Identification of Nonresponsive Isolates to Glucantime in Patients with Cutaneous Leishmanaisis in Bam

Cutaneous leishmaniasis (CL) is a prevalent disease worldwide including Iran. In Iran Leishmania tropica and Leishmania major are two causing factors of cutaneous leishmaniasis and Bam is one of the old and well-known focuses of CL. The objective of the present study was to identify the resistant isolates to meglumine antimoniate (MA) for implementation of future control measures in Bam.

This work has been conducted during 2009-2010 in the city of Bam and Kerman School of Medicine. From a total of 2126 patients with CL, 235 patients (11.1%) were resistant against MA (Glucantime) of whom 51 ones were randomly selected. Skin scrapings were taken for direct smear preparations and culture media and Nested-polymerase chain reaction (PCR) were used for species identification.

In this study, 122 males (51.9%) and 113 females (48.1%), resistant to MA were identified that shows no significant difference between the two sexes. With a significant difference most of the resistant patients were in the age group 11-21 years (29.4%), followed by ≤ 10 years (21.6%) and the lowest were in the age group≥ 55 years (5.9%). Most of the lesions were on face (55.5%), the majority had one lesion (64.5%) and 33.3% received MA intra -lesionally. According to the results of PCR, all 51 isolates were Leishmania tropica.

To our knowledge this is the first study that is carried out on the resistant patients to MA in Bam. Since the incidence of this disease and drug resistance have been increased after the earth quake of 2003, further studies to identify genetic variants of resistant isolates in order to use new alternative drugs are required.