Browsing by Autor "Paula Soto"

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Efficacy of Miltefosine for Bolivian Cutaneous Leishmaniasis
(American Society of Tropical Medicine and Hygiene, 2008) Jaime Soto; Jaime Rea; Margarita Balderrama; Julia Toledo; Paula Soto; L Valda; Jonathan Berman
Oral miltefosine (2.5 mg/kg/d for 28 days) was compared with intramuscular antimony (20 mg/kg/d for 20 days) in the treatment of cutaneous leishmaniasis caused by Leishmania braziliensis in Palos Blancos, Bolivia. The cure rates with 6 months of follow-up were statistically similar: 36 of 41 evaluable miltefosine patients (88%) versus 15 of 16 (94%) evaluable antimony patients. However, antimony cured more rapidly, because, by 1 month after therapy, 31 of 44 miltefosine patients (70%) compared with 16 of 16 antimony patients (100%) had achieved cure. The two conclusions from this work are that oral miltefosine can be used for cutaneous disease in this part of Bolivia and that miltefosine was more effective for L. braziliensis in this region than for L. braziliensis in Guatemala. Chemotherapy needs to be evaluated in each endemic region, even if the "same" species of Leishmania causes disease in these locales.
Inhaled Pentamidine for Bolivian Mucosal Leishmaniasis
(American Society of Tropical Medicine and Hygiene, 2025) Jaime Soto; Patrícia Gutiérrez; Paula Soto; Jaime Escobar; David Paz; Daniela Rivero; Alejandro Villalba; Jonathan Berman
Aerosolized pentamidine is Food and Drug Administration approved to treat Pneumocystis pneumonia via a route that does not lead to systemic absorption or toxicity. Because Leishmania is also susceptible to pentamidine and mucosal leishmaniasis is also an infection of the respiratory tract, we performed a pilot study of aerosolized pentamidine (300 mg for 10 days over approximately 4 weeks) for mucosal leishmaniasis caused by Bolivian Leishmania braziliensis with a 2-year follow-up. Of 15 patients, 6 of 7 patients with initially mild disease were cured, 3 of 4 patients with initially moderate disease relapsed at the 18- to 24-month follow-up visits, and 3 of 4 patients with initially severe disease failed early after treatment. This study suggests that inhaled pentamidine may be useful as a well-tolerated treatment of mild mucosal leishmaniasis and that to rule out relapse, mucosal leishmaniasis follow-up should extend to 2 years.
Intralesional Pentamidine: A Novel Therapy for Single Lesions of Bolivian Cutaneous Leishmaniasis
(American Society of Tropical Medicine and Hygiene, 2016) Jaime Soto; David Paz; Daniela Rivero; Paula Soto; Jorge Alberto Morales Quispe; Julia Toledo; Jonathan Berman
A novel therapy, intralesional (IL) pentamidine, was compared to intralesional therapy with antimony (ILSb), a World Health Organization-recommended therapy, for single Bolivian Leishmania braziliensis lesions. In Study 1, 90 patients were randomized equally between three injections of ILSb over 5 days, five injections of ILSb over 11 days, and three injections of IL pentamidine (120 μg/mm(2)lesion area [ILPenta-120-3]) over 5 days. Cure rates at 6 months were 57% for ILSb-3 injections, 73% for ILSb-5 injections, and 72% for ILPenta-120-3 injections. Adverse effects were local irritation and injection-site pain-ILSb (60 patients): mild (25), moderate (4); IL pentamidine (30 patients): mild (4), moderate (3). In Study 2, 60 patients were randomized equally between five injections of ILSb and three injections of a double dose of IL pentamidine (240 μg/mm(2)[ILPenta-240-3]). In Study 2, cure rates were 67% for ILSb-5 injections and 73% for ILPenta-240-3. For three IL injections of pentamidine, efficacy was optimized at a dose of 120 μg/mm(2)lesion area. The cure rate of that regimen was similar to that for ILSb-5 injections and nonstatistically larger than that of ILSb-3 injections. IL pentamidine is an attractive alternative to ILSb on the basis of efficacy for Bolivian L. braziliensis, the threat of Sb-resistant parasites, tolerance, and patient convenience of three visits over 5 days.
Mass Drug Administration of Triclabendazole for Fasciola Hepatica in Bolivia
(American Society of Tropical Medicine and Hygiene, 2019) S. Mollinedo; Patrícia Gutiérrez; Rosa Azurduy; Freddy Valle; Alejandra Salas; Zoraida Aymara Mollinedo; Paula Soto; Cleye F. Villarroel; Janet H. Ransom; Robb Lawrence
Human infection with Fasciola hepatica leads to obstruction of the common bile duct by adult worms and disease characterized by biliary colic, epigastric pain, and nausea. Recommended treatment is a single dose of triclabendazole (TCBZ) (10 mg/kg). Because in the 1990s the Bolivian Altiplano bordering Lake Titicaca was thought to have the highest prevalence of human fascioliasis worldwide, the Bolivian Ministry of Health instituted TCBZ mass drug administration (MDA). From 2008 to 2016 (excepting 2015), one dose of 250 mg was administered, usually in September/October, to each resident of highly endemic regions willing to participate. This is apparently the first reported use of MDA for Fasciola . The proportion of persons in key regions receiving TCBZ MDA was 87% in 2016. In 2017, we resurveyed key regions, and found that the MDA program had been dramatically successful. Whereas Fasciola prevalence was reported as 26.9% in Huacullani/Tiahuanaco and 12.6% in Batallas in 1999, there was 0.7% prevalence in Huacullani/Tiahuanaco and 1% in Batallas in 2017. However, lessons from schistosomiasis control efforts suggest that for sustained control of Fasciola infection, Fasciola MDA needs to be maintained and coupled with measures to control infection in the intermediary snail and in the animal hosts of F. hepatica .
Miltefosine Combined with Intralesional Pentamidine for Leishmania braziliensis Cutaneous Leishmaniasis in Bolivia
(American Society of Tropical Medicine and Hygiene, 2018) Jaime Soto; Paula Soto; Andrea Ajata; Daniela Rivero; Carmelo Luque; Carlos Tintaya; Jonathan Berman
Bolivian cutaneous leishmaniasis due to <i>Leishmania braziliensis</i> was treated with the combination of miltefosine (150 mg/day for 28 days) plus intralesional pentamidine (120 μg/mm<sup>2</sup> lesion area on days 1, 3, and 5). Ninety-two per cent of 50 patients cured. Comparison to historic controls at our site suggests that the efficacy of the two drugs was additive. Adverse effects and cost were also additive. This combination may be attractive when a prime consideration is efficacy (e.g., in rescue therapy), avoidance of parenteral therapy, or the desire to treat locally and also provide systemic protection against parasite dissemination.
Treatment of Bolivian Leishmania braziliensis Cutaneous and Mucosal Leishmaniasis
(American Society of Tropical Medicine and Hygiene, 2022) Jaime Soto; Patrícia Gutiérrez; Paula Soto; David Paz; Eduardo Cayhuara; Carmen Molina; Mia Sánchez; Jonathan Berman
Although infection with Leishmania braziliensis is perhaps the key reason to treat New World cutaneous leishmaniasis (CL) and mucosal leishmaniasis (ML), the total literature contains relatively few reported cases. With the aim of supplementing the meager clinical information available, we searched the records of Jorochito (Dermatology) Hospital, Bolivia, for the years 1999-2020 and identified treatment records for 1,696 naive CL patients and 355 naive ML patients. Because follow-up was poor for this real-world treatment experience in the developing world, only 255 CL patients (15%) and 114 ML patients (32%) attended follow-up at Hospital. We therefore engaged in an Active Search for "lost" patients, located a further 542 CL patients (32%) and 142 ML patients (44%), thus eventually accomplished follow up on 697 CL patients (41%) and 256 ML patients (72%). Granular adverse event data derived from hospital records is listed for the 902 CL and 86 ML patients administered Glucantime intramuscularly, the 401 CL and 202 ML patients administered Glucantime intravenously, and the 163 CL and 89 ML patients administered miltefosine orally. Efficacy was obtained from hospital records for patients seen at hospital and from patient recall communicated by telephone for the patients found in the Active Search. The overall CL cure rate was 508 of 697 CL patients (73%) with follow-up: intramuscular Glucantime-196/293 (67%); intravenous Glucantime-90/126 (71%); intralesional Glucantime-34/54 (63%); oral miltefosine-52/69 (75%). The overall ML cure rate was 161 of 256 ML patients (63%) with follow-up: intramuscular Glucantime-26/48 (54%); intravenous Glucantime-66/104 (63%); intravenous amphotericin B deoxycholate-19/35 (54%); oral miltefosine-50/71 (70%). We offer this extensive adverse event and efficacy experience as useful guides for clinicians presented with a L. braziliensis infection. The cure rates also illustrate the quandary of New World CL and ML chemotherapy: sufficiently high to be useful but nevertheless needing augmentation with new agents.
Treatment of Bolivian Mucosal Leishmaniasis with Miltefosine
(Oxford University Press, 2007) Jaime Soto; Julia Toledo; L Valda; Margarita Balderrama; Irene Maeve Rea; Rolando Sergio Llópiz Parra; J Herrera Ardiles; Paula Soto; Ángel Herrera‐Gómez; F. Molleda
In this unrandomized trial, oral miltefosine was at least as effective as heroic doses of parenteral amphotericin B. The cure rate for miltefosine was approximately equivalent to historical cure rates using parenteral pentavalent antimony for mild and extensive disease in neighboring Peru. Although gastrointestinal side reactions do occur with miltefosine, its toxicity profile is superior to that of antimony and far superior to that of amphotericin B--in part because of the inherent attractiveness of oral versus parenteral agents. Our results suggest that miltefosine should be the treatment of choice for mucosal disease in North and South America.
Treatment of New World Mucosal Leishmaniasis: Randomized Comparison of Glucantime®, Liposomal Amphotericin B, and Miltefosine
(American Society of Tropical Medicine and Hygiene, 2026) Jaime Alberto Restrepo Soto; Paula Soto; David Paz; Daniela Rivero; Martha Sánchez; María Clara Arteaga; Jonathan Berman
New World Mucosal Leishmaniasis (ML) is predominantly caused by Leishmania braziliensis. We performed the first randomized trial of the three recommended agents for this disease-intravenous pentavalent antimony (Sb), intravenous liposomal amphotericin B (LAMB), oral miltefosine-with 24-month follow-up. Upon study enrollment, disease was scored by the number of sites (oro-nasal-palate, pharynx, larynx) and degree of disease at each site (maximum score = 60.) Our criterion for "cure" was ≥90% diminution in the enrollment score. Cure rates were 20/40 (50%) for Sb, 18/40 (45%) for LAMB, and 23/40 (57%) for miltefosine. Cure was highly dependent on whether the patient was being treated for the first time (39/55 = 71% cure) or undergoing repeat treatment (22/63 = 35% cure). The primary reason for the low cure rate for repeat patients was laryngeal disease at enrollment. For all patients, naïve patients, and repeat patients, the miltefosine cure rate was highest but not statistically so. A curative score at 2-6 months of follow-up had a predictive value of 94% for cure. It is notable that 14 of the 57 treatment failures (25%) were attributable to relapses occurring more than 24 months after therapy completion. Myalgias/arthralgias/general bodily discomfort occurred for LAMB and Sb patients; diarrhea and motion sickness occurred for miltefosine patients; Electrocardiogram abnormalities (occasionally severe) were seen in LAMB and Sb patients. When choosing a treatment of a ML patient, cure rates in part based on disease location and absence/presence of previous treatment, route of administration, tolerability, and cost should be considered. Patients should be followed for ≥2 years.