Assessment of Co-Infections as Determinants of Treatment Failure in Cutaneous Leishmaniasis

Cutaneous Leishmaniosis (CL) is a skin infection caused by various parasite species of the Leishmania genus. Pentavalent antimonials (SbV) are being used as first line drug to treat CL worldwide. Unfortunately, an increased treatment failure rate has been documented over the past years. The clinical characteristics, but also evolution and treatment outcome of CL depend on factors related to the parasite and to the host. Leishmania (V.) braziliensis species has been associated with worse treatment outcome; and the recognized host factors associated with treatment failure include number of lesions, young age, duration of stay in the area of acquisition, short duration of disease (<5 weeks), compliance , and immune status . Other proposed factors that might affect the clinical course include infectious diseases with some kind of modulating or immunosuppressive effect over the immune system such as intestinal helminths and tuberculosis co-infection; though the latter association has not been firmly established. Better knowledge is required about the role of co-infections as factors associated to treatment failure, including the co-infection with intestinal helminths. The proposed PhD project aims to contribute to fill this gap. A broad review of the published biomedical literature about the effect of co-infection on the kinetoplastid diseases will be performed. A retrospective study of the epidemiological, epidemiological and treatment outcomes among the CL, including co-infections will be done in a national reference center level to study the association between CL and other infectious diseases. Then, a case control study will be executed to assess the risk factors for treatment failure, including the identified infectious diseases in the review (including intestinal helminthiasis, HIV, HTLVI, TB, etc) in a Leishmania (V) braziliensis prevalent area. A thorough understanding of the underlying factors will help to delineate a more comprehensive management strategy for CL patients'.

Trefwoorden:B680-volksgezondheid

Project type:PhD project