Leishmaniasis and tumor necrosis factor alpha antagonists in the Mediterranean basin. A switch in clinical expression
Bosch-Nicolau, Pau (Hospital Universitari Vall d'Hebron)
Ubals, Maria (Hospital Universitari Vall d'Hebron)
Salvador, Fernando (Hospital Universitari Vall d'Hebron)
Sánchez-Montalvá, Adrián (Hospital Universitari Vall d'Hebron)
Aparicio, Gloria (Hospital Universitari Vall d'Hebron)
Erra Duran, Alba (Hospital Universitari Vall d'Hebron)
Martínez de Salazar, Pablo (Hospital Universitari Vall d'Hebron)
Sulleiro Igual, Elena (Hospital Universitari Vall d'Hebron)
Molina Romero, Israel (Hospital Universitari Vall d'Hebron)
Universitat Autònoma de Barcelona

Data:	2019
Resum:	Background Tumor necrosis factor alpha (TNF-α) blockers are recognized as a risk factor for reactivation of granulomatous infections. Leishmaniasis has been associated with the use of these drugs, although few cases have been reported. Methodology We performed a retrospective observational study including patients with confirmed leishmaniasis acquired in the Mediterranean basin that were under TNF-α blockers therapy at the moment of the diagnosis. Patients diagnosed in our hospital from 2008 to 2018 were included. Moreover, a systematic review of the literature was performed and cases fulfilling the inclusion criteria were also included. Principal findings Forty-nine patients were analyzed including nine cases from our series. Twenty-seven (55. 1%) cases were male and median age was 55 years. Twenty-five (51%) patients were under infliximab treatment, 20 (40. 8%) were receiving adalimumab, 2 (4. 1%) etanercept, one (2%) golimumab and one (2%) a non-specified TNF-α blocker. Regarding clinical presentation, 28 (57. 1%) presented as cutaneous leishmaniasis (CL), 16 (32. 6%) as visceral leishmaniasis (VL) and 5 (10. 2%) as mucocutaneous leishmaniasis (MCL). All VL and MCL patients were treated with systemic therapies. Among CL patients, 13 (46. 4%) were treated with a systemic drug (11 received L-AmB, one intramuscular antimonials and one miltefosine) while 14 (50%) patients were given local treatment (13 received intralesional pentavalent antimonials, and one excisional surgery). TNF-α blockers were interrupted in 32 patients (65. 3%). After treatment 5 patients (10. 2%) relapsed. Four patients with a CL (3 initially treated with local therapy maintaining TNF-α blockers and one treated with miltefosine) and one patient with VL treated with L-AmB maintaining TNF-α blockers. Conclusions This data supports the assumption that the blockage of TNF-α modifies clinical expression of leishmaniasis in endemic population modulating the expression of the disease leading to atypical presentations. According to the cases reported, the best treatment strategy would be a systemic drug and the discontinuation of the TNF-α blockers therapy until clinical resolution.
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Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Female ; Humans ; Immunosuppressive Agents ; Injections, Intramuscular ; Leishmaniasis ; Male ; Mediterranean Region ; Middle Aged ; Recurrence ; Retrospective Studies ; Systematic Reviews as Topic ; Tumor Necrosis Factor-alpha ; Young Adult
Publicat a:	PLoS neglected tropical diseases, Vol. 13 Núm. 8 (2019) , p. e0007708, ISSN 1935-2735

DOI: 10.1371/journal.pntd.0007708
PMID: 31469834

16 p, 1.3 MB

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