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Bel Hadj Ali I, Saadi-Ben Aoun Y, Hammami Z, Rhouma O, Chakroun AS, Guizani I. Handheld Ultra-Fast Duplex Polymerase Chain Reaction Assays and Lateral Flow Detection and Identification of Leishmania Parasites for Cutaneous Leishmaniases Diagnosis. Pathogens 2023; 12:1292. [PMID: 38003756 PMCID: PMC10675497 DOI: 10.3390/pathogens12111292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 10/23/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023] Open
Abstract
Early and accurate detection of infectious diseases is a key step for surveillance, epidemiology and control, notably timely disease diagnosis, patient management and follow-up. In this study, we aimed to develop handheld ultra-fast duplex PCR assays coupled to amplicon detection by lateral flow (LF) immunoassay to deliver a rapid and simple molecular diagnostic test for concomitant detection and identification of the main Leishmania parasites encountered in Tunisia. We selected two DNA targets to amplify L. major/L. tropica and L. infantum/L. tropica groups of species DNAs, respectively. We optimized the experimental conditions of a duplex ultra-fast PCR. The amplification is performed using a portable Palm convection PCR machine within 18 min, and the products are detected using an LF cassette within 10 min. The test allows the identification of the infecting species according to the position and number of test lines revealed. Tested on a selection of DNAs of representative Leishmania strains of the three studied species (N = 37), the ultra-fast duplex PCR-LF showed consistent, stable and reproducible results. The analytical limit of detection of the test was 0.4 pg for L. major, 4 pg for L. infantum and 40 pg for L. tropica.
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Affiliation(s)
- Insaf Bel Hadj Ali
- Laboratory of Molecular Epidemiology and Experimental Pathology-LR16IPT04, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis 1002, Tunisia; (Y.S.-B.A.); (Z.H.); (O.R.); (A.S.C.); (I.G.)
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2
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Linquest LA, Hickham LC, Richardson BJ, Hickham PR. Successful Treatment of Cutaneous Leishmaniasis With Cryotherapy. Cureus 2023; 15:e41871. [PMID: 37457607 PMCID: PMC10348073 DOI: 10.7759/cureus.41871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2023] [Indexed: 07/18/2023] Open
Abstract
Leishmaniasis, a protozoal infection, is a growing health concern with 1.5 million new cases reported annually resulting in a wide spectrum of disease and clinical presentations. The disease is endemic in 98 countries with increasing prevalence in non-endemic areas. There are various treatment approaches that are often individualized based on host and parasite factors. Current treatment guidelines and data are variable and provide limited direction for specific treatment plans. Additionally, current recommended therapies are not benign, and are expensive and unavailable to most patients, especially in low-resource areas where leishmaniasis is most prevalent. Here, we report the diagnosis and successful treatment of cutaneous leishmaniasis in a 65-year-old male, who recently traveled to Mexico. Initial treatment with topical antifungals and oral antibiotics was ineffective. After successive treatment with local liquid nitrogen, the lesions completely resolved with no adverse effects or recurrence. Given there is limited evidence-based data supporting cryotherapy treatment as a first-line treatment, this report supports the efficacy of cryotherapy as a safe, cost-effective, and accessible treatment for cutaneous leishmaniasis.
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Affiliation(s)
- Lauren A Linquest
- Dermatology, Louisiana State University Health Shreveport - School of Medicine, Shreveport, USA
| | - Leigh C Hickham
- Dermatology, Louisiana State University Health Sciences Center New Orleans - School of Medicine, New Orleans, USA
| | - Bayley J Richardson
- Dermatology, Texas Tech University Health Sciences Center Paul L. Foster School of Medicine, Lubbock, USA
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3
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Madusanka RK, Silva H, Karunaweera ND. Treatment of Cutaneous Leishmaniasis and Insights into Species-Specific Responses: A Narrative Review. Infect Dis Ther 2022; 11:695-711. [PMID: 35192172 PMCID: PMC8960542 DOI: 10.1007/s40121-022-00602-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 01/31/2022] [Indexed: 12/16/2022] Open
Abstract
Cutaneous leishmaniasis (CL) is a complex skin infection that has imposed a heavy burden on many developing countries and is caused by more than 20 Leishmania species. This disease is predominantly associated with disfiguring scars and major social stigma upon infection. The severity of the disease seemingly depends on many factors including the species of parasite, the host, region of endemicity, socio-economic status and the accessibility to health facilities. Despite myriad studies that have been performed on current and novel therapies, the treatment outcomes of CL remain contentious, possibly because of the knowledge gaps that still exist. The differential responses to the current CL therapies have become a major drawback in disease control, and the dearth of information on critical analyses of outcomes of such studies is a hindrance to the overall understanding. On the basis of currently available literature on treatment outcomes, we discuss the most effective doses, drug susceptibilities/resistance and treatment failures of the Leishmania genus for both monotherapy and combination therapy. This review focuses on the available treatment modalities for CL caused by different Leishmania species, with insights into their species-specific efficacies, which would inform the selection of appropriate drugs for the treatment and control of leishmaniasis.
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Affiliation(s)
| | - Hermali Silva
- Department of Parasitology, Faculty of Medicine, University of Colombo, No. 25, Kynsey Road, Colombo 8, Sri Lanka
| | - Nadira D Karunaweera
- Department of Parasitology, Faculty of Medicine, University of Colombo, No. 25, Kynsey Road, Colombo 8, Sri Lanka.
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4
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The Inflammatory Effects of Dietary Lipids Regulate Growth of Parasites during Visceral Leishmaniasis. mSphere 2021; 6:e0042321. [PMID: 34259561 PMCID: PMC8386445 DOI: 10.1128/msphere.00423-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Visceral leishmaniasis is a potentially fatal disease caused by the protozoon Leishmania donovani or L. infantum (Li). Although previous studies revealed that high lipid intake reduces parasite burdens in Leishmania donovani-infected mice, the specific contributions of dietary lipids to Li-associated pathogenesis are not known. To address this, we evaluated parasite growth, liver pathology, and transcriptomic signatures in Li-infected BALB/c mice fed either a control, high-fat, high-cholesterol, or high-fat–high-cholesterol diet. Using quantitative PCR (qPCR), we observed significantly reduced liver parasite burdens in mice fed the high-fat–high-cholesterol diet compared to mice fed the control diet. In contrast to the liver, parasite expansion occurred earlier in the spleens of mice fed the experimental diets. Histological examination revealed an intense inflammatory cell infiltrate in livers predominantly composed of neutrophils caused by the high-fat–high-cholesterol diet specifically. After 8 weeks of infection (12 weeks of diet), Illumina microarrays revealed significantly increased expression of transcripts belonging to immune- and angiogenesis-related pathways in livers of both uninfected and Li-infected mice fed the high-fat–high-cholesterol diet. These data suggest that increased fat and cholesterol intake prior to Li infection leads to a hepatic inflammatory environment and thus reduces the parasite burden in the liver. Defining inflammatory signatures as well as pathology in the liver may reveal opportunities to modify the therapeutic approach to Li infection. IMPORTANCE Leishmaniasis is a spectrum of diseases caused by Leishmania species protozoa that is most common in warm climates, coinciding with impoverished regions. Visceral leishmaniasis is a potentially fatal disease in which parasites infect reticuloendothelial organs and cause progressive wasting and immunocompromise. The distribution and demographics of visceral leishmaniasis have changed over recent years, coinciding with modernizing societies and the increased availability of Western diets rich in lipid content. We report here that increased dietary fat and cholesterol intake affected disease pathogenesis by increasing inflammation and reducing localized parasite burdens in the liver. These diet-induced changes in disease pathogenesis might explain in part the changing epidemiology of visceral leishmaniasis. A relationship between diet and inflammatory responses may occur in leishmaniasis and other microbial or immune-mediated diseases, possibly revealing opportunities to modify the therapeutic approach to microbial infections.
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5
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Menu E, Blaizot R, Mary C, Simon S, Adenis A, Blanchet D, L'Ollivier C, Ranque S, Demar M. Immunoblot for the Diagnosis of Cutaneous Leishmaniasis in French Guiana. Am J Trop Med Hyg 2021; 104:2091-2096. [PMID: 33939643 PMCID: PMC8176500 DOI: 10.4269/ajtmh.19-0591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 04/28/2020] [Indexed: 11/07/2022] Open
Abstract
Cutaneous leishmaniasis (CL) is firmly established in South America. We aimed to assess the detection of IgG antibodies against 14 and/or 16 kDa antigens by immunoblot (IB) for CL serological diagnosis in French Guiana, an area where many endemic pathogens could interfere with it. This study was performed retrospectively on sera from 141 patients at the Cayenne tertiary hospital: 30 were patients with confirmed CL, 71 were diagnosed with various other endemic pathogens, 11 were diagnosed with an autoimmune disease, and 29 controls had no history of CL. Antibodies bound to the 14 and/or 16 kDa antigens in 27 of the 30 CL patients' sera and in 39 of the 111 non-CL patients' sera (26 from the infectious diseases group, four from the autoimmune diseases group, and nine from the dermatology department). The method tested showed a high sensitivity (90%) and a low specificity (66%), and a diagnosis odds ratio of 17.5 (95% CI [4.6-78.0]). This IB may be helpful to exclude the diagnosis of CL, prompting physicians to look for another diagnosis in the case of a negative IB.
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Affiliation(s)
- Estelle Menu
- 1Laboratoire Hospitalo-Universitaire de Parasitologie-Mycologie, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana.,2Laboratoire Hospitalo-Universitaire de Parasitologie-Mycologie, Institut Hospitalo-Universitaire, Méditerranée Infection, Marseille, French Guiana.,3Aix Marseille Université, IRD, AP-HM, IHU-Méditerranée Infection, UMR Vecteurs - Infections Tropicales et Méditerranéennes (VITROME), Marseille, France
| | - Romain Blaizot
- 4Department of Dermatology, Andrée Rosemon Hospital, Cayenne, French Guiana.,5EA3593, Ecosystèmes Amazoniens et Pathologies Tropicales, University of French Guiana, Cayenne, French Guiana
| | - Charles Mary
- 2Laboratoire Hospitalo-Universitaire de Parasitologie-Mycologie, Institut Hospitalo-Universitaire, Méditerranée Infection, Marseille, French Guiana.,3Aix Marseille Université, IRD, AP-HM, IHU-Méditerranée Infection, UMR Vecteurs - Infections Tropicales et Méditerranéennes (VITROME), Marseille, France
| | - Stéphane Simon
- 1Laboratoire Hospitalo-Universitaire de Parasitologie-Mycologie, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana.,5EA3593, Ecosystèmes Amazoniens et Pathologies Tropicales, University of French Guiana, Cayenne, French Guiana
| | - Antoine Adenis
- 7Department of Internal Medicine, Andrée Rosemon Hospital, Cayenne, French Guiana
| | - Denis Blanchet
- 1Laboratoire Hospitalo-Universitaire de Parasitologie-Mycologie, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana.,5EA3593, Ecosystèmes Amazoniens et Pathologies Tropicales, University of French Guiana, Cayenne, French Guiana
| | - Coralie L'Ollivier
- 2Laboratoire Hospitalo-Universitaire de Parasitologie-Mycologie, Institut Hospitalo-Universitaire, Méditerranée Infection, Marseille, French Guiana.,3Aix Marseille Université, IRD, AP-HM, IHU-Méditerranée Infection, UMR Vecteurs - Infections Tropicales et Méditerranéennes (VITROME), Marseille, France
| | - Stéphane Ranque
- 2Laboratoire Hospitalo-Universitaire de Parasitologie-Mycologie, Institut Hospitalo-Universitaire, Méditerranée Infection, Marseille, French Guiana.,3Aix Marseille Université, IRD, AP-HM, IHU-Méditerranée Infection, UMR Vecteurs - Infections Tropicales et Méditerranéennes (VITROME), Marseille, France
| | - Magalie Demar
- 1Laboratoire Hospitalo-Universitaire de Parasitologie-Mycologie, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana.,5EA3593, Ecosystèmes Amazoniens et Pathologies Tropicales, University of French Guiana, Cayenne, French Guiana
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6
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Parvizi MM, Zare F, Handjani F, Nimrouzi M, Zarshenas MM. Overview of herbal and traditional remedies in the treatment of cutaneous leishmaniasis based on Traditional Persian Medicine. Dermatol Ther 2020; 33:e13566. [PMID: 32401415 DOI: 10.1111/dth.13566] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/10/2020] [Indexed: 01/19/2023]
Abstract
This study aims to describe the herbal and traditional remedies in the treatment of cutaneous leishmaniasis (CL) with an overview on related available evidence in modern medicine. This study is a review that focuses on the most important Traditional Persian Medicine (TPM) sources including Avicenna's Canon of Medicine, Jorjani's Zakhīra-yi Khārazmshāhī, and Aazam-Khan's Eksir-e-Aazam, as well as pertinent information from Embase, PubMed, Scopus, Scientific Information Database, and Google Scholar by using the keywords salak, rīsh-e-balkhi, cutaneous leishmaniasis, and leishmaniasis for selected remedies. Several oral and topical herbal remedies, such as Vitis vinifera L. (Unripe grapes), Berberis vulgaris L., Rheum ribes L., Santalum album L., Cinnamomum camphora (L.) J.Presl (Camphor), Brassica nigra (L.) K. Koch, Crocus sativus L., Juniperus excelsa M. Bieb, honey, and Alum root, were mentioned in TPM resources for the treatment of CL. Furthermore, cauterization, cupping, and leech therapy were considered for this purpose. In this review, some evidence-based studies will also be presented that have demonstrated the therapeutic properties of some of these products. In conclusion, the sages of TPM have recommended several systemic or topical medications, in addition to physical procedures, for treatment of CL, all of which could be a base for conducting further research on its efficacy.
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Affiliation(s)
- Mohammad Mahdi Parvizi
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farzaneh Zare
- Department of History of Medicine, School of Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Handjani
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Dermatology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Majid Nimrouzi
- Department of Traditional Persian Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad M Zarshenas
- Department of Phytopharmaceuticals (Traditional Pharmacy), School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran.,Medicinal Plants Processing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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7
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El Hamouchi A, Daoui O, Ait Kbaich M, Mhaidi I, El Kacem S, Guizani I, Sarih M, Lemrani M. Epidemiological features of a recent zoonotic cutaneous leishmaniasis outbreak in Zagora province, southern Morocco. PLoS Negl Trop Dis 2019; 13:e0007321. [PMID: 30964864 PMCID: PMC6474635 DOI: 10.1371/journal.pntd.0007321] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 04/19/2019] [Accepted: 03/21/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Leishmania major is an endemic vector-borne disease in Morocco that causes zoonotic cutaneous leishmaniasis (ZCL), especially in arid pre-Saharan regions where its unique vector and reservoir are Phlebotomus papatasi and Meriones shawi, respectively, and may cause epidemics. In late 2017, the Zagora province, an endemic focus for ZCL in southern Morocco, had CL outbreak. The main objective of our investigation was to analyze the epidemiological features of this latest ZCL outbreak. METHODOLOGY/PRINCIPAL FINDINGS We analyzed epidemiological features of this latest ZCL outbreak. The Regional Delegation of Health, Zagora, recorded 4,402 CL patients between October 2017 and end of March 2018. Our findings showed that 24 municipalities were affected and majority (55.1%) of infected cases belonged to the Tinzouline rural municipality. Majority of patients were females (57.2%). While all age group patients were affected, those aged <10 years were the most affected (42.1%). During this outbreak over 5 days in December 2017, we conducted a survey in Tinzouline and recruited and sampled 114 CL patients to confirm CL diagnosis by parasitological (direct examination and culture) and molecular (ITS1-PCR) methods and identify the etiological agent of infection using ITS1-PCR-RFLP and sequencing. We completed a detailed questionnaire including clinical and epidemiological data for each patient and found 72.8% of patients presenting multiple lesions (≥2), with an average number of lesions of 5.16 ± 0.5. Lesions were more prevalent in the upper limbs, with the most common type being the ulcerocrusted lesion (60.5%). We detected no associations between lesion type and patients' sex or age. CONCLUSIONS/SIGNIFICANCE Among 114 clinically diagnosed CL patients, we confirmed 90.35% and identified L. major as the species responsible for this outbreak. Self-medication using various products caused superinfection and inflammation of lesions and complicated the diagnosis and treatment. Thus, ZCL remains a major public health problem in the Zagora province, and commitment of all stakeholders is urgently required to implement a sustainable regional control program.
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Affiliation(s)
- Adil El Hamouchi
- Laboratory of Parasitology and Vector-Borne-Diseases, Institut Pasteur du Maroc, Casablanca, Morocco
| | - Othmane Daoui
- Laboratory of Parasitology and Vector-Borne-Diseases, Institut Pasteur du Maroc, Casablanca, Morocco
- Molecular Genetics and Immunophysiopathology Research Team, Health and Environment Laboratory, Hassan II University of Casablanca, Aïn Chock Faculty of Sciences, Morocco
| | - Mouad Ait Kbaich
- Laboratory of Parasitology and Vector-Borne-Diseases, Institut Pasteur du Maroc, Casablanca, Morocco
- Molecular Genetics and Immunophysiopathology Research Team, Health and Environment Laboratory, Hassan II University of Casablanca, Aïn Chock Faculty of Sciences, Morocco
| | - Idris Mhaidi
- Laboratory of Parasitology and Vector-Borne-Diseases, Institut Pasteur du Maroc, Casablanca, Morocco
- Molecular Genetics and Immunophysiopathology Research Team, Health and Environment Laboratory, Hassan II University of Casablanca, Aïn Chock Faculty of Sciences, Morocco
| | - Sofia El Kacem
- Laboratory of Parasitology and Vector-Borne-Diseases, Institut Pasteur du Maroc, Casablanca, Morocco
- Laboratory of Biology and Health, Faculty of Sciences Ben M'Sik, Hassan II University, Casablanca, Morocco
| | - Ikram Guizani
- Molecular Epidemiology and Experimental Pathology (MEEP)/ LR16IPT04, Institut Pasteur de Tunis, Université de Tunis El Manar, Tunisia
| | - M’hammed Sarih
- Laboratory of Parasitology and Vector-Borne-Diseases, Institut Pasteur du Maroc, Casablanca, Morocco
| | - Meryem Lemrani
- Laboratory of Parasitology and Vector-Borne-Diseases, Institut Pasteur du Maroc, Casablanca, Morocco
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8
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Weinkopff T, Konradt C, Christian DA, Discher DE, Hunter CA, Scott P. Leishmania major Infection-Induced VEGF-A/VEGFR-2 Signaling Promotes Lymphangiogenesis That Controls Disease. THE JOURNAL OF IMMUNOLOGY 2016; 197:1823-31. [PMID: 27474074 DOI: 10.4049/jimmunol.1600717] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 06/29/2016] [Indexed: 01/09/2023]
Abstract
Cutaneous leishmaniasis causes a spectrum of diseases from self-healing to severe nonhealing lesions. Defining the factors contributing to lesion resolution may help in developing new therapies for those patients with chronic disease. We found that infection with Leishmania major increases the expression of vascular endothelial growth factor-A and vascular endothelial growth factor receptor (VEGFR)-2 and is associated with significant changes in the blood and lymphatic vasculature at the site of infection. Ab blockade of VEGFR-2 during infection led to a reduction in lymphatic endothelial cell proliferation and simultaneously increased lesion size without altering the parasite burden. These data show that L. major infection initiates enhanced vascular endothelial growth factor-A/VEGFR-2 signaling and suggest that VEGFR-2-dependent lymphangiogenesis is a mechanism that restricts tissue inflammation in leishmaniasis.
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Affiliation(s)
- Tiffany Weinkopff
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104; and
| | - Christoph Konradt
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104; and
| | - David A Christian
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104; and
| | - Dennis E Discher
- Biophysical Eng'g Labs, University of Pennsylvania, Philadelphia, PA 19104
| | - Christopher A Hunter
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104; and
| | - Phillip Scott
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104; and
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9
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Handler MZ, Patel PA, Kapila R, Al-Qubati Y, Schwartz RA. Cutaneous and mucocutaneous leishmaniasis: Clinical perspectives. J Am Acad Dermatol 2016; 73:897-908; quiz 909-10. [PMID: 26568335 DOI: 10.1016/j.jaad.2014.08.051] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 08/11/2014] [Accepted: 08/22/2014] [Indexed: 10/22/2022]
Abstract
Leishmaniasis is endemic in 98 countries and territories, with 1.2 million new cases per year, making it a worldwide concern. The deadly visceral form is a leading cause of death from tropical parasitic infections, second only to malaria. Leishmaniasis appears to be increasing in many countries because of extended urbanization. The disease reservoir includes small mammals; parasite transmission occurs via bite of the female phlebotomine sandfly. Disease manifestations vary and largely depend upon the Leishmania species acquired. It may be first evident with a range of findings-from a localized cutaneous ulcer to diffuse painless dermal nodules-or, in the mucocutaneous form, ulceration of the oropharynx. In the potentially deadly visceral form, the internal organs and bone marrow are affected.
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Affiliation(s)
- Marc Z Handler
- Dermatology, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Parimal A Patel
- Dermatology, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Rajendra Kapila
- Infectious Diseases, Rutgers New Jersey Medical School, Newark, New Jersey; Medicine, Rutgers New Jersey Medical School, Newark, New Jersey; Preventive Medicine and Community Health, Rutgers New Jersey Medical School, Newark, New Jersey
| | | | - Robert A Schwartz
- Dermatology, Rutgers New Jersey Medical School, Newark, New Jersey; Medicine, Rutgers New Jersey Medical School, Newark, New Jersey; Preventive Medicine and Community Health, Rutgers New Jersey Medical School, Newark, New Jersey; Rutgers School of Public Affairs and Administration, Newark, New Jersey.
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10
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Handler MZ, Patel PA, Kapila R, Al-Qubati Y, Schwartz RA. Cutaneous and mucocutaneous leishmaniasis: Differential diagnosis, diagnosis, histopathology, and management. J Am Acad Dermatol 2016; 73:911-26; 927-8. [PMID: 26568336 DOI: 10.1016/j.jaad.2014.09.014] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 09/03/2014] [Accepted: 09/05/2014] [Indexed: 12/25/2022]
Abstract
The diagnosis of leishmaniasis can be challenging because it mimics both infectious and malignant conditions. A misdiagnosis may lead to an unfavorable outcome. Using culture, histologic, and/or polymerase chain reaction study results, a diagnosis of leishmaniasis can be established and treatment initiated. Appropriate management requires an accurate diagnosis, which often includes identification of the specific etiologic species. Different endemic areas have varying sensitivities to the same medication, even within individual species. Species identification may be of practical value, because infections with select species have a substantial risk of visceral involvement. In addition, HIV and otherwise immunocompromised patients with leishmaniasis have a propensity for diffuse cutaneous leishmaniasis. For most New World Leishmania species, parenteral antimonial drugs remain the first line of therapy, while Old World species are easily treated with physical modalities. Historically, live organism vaccination has been used and is effective in preventing leishmaniasis, but results in an inoculation scar and an incubation period that may last for years. A more effective method of vaccination would be welcome.
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Affiliation(s)
- Marc Z Handler
- Dermatology, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Parimal A Patel
- Dermatology, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Rajendra Kapila
- Infectious Diseases, Rutgers New Jersey Medical School, Newark, New Jersey; Medicine, Rutgers New Jersey Medical School, Newark, New Jersey; Preventive Medicine and Community Health, Rutgers New Jersey Medical School, Newark, New Jersey
| | | | - Robert A Schwartz
- Dermatology, Rutgers New Jersey Medical School, Newark, New Jersey; Medicine, Rutgers New Jersey Medical School, Newark, New Jersey; Preventive Medicine and Community Health, Rutgers New Jersey Medical School, Newark, New Jersey; Rutgers School of Public Affairs and Administration, Newark, New Jersey.
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11
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Sharlow ER, Leimgruber S, Murray S, Lira A, Sciotti RJ, Hickman M, Hudson T, Leed S, Caridha D, Barrios AM, Close D, Grögl M, Lazo JS. Auranofin is an apoptosis-simulating agent with in vitro and in vivo anti-leishmanial activity. ACS Chem Biol 2014; 9:663-72. [PMID: 24328400 DOI: 10.1021/cb400800q] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Cutaneous leishmaniasis remains ignored in therapeutic drug discovery programs worldwide. This is mainly because cutaneous leishmaniasis is frequently a disease of impoverished populations in countries where funds are limited for research and patient care. However, the health burden of individuals in endemic areas mandates readily available, effective, and safe treatments. Of the existing cutaneous leishmaniasis therapeutics, many are growth inhibitory to Leishmania parasites, potentially creating dormant parasite reservoirs that can be activated when host immunity is compromised, enabling the reemergence of cutaneous leishmaniasis lesions or worse spread of Leishmania parasites to other body sites. To accelerate the identification and development of novel cutaneous leishmaniasis therapeutics, we designed an integrated in vitro and in vivo screening platform that incorporated multiple Leishmania life cycles and species and probed a focused library of pharmaceutically active compounds. The objective of this phenotypic drug discovery platform was the identification and prioritization of bona fide cytotoxic chemotypes toward Leishmania parasites. We identified the Food and Drug Administration-approved drug auranofin, a known inhibitor of Leishmania promastigote growth, as a potent cytotoxic anti-leishmanial agent and inducer of apoptotic-like death in promastigotes. Significantly, the anti-leishmanial activity of auranofin transferred to cell-based amastigote assays as well as in vivo murine models. With appropriate future investigation, these data may provide the foundation for potential exploitation of gold(I)-based complexes as chemical tools or the basis of therapeutics for leishmaniasis. Thus, auranofin may represent a prototype drug that can be used to identify signaling pathways within the parasite and host cell critical for parasite growth and survival.
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Affiliation(s)
| | | | | | | | - Richard J. Sciotti
- Department
of Discovery, Division of Experimental Therapeutics, Walter Reed Army Institute of Research, Silver Spring, Maryland 20910, United States
| | - Mark Hickman
- Department
of Discovery, Division of Experimental Therapeutics, Walter Reed Army Institute of Research, Silver Spring, Maryland 20910, United States
| | - Thomas Hudson
- Department
of Discovery, Division of Experimental Therapeutics, Walter Reed Army Institute of Research, Silver Spring, Maryland 20910, United States
| | - Susan Leed
- Department
of Discovery, Division of Experimental Therapeutics, Walter Reed Army Institute of Research, Silver Spring, Maryland 20910, United States
| | - Diana Caridha
- Department
of Discovery, Division of Experimental Therapeutics, Walter Reed Army Institute of Research, Silver Spring, Maryland 20910, United States
| | - Amy M. Barrios
- Department
of Medicinal Chemistry, University of Utah, Salt Lake City, Utah 84112, United States
| | - David Close
- Department
of Pharmaceutical Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, United States
| | - Max Grögl
- Department
of Discovery, Division of Experimental Therapeutics, Walter Reed Army Institute of Research, Silver Spring, Maryland 20910, United States
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12
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Nadal-Nadal A, Nadal-Lladó C, Terrasa-Sagristà F, Díaz-Antolín MP. [Pain and inflammation of the pinna]. Enferm Infecc Microbiol Clin 2013; 32:125-6. [PMID: 23972568 DOI: 10.1016/j.eimc.2013.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 05/23/2013] [Accepted: 05/24/2013] [Indexed: 12/20/2022]
Affiliation(s)
- Antoni Nadal-Nadal
- Servicio de Dermatología, Hospital Son Llàtzer, Palma de Mallorca, España.
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13
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Gonzalez-Lombana C, Gimblet C, Bacellar O, Oliveira WW, Passos S, Carvalho LP, Goldschmidt M, Carvalho EM, Scott P. IL-17 mediates immunopathology in the absence of IL-10 following Leishmania major infection. PLoS Pathog 2013; 9:e1003243. [PMID: 23555256 PMCID: PMC3605236 DOI: 10.1371/journal.ppat.1003243] [Citation(s) in RCA: 116] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 01/29/2013] [Indexed: 12/31/2022] Open
Abstract
Leishmaniasis, resulting from infection with the protozoan parasite Leishmania, consists of a wide spectrum of clinical manifestations, from healing cutaneous lesions to fatal visceral infections. A particularly severe form of cutaneous leishmaniasis, termed mucosal leishmaniasis, exhibits decreased IL-10 levels and an exaggerated inflammatory response that perpetuates the disease. Using a mouse model of leishmaniasis, we investigated what cytokines contribute to increased pathology when IL-10-mediated regulation is absent. Leishmania major infected C57BL/6 mice lacking IL-10 regulation developed larger lesions than controls, but fewer parasites. Both IFN-γ and IL-17 levels were substantially elevated in mice lacking the capacity to respond to IL-10. IFN-γ promoted an increased infiltration of monocytes, while IL-17 contributed to an increase in neutrophils. Surprisingly, however, we found that IFN-γ did not contribute to increased pathology, but instead regulated the IL-17 response. Thus, blocking IFN-γ led to a significant increase in IL-17, neutrophils and disease. Similarly, the production of IL-17 by cells from leishmaniasis patients was also regulated by IL-10 and IFN-γ. Additional studies found that the IL-1 receptor was required for both the IL-17 response and increased pathology. Therefore, we propose that regulating IL-17, possibly by downregulating IL-1β, may be a useful approach for controlling immunopathology in leishmaniasis. Leishmaniasis is a tropical disease transmitted by sand flies that causes visceral and cutaneous lesions. In humans, the most severe form of cutaneous leishmaniasis is the mucosal form, causing disfiguring lesions in the nasal and oral mucosa. Why these patients develop severe disease is not clear. It is known, however, that the severe disease is not due to an overwhelming number of parasites, but rather appears to be due to an uncontrolled inflammatory response that includes elevated production of IFN-γ and IL-17. Here, we used a murine model of leishmaniasis to identify the factors involved in this pathology, and found that mice infected with Leishmania major developed severe lesions in the absence of IL-10 or IL-10 signaling, and similar to patients, contained high levels of IFN-γ and IL-17. While both of these cytokines have the potential to induce pathology, we found that IL-17 was responsible for the severe pathology seen in the absence of IL-10 regulation, and furthermore that IL-17 levels were higher and pathology greater in the absence of IFN-γ. Thus, our study suggests that IL-17, but not the IFN-γ, is a strong candidate to be targeted in strategies to control the severe immunopathology observed in mucosal leishmaniasis patients.
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Affiliation(s)
- Claudia Gonzalez-Lombana
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Ciara Gimblet
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Olivia Bacellar
- Instituto Nacional de Ciência e Tecnologia de Doenças Tropicais-INCT-DT(CNPq/MCT), Serviço de Imunologia, Hospital Universitario Prof. Edgard Santos, Universidade Federal da Bahia Salvador, Bahia, Brasil
| | - Walker W. Oliveira
- Instituto Nacional de Ciência e Tecnologia de Doenças Tropicais-INCT-DT(CNPq/MCT), Serviço de Imunologia, Hospital Universitario Prof. Edgard Santos, Universidade Federal da Bahia Salvador, Bahia, Brasil
| | - Sara Passos
- Instituto Nacional de Ciência e Tecnologia de Doenças Tropicais-INCT-DT(CNPq/MCT), Serviço de Imunologia, Hospital Universitario Prof. Edgard Santos, Universidade Federal da Bahia Salvador, Bahia, Brasil
| | - Lucas P. Carvalho
- Instituto Nacional de Ciência e Tecnologia de Doenças Tropicais-INCT-DT(CNPq/MCT), Serviço de Imunologia, Hospital Universitario Prof. Edgard Santos, Universidade Federal da Bahia Salvador, Bahia, Brasil
| | - Michael Goldschmidt
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Edgar M. Carvalho
- Instituto Nacional de Ciência e Tecnologia de Doenças Tropicais-INCT-DT(CNPq/MCT), Serviço de Imunologia, Hospital Universitario Prof. Edgard Santos, Universidade Federal da Bahia Salvador, Bahia, Brasil
| | - Phillip Scott
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- * E-mail:
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Al-Qubati Y, Janniger EJ, Schwartz RA. Cutaneous leishmaniasis: cryosurgery using carbon dioxide slush in a resource-poor country. Int J Dermatol 2013; 51:1217-20. [PMID: 22994668 DOI: 10.1111/j.1365-4632.2011.04958.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Leishmaniasis is a widespread parasitic disease seen most often in children and young adults, although it may occur at any age. In Yemen, up until now, specific treatment for cutaneous leishmaniasis (CL) has been challenging. Available chemotherapy is expensive and replete with significant side effects. Standard cryosurgery with liquid nitrogen is prohibitively expensive and often unavailable. The objective of this paper is to highlight the importance of cryosurgery with carbon dioxide slush in the treatment of CL in an economically underdeveloped region as a cost-effective, simple, successful, and affordable option.
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Affiliation(s)
- Yasin Al-Qubati
- Dermatology, Taiz University School of Medicine, Taiz, Yemen.
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15
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Cutaneous leishmaniasis: a diagnostic challenge for plastic surgeons. EUROPEAN JOURNAL OF PLASTIC SURGERY 2008. [DOI: 10.1007/s00238-008-0316-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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16
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Sinha S, Fernández G, Kapila R, Lambert WC, Schwartz RA. Diffuse cutaneous leishmaniasis associated with the immune reconstitution inflammatory syndrome. Int J Dermatol 2008; 47:1263-70. [DOI: 10.1111/j.1365-4632.2008.03804.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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17
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Marcussi VM, Marcussi LM, Barbosa-Tessmann IP, Lonardoni MVC, Silveira TGV. Leishmania (Viannia) braziliensis: New primers for identification using polymerase chain reaction. Exp Parasitol 2008; 120:300-5. [PMID: 18786532 DOI: 10.1016/j.exppara.2008.08.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Revised: 08/06/2008] [Accepted: 08/12/2008] [Indexed: 10/21/2022]
Abstract
The objective of this study was to develop specific primers for Leishmania (Viannia) braziliensis species identification using PCR. The designed primers (LBF1 and LBR1) were evaluated for sensitivity and specificity using various L. (V.) braziliensis serodemes and various Leishmania species and also using Trypanosoma cruzi. A specific fragment of 536bp was detected from 50ng of DNA in a crude extract derived from L. (V.) braziliensis. The DNA fragment was not detected when DNA from other Leishmania species or from T. cruzi was used as template in the PCR. Furthermore, when tested with DNA from cutaneous leishmaniasis the designed primers and reaction gave positive results. Taking into consideration that the primers LBF1 and LBR1 could specifically identify L. (V.) braziliensis, they could be considered for use in L. (V.) braziliensis diagnosis and epidemiological studies.
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Affiliation(s)
- V M Marcussi
- Master program in Clinical Analyses, Universidade Estadual de Maringá, Maringá, PR, Brazil
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Esfandiarpour I, Dabiri SH. Treatment of cutaneous leishmaniasis recidivans with a combination of allopurinol and meglumine antimoniate: a clinical and histologic study. Int J Dermatol 2007; 46:848-52. [PMID: 17651170 DOI: 10.1111/j.1365-4632.2007.03086.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cutaneous leishmaniasis (CL) is an endemic disease in Iran, particularly in Kerman Province. Leishmaniasis recidivans (LR) is one of the characteristics of this disease with a chronic course. Most patients with LR are resistant to the usual treatments. METHODS Thirty-two patients (18 females and 14 males), suffering from LR, whose disease had been demonstrated by previous direct smears or skin biopsies, were included in this study in Kerman. The duration of disease in all patients was more than 1.5 years, and they had all previously received various drugs for their disease. All patients were treated with a combination of oral allopurinol (20 mg/kg for 30 days) and intramuscular injection of meglumine antimoniate (50 mg/kg for 15 days) and were followed up for 2 years. Skin biopsies were obtained from the skin lesions of nine cases at the beginning (baseline), during, and end of therapy. All patients were checked for complete blood count (CBC) and liver and kidney function tests on the first and last day of treatment. RESULTS All patients, except two (87.5%), responded well to treatment within 30 days. No significant side-effects were observed. The disease of two patients (Cases 24 and 28) recurred 6 and 13 months after treatment, respectively. Histologic examination of nine cases during and at the end of therapy showed a progression to atrophied granulomata, more lymphocytic than histiocytic infiltration, and, finally, fibrosis replacing the granulomata. CONCLUSIONS From the results of this study, a combination of allopurinol plus meglumine antimoniate may be considered as a highly effective treatment for LR.
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Masmoudi A, Dammak A, Bouassida S, Elleuch N, Akrout F, Turki H, Zahaf A. [Interest of metronidazole in the treatment of cutaneous leishmaniasis]. Therapie 2007; 62:68-9. [PMID: 17474188 DOI: 10.2515/therapie:2006088] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
A leishmaniose tegumentar americana é doença infecciosa da pele e mucosa, cujo agente etiológico é um protozoário do gênero Leishmania. Seu tratamento é desafio porque as drogas disponíveis apresentam elevada toxicidade, e nenhuma delas é bastante eficaz. A recidiva, a falha terapêutica em pacientes imunodeprimidos e a resistência ao tratamento são fatores que motivam a busca de uma droga ideal.
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21
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Salmanpour R, Razmavar MR, Abtahi N. Comparison of intralesional meglumine antimoniate, cryotherapy and their combination in the treatment of cutaneous leishmaniasis. Int J Dermatol 2006; 45:1115-6. [PMID: 16961529 DOI: 10.1111/j.1365-4632.2006.02822.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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22
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Velozo D, Cabral A, Ribeiro MCM, Motta JDOCD, Costa IMC, Sampaio RNR. Leishmaniose mucosa fatal em criança. An Bras Dermatol 2006. [DOI: 10.1590/s0365-05962006000300008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A leishmaniose tegumentar americana, doença endêmica e crescente no Brasil, pode manifestar-se por úlceras na pele e lesões nas mucosas nasal, oral e faringiana. O antimônio pentavalente é a droga de primeira escolha no tratamento, com resposta menos favorável nas formas mucosas. Destaca-se a dificuldade para diagnosticar e tratar um caso de leishmaniose mucosa em criança de cinco anos que teve exames parasitológicos, imunológicos e reação em cadeia da polimerase negativos. Somente após várias repetições o esfregaço foi positivo. A paciente apresentou infecção bacteriana secundária persistente das lesões e falta de resposta a drogas específicas e antibióticos, evoluindo para septicemia e óbito.
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23
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Masmoudi A, Maalej N, Boudaya S, Turki H, Zahaf A. [Adverse effects of intralesional Glucantime in the treatment of cutaneous leishmaniosis]. Med Mal Infect 2006; 36:226-8. [PMID: 16600554 DOI: 10.1016/j.medmal.2005.11.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2005] [Accepted: 11/21/2005] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The treatment of cutaneous leishmaniasis used in Tunisia is Glucantime. The aim of this retrospective study was to determine the adverse effects of intralesional Glucantime and to calculate the risk/benefit rate of this treatment. RESULTS Adverse effects were observed in 14 cases (5%). For facial lesions, we observed facial staphylococci in 2 cases, stibio-intolerance in 1 case, and a palpebral subcutaneous nodule in 1 case. In limb lesions the complications were: sporotrichoid nodules in 5 cases, vagal malaise (1 case), pyodermitis (1 case), erysipelas (1 case), necrosis (1 case), and urticaria (1 case). COMMENTARY The adverse effects of intralesional Glucantime are mostly infections, mainly observed in cephalic localization, and stibio-intolerance. For this reason, intralesional injection of Glucantime must be avoided in the cephalic region.
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Affiliation(s)
- A Masmoudi
- Service de Dermatologie, EPS Hédi-Chaker, CHU Hédi-Chaker, 3029 Sfax, Tunisie.
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24
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Mayrink W, Botelho ACDC, Magalhães PA, Batista SM, Lima ADO, Genaro O, Costa CAD, Melo MND, Michalick MSM, Williams P, Dias M, Caiaffa WT, Nascimento ED, Machado-Coelho GLL. Immunotherapy, immunochemotherapy and chemotherapy for American cutaneous leishmaniasis treatment. Rev Soc Bras Med Trop 2006; 39:14-21. [PMID: 16501760 DOI: 10.1590/s0037-86822006000100003] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The first choice of treatment for American cutaneous leishmaniasis is the pentavalent antimonial drug. Although it has been shown that this treatment is mostly effective and indicated, some disadvantages should be taken into account such as side effects, long term treatment inconveniences and counter-indication for patients suffering from cardiopathy, nephropathy; yet, aging, pregnancy and other conditions. With the advent of the vaccine anti-American cutaneous leishmaniasis as a prophylactic measure, studies on therapy using the vaccine associated or not with other drugs have been performed by many investigators and it is currently among the alternative treatments and prevention measures for American cutaneous leishmaniasis. In conclusion, the association between antimony and vaccine (immunochemotherapy) showed the same cure rate when compared with the standard treatment (100%) and it was also able to reduce the salt volume in 17.9% and treatment length from 87 to 62 days, decreasing side effects.
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Affiliation(s)
- Wilson Mayrink
- Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
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25
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Romero Maldonado N, Ojea Yáñez AM. Placa eritematosa facial persistente en una paciente anciana. Rev Clin Esp 2006; 206:38-40. [PMID: 16527046 DOI: 10.1157/13084767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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White JML, Salisbury JR, Jones J, Higgins EM, Vega-Lopez F. Cutaneous leishmaniasis: three children with Leishmania major successfully treated with itraconazole. Pediatr Dermatol 2006; 23:78-80. [PMID: 16445420 DOI: 10.1111/j.1525-1470.2006.00177.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report the rare instance of four family members with numerous cutaneous lesions of Leishmania major contracted while on holiday in Algeria. Treatment was successful with oral itraconazole for the children and intralesional sodium stibogluconate for the mother. Cutaneous leishmaniasis should be considered in those with apparently sterile plaques returning from endemic areas. These results suggest that itraconazole, which is ideally suited for use in children, is an effective monotherapy for L. major.
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Affiliation(s)
- J M L White
- Department of Dermatology, King's College Hospital, London, United Kingdom.
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27
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Panagiotopoulos A, Stavropoulos PG, Hasapi V, Papakonstantinou AM, Petridis A, Katsambas A. Treatment of cutaneous leishmaniasis with cryosurgery. Int J Dermatol 2005; 44:749-52. [PMID: 16135144 DOI: 10.1111/j.1365-4632.2005.02628.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The management of cutaneous leishmaniasis with topical methods, if effective, can spare patients from long and costly inpatient treatments. METHODS Seventeen patients with cutaneous leishmaniasis were treated with cryosurgery using liquid nitrogen as the cryogen. Two cycles of 10-30 s freezing time were used and repeated at 3-week intervals. RESULTS All patients responded well to therapy with excellent cosmetic results and no relapse in any case. Side-effects were rare. CONCLUSIONS Cutaneous leishmaniasis can be successfully treated with a simple protocol of cryosurgery with minor side-effects.
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Affiliation(s)
- Antonios Panagiotopoulos
- Department of Cryosurgery, Third Department of Dermatology and Venereology, University of Athens School of Medicine, A. Syggros Hospital, Athens, Greece
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Abstract
Leishmaniases are diseases caused by infection by protozoa of the genus Leishmania. Cutaneous leishmaniasis caused by Leishmania infantum is frequent in Spain, especially in certain geographic areas. Diagnosis of cutaneous leishmaniasis is difficult because of the varied symptoms and because making cultures of this parasite is complicated. There are also different therapeutic, medical and surgical options, none of which is fully satisfactory. We review the most significant agents of cutaneous leishmaniasis in Spain.
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Affiliation(s)
- Domingo García-Almagro
- Servicio de Dermatología, Hospital Virgen de la Salud, Avda. Barber 30, 45004 Toledo, Spain
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Abstract
A psychiatric disorder would be associated with extensive, unsightly lesions on exposed body parts. Cutaneous leishmaniasis (CL) has long been endemic in Sanliurfa and is called 'beauty scar'. The aim of this study was to determine psychological impact of CL. Patients with active CL, with CL that had healed with scaring, and healthy controls were included in this case-control study. The Hospital Anxiety Depression Scale (HAD), Body Image Satisfaction Scale (BIS), and Dermatology Quality of Life Scale (DQL) assessments were performed to determine the psychological effect of CL. The patients with CL had significantly higher HAD anxiety and depression subscale scores than the control groups. Patients with CL have decreased body satisfaction and lower quality of life than those in the control group. It was found that CL patients with active lesions have the lowest quality of life score than other groups. CL lesions on exposed body parts such as the face and hands, active CL for more than 1 year, permanent scar formation, and social stigmatization cause anxiety, depressive symptoms, decreased body satisfaction and quality of life in CL patients.
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Affiliation(s)
- M Yanik
- Department of Psychiatry, Medical Faculty of Harran University, Sanliurfa, Turkey.
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30
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Ferreli C, Atzori L, Zucca M, Pistis P, Aste N. Leishmaniasis of the lip in a patient with Down's syndrome. J Eur Acad Dermatol Venereol 2004; 18:599-602. [PMID: 15324405 DOI: 10.1111/j.1468-3083.2004.00987.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cutaneous leishmaniasis is an endemic protozoan infection in Sardinia, one of the major islands of the Mediterranean Basin. The main causative strain in this country is Leishmania infantum, which rarely involves mucocutaneous areas, but has the potential to cause visceral leishmaniasis. An atypical leishmaniasis involving the inferior lip of a 57-year-old female with Down's syndrome was observed at the Dermatology Department of Cagliari (italy). The diagnosis was mainly based upon histopathological examination, revealing intra- and extra-cellular leishmania amastigotes. The leishmania infantum zymodeme MON-111 was identified by isoenzymatic characterization. Laboratory investigations revealed a normal complete blood count and biochemistry profile, except for an inverted CD4/CD8 ratio. Treatment with meglumine antimoniate 60 mg/kg/day (Glucantime) intramuscularly for 15 days, followed by intralesional administration 1 ml weekly for 4 weeks led to complete recovery. No relapses were observed at 6-month follow-up. The unusual localization is likely to be a reflection of the uncommon site of inoculation of the protozoa, transmitted by bites from flying vectors. Nevertheless, the presence of Down's syndrome in our patient may have contributed to the atypical presentation by traumatic exacerbation of the lesion, due to repeated auto-induced microtraumas of the inferior lip accompanied by subclinical immunodeficiency. In fact, the specific immune response to Leishmania infection depends on a host-cell-mediated immune response, reported as defective in Down's syndrome patients. Differential diagnosis and early detection of the infection are necessary in order to start effective treatment and prevent more serious complications.
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Affiliation(s)
- C Ferreli
- Dermatology Department, Cagliari University via Ospedale 54-09124, Cagliari, Italy.
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31
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Satici A, Gurler B, Aslan G, Ozturk I. Ocular involvement in cutaneous leishmaniasis four cases with blepharoconjunctivitis. Eur J Epidemiol 2004; 19:263-6. [PMID: 15117121 DOI: 10.1023/b:ejep.0000020346.15800.d3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE To determine the rate of ocular involvement in cutaneous leishmaniasis (CL). METHODS Nine hundred and eighty seven cutaneous leishmaniasis patients diagnosed and identified by clinical examination and parasitological methods in Harrankapi Health Centre between January 1996 and November 1997 were examined at the Harran University School of Medicine Eye Clinic, Sanliurfa, Turkey. RESULTS One thousand seven hundred and three CL lesions were identified in 987 patients (484 women and 503 men) with ages ranging from 0 to 78 years (mean +/- SD 16.70 +/- 13.47 years). A total of 33 lesions were located on the eyelid and in the periorbital region, making up 1.93% of all cutaneous lesions and 3.57% of facial lesions. In three cases with ocular involvement, blepharoconjunctivitis was identified, and in one case with ocular involvement, mechanical ptosis, lagophthalmos and blepharoconjunctivitis were identified. CONCLUSIONS It was observed that the size of the lesions and their vicinity to the marginal free edge of the eyelid played an important role in the occurrence of ocular symptoms. It was concluded that many ocular findings could be missed because of the failure to conduct ophthalmological examination of CL cases with eyelid involvement, and hence, proper follow up and treatment may not be carried out.
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Affiliation(s)
- Ahmet Satici
- Department of Ophthalmology, School of Medicine, Harran University, Sanliurfa, Turkey.
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32
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Santos WR, Aguiar IA, Paraguai de Souza E, de Lima VMF, Palatnik M, Palatnik-de-Sousa CB. Immunotherapy against murine experimental visceral leishmaniasis with the FML-vaccine. Vaccine 2004; 21:4668-76. [PMID: 14585674 DOI: 10.1016/s0264-410x(03)00527-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The fucose mannose ligand (Leishmania donovani FML)-saponin vaccine has earlier shown its immunoprophylactic potential against visceral leishmaniasis in the CB hamster (87.7% of parasite load reduction), Balb/c (84.4%) and Swiss albino mouse (85-93%) models. In this investigation its specific immunotherapeutic efficacy against L. donovani infection in Balb/c mice was studied. The effects of vaccine treatment on the humoral response, delayed type of hypersensitivity to promastigote lysate (DTH), cytokine levels in sera and reduction of the liver parasitic load of L. donovani infected mice, were examined. The types and subtypes of anti-FML antibodies increased significantly in the vaccinees over the saline and saponin controls. As expected for a saponin vaccine, the highest ratios were found in relation to IgG1, IgG2a and IgG2b (4.4, 5 and 2.5, respectively). The DTH response and the in vitro ganglion cell proliferative response against FML antigen were also significantly higher than controls (P<0.005). Concomitantly, an impressive and specific decrease of liver parasitic burden was detected only in vaccine-treated animals (94.7%). Our results indicate that the therapeutic FML-vaccine has a potent effect on modulation of the murine infection leading to the reduction of parasitic load and signs of disease, being a new potential tool in the therapy and control of visceral leishmaniasis.
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Affiliation(s)
- Wania Renata Santos
- Instituto de Microbiologia, Professor Paulo de Góes, Universidade Federal do Rio de Janeiro (UFRJ), CCS, Cidade Universitária, Ilha do Fundão, CP 68040, CEP 21941-590 Rio de Janeiro, Brazil
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Paula CDRD, Sampaio JHD, Cardoso DR, Sampaio RNR. Estudo comparativo da eficácia de isotionato de pentamidina administrada em três doses durante uma semana e de N-metil-glucamina 20mgSbV/kg/dia durante 20 dias para o tratamento da forma cutânea da leishmaniose tegumentar americana. Rev Soc Bras Med Trop 2003. [DOI: 10.1590/s0037-86822003000300009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Setenta e nove pacientes com leishmaniose tegumentar americana, forma cutânea, foram divididos em dois grupos: o grupo experimental (I), formado por 38 pessoas que receberam isotionato de pentamidina, 4mg/kg/dia, três aplicações, IM, durante uma semana, e o grupo controle (II), formado por 41 doentes tratados com N-metilglucamina, 20mgSbV/kg/dia por 20 dias, EV. Foram identificados, por técnica de anticorpos monoclonais, 21 isolados com predominância de Leishmania (Viannia) braziliensis. Encontrou-se cura clínica em 71,05% do grupo experimental e 73,17% do grupo controle (p=0,47). Alterações de ECG foram mais freqüentes utilizando antimonial pentavalente, com significância (p<0,05). O tratamento com a pentamidina mostrou eficácia semelhante quando comparado ao antimonial e apresenta vantagens como duração reduzida de tratamento e baixa toxicidade cardiológica.
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Abstract
There have been many treatment modalities used for the therapy of cutaneous leishmaniasis. Although treatment need not be given for cosmetically insignificant lesions, which are often self-limited, therapy is usually indicated for larger, cosmetically significant and disfiguring lesions, and lesions which progress. This review summarizes the published evidence in support of the numerous therapeutic options that have been employed for cutaneous leishmaniasis.
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Affiliation(s)
- Samuel A Lee
- Infectious Diseases Section, VA Connecticut Healthcare System, West Haven, CT 06516, USA.
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Báfica A, Oliveira F, Freitas LAR, Nascimento EG, Barral A. American cutaneous leishmaniasis unresponsive to antimonial drugs: successful treatment using combination of N-methilglucamine antimoniate plus pentoxifylline. Int J Dermatol 2003; 42:203-7. [PMID: 12653916 DOI: 10.1046/j.1365-4362.2003.01868.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND American cutaneous leishmaniasis is characterized by single or multiple ulcerations. Cytokines, among other factors, have been shown to influence lesion development and tumoral necrosis factor-alpha is a major cytokine implicated in pathogenesis of ulcers. OBSERVATIONS We tested oral pentoxifylline, a known tumoral necrosis factor-alpha inhibitor, at doses of 400 mg (2-3x/day), associated to N-methylglucamine antimoniate (15 mg/kg/day) in two patients with American cutaneous leishmaniasis unresponsive to antimonial drugs. We observed a satisfactory response with quick cure of skin lesions of these patients. CONCLUSIONS Our results suggest that oral pentoxifylline in association to N-methylglucamine antimoniate should be consider in refractory cutaneous leishmaniasis patients.
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Affiliation(s)
- André Báfica
- Faculdade de Medicina da Universidade Federal da Bahia, Brazil
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Lai A Fat EJSK, Vrede MA, Soetosenojo RM, Lai A Fat RFM. Pentamidine, the drug of choice for the treatment of cutaneous leishmaniasis in Surinam. Int J Dermatol 2002; 41:796-800. [PMID: 12453009 DOI: 10.1046/j.1365-4362.2002.01633.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Cutaneous leishmaniasis is an endemic disease in Surinam. The disease was treated until the early 1970s with pentavalent antimony. Pentamidine mesylate was introduced by Niemel in 1973 for the treatment of cutaneous leishmaniasis in Surinam. MATERIALS AND METHODS In this retrospective study, we evaluate the results of treatment with pentamidine mesylate in 235 patients and with pentamidine isethionate in 80 patients. RESULTS In the pentamidine mesylate- and pentamidine isethionate-treated groups, a cure rate (healing without relapse) of nearly 90% was found. Relapses were seen in approximately 10% of patients in both groups. Minor side-effects, such as pain at the injection site, bitter taste, and nausea, were seen with both drugs in about 65% of patients. Complaints of the respiratory tract were seen in less than 10% of patients in the pentamidine isethionate-treated group, but were uncommon in the pentamidine mesylate-treated group. CONCLUSIONS Pentamidine mesylate and isethionate have similar safety, efficacy, and side-effect profiles in the treatment of cutaneous leishmaniasis in Surinam.
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Esfandiarpour I, Alavi A. Evaluating the efficacy of allopurinol and meglumine antimoniate (Glucantime) in the treatment of cutaneous leishmaniasis. Int J Dermatol 2002; 41:521-4. [PMID: 12207774 DOI: 10.1046/j.1365-4362.2002.01526.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Cutaneous leishmaniasis is a common disease in Iran, particularly in Kerman province. It usually occurs via the bite of an infected sandfly. METHODS One hundred and fifty patients suffering from cutaneous leishmaniasis were included in this study in Kerman. The patients were randomly divided into three groups. They were matched with regard to age, sex, duration of the disease, and type, number, and site of the lesions. For each group, one of the following therapeutic methods was applied: (i) oral allopurinol (15 mg/kg/day) for 3 weeks; (ii) intramuscular injection of Glucantime (30 mg/kg/day), corresponding to 8 mg/kg/day of pentavalent antimony, for 2 weeks; (iii) combined therapy. The lesions were re-examined at the end of treatment and 2 and 4 weeks later. The response to treatment was graded as excellent (reduction in the size of the lesion by at least 80% or complete clearance), good (reduction in the size of the lesion by 50%), and poor (minimal or no change in the lesion). RESULTS The overall results indicated that 18% of patients showed excellent response, 6% good response, and 76% poor response in the first group. In the second group, 24% of patients showed excellent response, 6% good response, and 70% poor response. In the third group, 46% of patients showed excellent response, 8% good response, and 46% poor response. CONCLUSIONS The results obtained by the three therapeutic methods indicated that combined therapy with allopurinol plus Glucantime was much more effective than that obtained by each of the two drugs when used alone (P < 0.05).
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Affiliation(s)
- Iraj Esfandiarpour
- Kerman University of Medical Sciences and Health Services, Kerman, Iran.
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38
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Affiliation(s)
- Uta Jappe
- Department of Dermatology and Venereology, University of Heidelberg, Heidelberg, Germany.
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Machado P, Araújo C, Da Silva AT, Almeida RP, D'Oliveira Jr A, Bittencourt A, Carvalho EM. Failure of early treatment of cutaneous leishmaniasis in preventing the development of an ulcer. Clin Infect Dis 2002; 34:E69-73. [PMID: 12032913 DOI: 10.1086/340526] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2001] [Revised: 01/10/2002] [Indexed: 11/03/2022] Open
Abstract
The clinical characteristics and treatment outcome were determined for 26 patients who presented with early-stage cutaneous leishmaniasis. Illness duration ranged from 8 to 20 days, and the commonest clinical presentation was the presence of a papule with small central crust on a lower extremity. Prominent regional adenopathy was found in 22 (85%) of 26 patients. The results of an intradermal skin test for Leishmania were positive for 96% of those patients, and results of serologic testing were positive for 61% of patients tested. Ten (46%) of 22 patients for whom follow-up data were available developed enlargement and ulceration of the lesion despite early antimony therapy and required additional courses of treatment. Histopathological studies of samples from the lesions of 3 patients showed vasculitis. These data show that early therapy for cutaneous leishmaniasis does not prevent the development of an ulcer in one-half of patients. This unfavorable outcome underlines the relevance of local exacerbated inflammatory and immune response in the pathogenesis of the disease.
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Affiliation(s)
- Paulo Machado
- Serviço de Imunologia, Hospital Universitário Prof. Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil
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Abstract
An unusual case of extensive cutaneous leishmaniasis of the upper limb in a patient with leukemia is presented. A trial of medical therapy (sodium stibogluconate) resulted in rapid healing of the large ulcers. The incidence of leishmaniasis is increasing globally as a result of the ease of travel and migrating populations. Hand surgeons worldwide should have a high index of suspicion of this parasitic infection of the upper limb and should be aware of its unusual presentation in immunocompromised patients.
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Affiliation(s)
- M M Al-Qattan
- Division of Plastic Surgery, Department of Surgery, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
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41
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Affiliation(s)
- Marcia Ramos-E-Silva
- Department of Dermatology and Post-Graduate Course, HUCFF-UFRJ and the School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
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Gurel MS, Ulukanligil M, Ozbilge H. Cutaneous leishmaniasis in Sanliurfa: epidemiologic and clinical features of the last four years (1997-2000). Int J Dermatol 2002; 41:32-7. [PMID: 11895511 DOI: 10.1046/j.0011-9059.2001.01396.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Sanliurfa is located in south-east Anatolia, the region with the largest focus of anthroponotic cutaneous leishmaniasis (CL) in Turkey. The present study was designed to determine the epidemiological and clinical patterns of cases of CL in the Sanliurfa area over a period of 4 years (1997-2000). METHODS 2120 CL cases attending the Harrankapi in this study. RESULTS There were 790 cases of CL in 1997, and 778 in 1998. The numbers declined to 277 in 1999 and to 275 in 2000. The majority of patients (70%) were less than 20 years of age, with the highest percentage (27%) occurring in the 5- to 9-year age group. Acute CL and chronic CL were observed in 1926 (90.8%) and 63 (3%) patients, respectively. Leishmaniasis recidivans (LR) was found only in 131 (6.2%) patients. Lesions of CL were seen mainly on the exposed parts of the body such as the face and neck (57.5%), upper limbs (32.2%) and lower limbs (10.2%). Ninety-three percent of the patients were residents of central Sanliurfa from the southern and eastern parts of the city, areas with poor housing and low socio-economic conditions. CONCLUSION Although the incidence of CL showed a sharp decline from 1997 to 2000 in Sanliurfa, this does not mean that the disease is on its way to eradication.
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Affiliation(s)
- Mehmet Salih Gurel
- Department of Dermatology, Medical Faculty of Harran University, 63200 Sanliurfa, Turkey.
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Hatchette T, Green P, Schlech W, Haase D, Miller R, Haldane DJ. Lesion on the Arm of a Returning Traveler. Clin Infect Dis 2001. [DOI: 10.1086/322582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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45
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Abstract
The incidence of leishmaniasis is increasing globally due to population and environmental changes. Ease of worldwide travel and immigrant populations means that the UK surgeon is more likely to encounter cutaneous lesions. Two cases are presented and treatment options discussed.
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Affiliation(s)
- S S Rayatt
- Department of Plastic and Reconstructive Surgery, St George's Hospital, London, UK
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46
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Braun-Falco O, Plewig G, Wolff HH, Burgdorf WHC. Protozoan Diseases. Dermatology 2000. [DOI: 10.1007/978-3-642-97931-6_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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47
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Rodrigues ML, Costa RS, Souza CS, Foss NT, Roselino AM. Nephrotoxicity attributed to meglumine antimoniate (Glucantime) in the treatment of generalized cutaneous leishmaniasis. Rev Inst Med Trop Sao Paulo 1999; 41:33-7. [PMID: 10436668 DOI: 10.1590/s0036-46651999000100007] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Pentavalent antimonials have became of basic importance for the treatment of leishmaniasis. Their most severe side effects have been reported to be increased hepatic enzyme levels and electrocardiographic abnormalities. Nephrotoxicity has been rarely related. OBSERVATIONS We report a case of generalized cutaneous leishmaniasis involving a 50-year old male patient who was submitted to treatment with meglumine antimoniate (Glucantime). He developed acute renal failure (ARF) due to acute tubular necrosis (ATN), followed by death after receiving a total of 53 ampoules of Glucantime. CONCLUSIONS The treatment with Glucantime was responsible by ARF diagnosed in this patient. The previous urine osmolarity and serum creatinine levels were normal and the autopsy showed ATN. It should be pointed out if ARF may also be explained by massive deposits of immunocomplexes by leishmania antibodies and antigens due to the antigenic break by the antimonial compound, since our patient presented countless lesions covering the entire tegument, similar to the Hexheimer phenomenon, but at the autopsy no glomerular alterations were seen.
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Affiliation(s)
- M L Rodrigues
- Division of Dermatology, Faculty of Medicine of Ribeirão Preto, SP, Brazil.
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Abstract
Ulcerations may appear on the genitalia in a variety of both infectious and noninfectious conditions. The vast diversity of etiologies, coupled with the often overlapping morphological features, make the diagnosis of genital ulcerations a challenging endeavor. This article highlights the most important clinical manifestations and laboratory findings which aid in the proper diagnosis of genital ulcerations.
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Affiliation(s)
- T Rosen
- Department of Dermatology, Baylor College of Medicine, Houston, Texas.
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Rosatelli J, Souza C, Soares F, Foss N, Roselino A. Generalized cutaneous leishmaniasis in acquired immunodeficiency syndrome. J Eur Acad Dermatol Venereol 1998. [DOI: 10.1111/j.1468-3083.1998.tb00741.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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