The efficacy of pentamidine combined with allopurinol and immunotherapy for the treatment of patients with diffuse cutaneous leishmaniasis

Parasitol Res. 1999 Mar;85(3):165-70. doi: 10.1007/s004360050529.

Abstract

A new treatment regimen was tested on patients with incurable diffuse cutaneous leshmaniasis (DCL) infected with Leishmania mexicana mexicana in Mexico. Two patients with advanced stages of the disease were treated with polychemotherapy (pentamidine and allopurinol) combined with recombinant human interferon-gamma (rIFN-gamma). For determination of the best medication, parasites isolated from patient lesions were exposed to available drugs both as promastigotes and as intracellular amastigotes. A synergistic effect was observed in vitro for the combination of pentamidine and allopurinol. Both patients were treated and recovered rapidly, but one of them developed insulin-dependent type I diabetes because of pentamidine toxicity. The complication was controlled and both patients were discharged with an apparent parasitologic cure, but after 3 months the two patients began to relapse. Our results suggest that allopurinol-pentamidine polychemotherapy, involving reduced dosage of pentamidine, combined with rIFN-gamma is an alternative for DCL patients infected with L. m. mexicana.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Allopurinol / therapeutic use*
  • Allopurinol / toxicity
  • Animals
  • Antiprotozoal Agents / adverse effects
  • Antiprotozoal Agents / therapeutic use*
  • Antiprotozoal Agents / toxicity
  • Combined Modality Therapy
  • Diabetes Mellitus, Type 1 / chemically induced
  • Drug Synergism
  • Humans
  • Interferon-gamma / therapeutic use*
  • Leishmania mexicana* / drug effects
  • Leishmaniasis, Diffuse Cutaneous / drug therapy
  • Leishmaniasis, Diffuse Cutaneous / immunology
  • Leishmaniasis, Diffuse Cutaneous / therapy*
  • Mexico
  • Pentamidine / adverse effects
  • Pentamidine / therapeutic use*
  • Pentamidine / toxicity
  • Recombinant Proteins

Substances

  • Antiprotozoal Agents
  • Recombinant Proteins
  • Allopurinol
  • Pentamidine
  • Interferon-gamma