Influence of Obesity on Clinical Manifestations and Response to Therapy in Cutaneous Leishmaniasis Caused by Leishmania braziliensis. (16th March 2021)

• Record Type: Journal Article
• Authors: Lago, Tainã; Carvalho, Lucas P; Nascimento, Mauricio; Guimarães, Luiz H; Lago, Jamile; Castellucci, Léa; Carvalho, Augusto M; Lago, Alex; Carvalho, Edgar M
• Is Part Of: Clinical infectious diseases. Volume 73:Number 6(2021)
• Page Start: 1020
• Page End: 1026
• Publication Date: 2021-03-16
• Subjects: cutaneous Leishmaniasis -- Leishmania braziliensis -- obesity -- atypical lesions -- immune response; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciab236
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract: Background: Cutaneous leishmaniasis (CL) caused by Leishmania braziliensis is characterized by a single ulcer or multiple cutaneous lesions with raised borders. Cure rates <60% are observed in response to meglumine antimoniate therapy. We investigated the impact of obesity on CL clinical presentation and therapeutic response. Methods: A total of 90 age-matched patients with CL were included (30 obese, 30 overweight, and 30 with normal body mass index [BMI]). CL was diagnosed through documentation of L. braziliensis DNA by polymerase chain reaction or identification of amastigotes in biopsied skin-lesion samples. Serum cytokine levels were determined by chemiluminescence. Antimony therapy with Glucantime (Sanofi-Aventis; 20 mg/kg/day) was administered for 20 days. Results: Obese CL patients may present hypertrophic ulcers rather than typical oval, ulcerated lesions. A direct correlation between BMI and healing time was noted. After 1 course of antimony, cure was achieved in 73% of patients with normal BMI, 37% of overweight subjects, yet just 18% of obese CL patients ( P < .01). Obese CL cases additionally presented higher leptin levels than overweight patients or those with normal BMI ( P < .05). Conclusions: Obesity modifies the clinical presentation of CL and host immune response and is associated with greater failure to therapy. Abstract : We investigated the impact of obesity on cutaneous leishmaniasis (CL) clinical presentation and therapeutic response. Obesity modifies the clinical presentation of CL and host immune response and is associated with greater failure to therapy.