AMINOSIDINE AND ITS COMBINATION WITH SODIUM STIBOGLUCONATE IN THE TREATMENT OF DIFFUSE CUTANEOUS LEISHMANIASIS CAUSED BY LEISHMANIA-AETHIOPICA

Treatment of diffuse cutaneous leishmaniasis (DCL) caused by Leishmani a aethiopica remains unsatisfactory as the parasite is relatively inse nsitive to antimonial compounds. Reports of the clinical effectiveness of aminosidine sulphate, especially in combination with sodium stibog luconate, in visceral leishmaniasis and the finding that this antibiot ic is potent against L. aethiopica in vitro, prompted us to evaluate i ts usefulness in DCL. Two patients with long-standing, active DCL were treated for 60 d with aminosidine sulphate, 14 mg/kg/d parenterally. The skin lesions resolved completely in both patients although they re lapsed subsequently. Synergism between aminosidine and stibogluconate was demonstrated in vitro against parasites isolated from the patients . This led us to administer combined therapy, aminosidine sulphate 14 mg/kg/d and sodium stibogluconate 10 mg/kg/d, to the 2 patients in rel apse and to another, third patient. Treatment was continued for 2 mont hs beyond parasitological cure. Side effects were minimal. Following t reatment, a return of specific cell-mediated immunity occurred, as exp ressed by a moderate infiltration of lymphocytes into the lesions and by lymphocyte proliferation in vitro in the presence of live Leishmani a antigen, with synthesis of interleukin-2 and interferon gamma with o ne patient and interleukin 4 with the other. During follow-up periods of 2 to 21 months after treatment, no sign of relapse was seen.