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The state of Maranh\u00e3o in the Northeast of Brazil is prevalent for these clinical forms of the disease and also has high rates of HIV infection. Here, we characterized the drug susceptibility of a\n                    <jats:italic>L<\/jats:italic>\n                    .\n                    <jats:italic>amazonensis<\/jats:italic>\n                    clinical isolate from a 46-year-old man with diffuse cutaneous leishmaniasis coinfected with HIV from this endemic area. This patient underwent several therapeutic regimens with meglumine antimoniate, liposomal amphotericin B, and pentamidine, without success.\n                    <jats:italic>In vitro<\/jats:italic>\n                    susceptibility assays against promastigotes and intracellular amastigotes demonstrated that this isolate had low susceptibility to amphotericin B, when compared with the reference strain of this species that is considered susceptible to antileishmanial drugs. Additionally, we investigated whether the low\n                    <jats:italic>in vitro<\/jats:italic>\n                    susceptibility would affect the\n                    <jats:italic>in vivo<\/jats:italic>\n                    response to amphotericin B treatment. The drug was effective in reducing the lesion size and parasite burden in mice infected with the reference strain, whereas those infected with the clinical isolate and a resistant line (generated experimentally by stepwise selection) were refractory to amphotericin B treatment. To evaluate whether the isolate was intrinsically resistant to amphotericin B in animals, infected mice were treated with other drugs that had not been used in the treatment of the patient (miltefosine, paromomycin, and a combination of both). Our findings demonstrated that all drug schemes were able to reduce lesion size and parasite burden in animals infected with the clinical isolate, confirming the amphotericin B-resistance phenotype. These findings indicate that the treatment failure observed in the patient may be associated with amphotericin B resistance, and demonstrate the potential emergence of amphotericin B-resistant\n                    <jats:italic>L<\/jats:italic>\n                    .\n                    <jats:italic>amazonensis<\/jats:italic>\n                    isolates in an area of Brazil endemic for cutaneous leishmaniasis.\n                  <\/jats:p>","DOI":"10.1371\/journal.pntd.0012175","type":"journal-article","created":{"date-parts":[[2024,5,20]],"date-time":"2024-05-20T13:48:11Z","timestamp":1716212891000},"page":"e0012175","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":20,"title":["Amphotericin B resistance in Leishmania amazonensis: In vitro and in vivo characterization of a Brazilian clinical isolate"],"prefix":"10.1371","volume":"18","author":[{"given":"Bianca A.","family":"Ferreira","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth M.","family":"Coser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephane","family":"de la Roca","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliana I.","family":"Aoki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nilson","family":"Branco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gustavo H. C.","family":"Soares","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mayara I. S.","family":"Lima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0659-6269","authenticated-orcid":true,"given":"Adriano C.","family":"Coelho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,5,20]]},"reference":[{"issue":"10151","key":"pntd.0012175.ref001","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1016\/S0140-6736(18)31204-2","article-title":"Leishmaniasis.","volume":"392","author":"S Burza","year":"2018","journal-title":"Lancet"},{"issue":"6","key":"pntd.0012175.ref002","doi-asserted-by":"crossref","DOI":"10.3390\/ijms18061296","article-title":"Cutaneous Manifestations of Human and Murine Leishmaniasis.","volume":"18","author":"BM Scorza","year":"2017","journal-title":"Int J Mol Sci."},{"key":"pntd.0012175.ref003","article-title":"Leishmaniasis: Epidemiological Report for the Americas. No.11 (December 2022).","author":"O Pan American Health","year":"2022","journal-title":"Epidemiological Report of the Americas"},{"issue":"4","key":"pntd.0012175.ref004","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1017\/S0031182016002523","article-title":"Chemotherapy of leishmaniasis: present challenges","volume":"145","author":"SRB Uliana","year":"2018","journal-title":"Parasitology"},{"issue":"2","key":"pntd.0012175.ref005","doi-asserted-by":"crossref","first-page":"255","DOI":"10.4269\/ajtmh.2011.10-0155","article-title":"Randomized controlled clinical trial to access efficacy and safety of miltefosine in the treatment of cutaneous leishmaniasis Caused by Leishmania (Viannia) guyanensis in Manaus, Brazil.","volume":"84","author":"A Chrusciak-Talhari","year":"2011","journal-title":"Am J Trop Med Hyg"},{"issue":"12","key":"pntd.0012175.ref006","doi-asserted-by":"crossref","first-page":"e912","DOI":"10.1371\/journal.pntd.0000912","article-title":"Miltefosine in the 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