Early enlargement of an ulcerated area during leishmaniasis treatment with meglumine antimoniate in Brazil

BACKGROUND: Cutaneous leishmaniasis is a public health problem in Brazil, where meglumine antimoniate is the drug of choice for treatment. Ulcers treated with pentavalent antimonials show increasing diameters during the first weeks of drug exposure. METHOD: We evaluated data from patients previously enrolled into an open study to compare changes in the ulcerated area of 189 lesions in 101 patients with localized cutaneous leishmaniasis caused by Leishmania braziliensis and L. guyanensis who were treated with i.v. meglumine antimoniate (Glucantime), 20 mg kg(-1) day(-1) for 20 days. RESULTS: An average increase in the ulcerated area of 0.3 cm(2) (95% CI 0.13-0.47 cm(2); p = 0.001) was observed at Day 10 compared with the baseline measurement. Comparison of Day 20 with Day 10 showed a significant decrease of 0.76 cm(2) (95% CI 0.53-0.99 cm(2); p < 0.001) in ulcer size. At Day 50, compared with Day 20, the ulcerated area was decreased by 0.77 cm(2) (95% CI 0.53-1.01 cm(2); p < 0.001). CONCLUSION: We conclude that early enlargement of the ulcerated area during treatment of localized cutaneous leishmaniasis with antimonials in Brazil is a common feature and easily detected by the 10th day of treatment. Following the end of the treatment period (20 days), it would be reasonable to observe a significant decrease in size of the ulcerated area.