Liposomal amphotericin B in travelers with cutaneous and muco-cutaneous leishmaniasis: Not a panacea

Background: complex cutaneous and muco-cutaneous leishmaniasis (cl and mcl) often requires systemic therapy. liposomal amphotericin b (l-amb) has a strong potential for a solid clinical benefit in this indication. methods: we conducted a retrospective analysis of data from a french centralized referral treatment program and from the “leishman” european consortium database. all patients with parasitologically proven cl or mcl who received at least one dose of l-amb were included. positive outcome was based on ulcer closure as per recent who workshop guidelines. results: from 2008 through 2016,43 travelers returning from 18 countries (old world n = 28; new world n = 15) were analyzed with a median follow-up duration of 79 days [range 28–803]. main clinical forms were: localized cl with one or multiple lesions (n = 32; 74%) and mcl (n = 8; 19%). as per published criteria 19 of 41 patients (46%) were cured 90 days after one course of l-amb. when the following items -improvement before day 90 but no subsequent follow-up,delayed healing (>3 months) and healing after a second course of l-amb- were included in the definition of cure,27 of 43 patients (63%) had a positive outcome. five patients (mcl = 1; cl = 4) experienced a relapse after a median duration of 6 months [range 3–27] post treatment and 53% of patients (23/43) experienced at least one adverse event including severe hypokalaemia and acute cardiac failure (one patient each). in multivariate analysis,tegumentary infection with l. infantum was associated with complete healing after l-amb therapy (or 5.8 ic 95% [1.03–32]) while infection with other species had no impact on outcome. conclusion: in conditions close to current medical practice,the therapeutic window of l-amb was narrow in travellers with cl or mcl,with the possible exception of those infected with l. infantum. strict follow-up is warranted when using l-amb in patients with mild disease. © 2017 guery et al.