence of typical skin lesions and a positive Montenegro skin test
Evidence of helminthic infection by parasitological examination of first stool sample
Males or females between 13 and 50 years of age
Maximum of 3 ulcers with no more than 2 body regions involved
Period of 15 to 60 days from the onset of the first ulcer
Subject agreement to follow-up visits and therapy
Ability to give informed consent
Presence of mucosal disease
History of prior treatment with antimonial drugs.
History of prior treatment with anthelminthic drugs within the last 6 months.
History of allergy to pentavalent antimony or antihelminthic
Presence of underlying disease which affects the immune response, such as HIV and diabetes mellitus