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Saffarian Z, Marandi ZV, Shakoei S, Hamzelou S, Rafati S. A Case Series of 36 Patients Treated for Old World Cutaneous leishmaniasis. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2024; 17:38-42. [PMID: 39006810 PMCID: PMC11238713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
Background Cutaneous leishmaniasis is endemic in Iran. Objective We sought to investigate the therapeutic outcomes and complications of treatment in patients with cutaneous leishmaniasis. Methods This case series enrolled patients with smear-proven cutaneous leishmaniasis who visited our center in Iran from 2018 to 2019. Results In total, 36 patients were treated with intralesional meglumine antimoniate, intramuscular meglumine antimoniate, sodium stibogluconate, and amphotericin B. Overall, this treatment was effective in 81.8 percent of patients. Relapse and treatment failure occurred in 6.1 percent and 12.1 percent of patients, respectively. Treatment with intralesional meglumine antimoniate, intramuscular meglumine antimoniate, sodium stibogluconate, and amphotericin B yielded a clearance rate of 80.8 percent, 92.3 percent, 75 percent, and 85.7 percent, respectively. Clearance was associated with a shorter time interval between injections of intralesional meglumine antimoniate (p=0.006) and relapse was associated with a longer time interval between injections (p=0.018). The average number of side effects per patient for intralesional meglumine antimoniate, sodium stibogluconate, intramuscular meglumine antimoniate, and amphotericin B was 0.62, 1.4, 1.6, and 2.8, respectively. The most common side effect of intralesional meglumine antimoniate, intramuscular meglumine antimoniate, and amphotericin B was local pain, arthralgia, and hypokalemia, respectively. Limitations Low sample size was the limitation of this study. Conclusion The cure rate of intramuscular meglumine antimoniate was higher than amphotericin B, which was higher than the cure rate of sodium stibogluconate. In patients treated with intralesional meglumine antimoniate, reducing the time interval between injections increased the clearance rate and decreased the rate of relapse.
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Affiliation(s)
- Zahra Saffarian
- Drs. Saffarian and Shakoei are with the Dermatology Department of Imam Khomeini Hospital Complex and Razi Dermatology Hospital at Tehran University of Medical Science in Tehran, Iran
| | - Zahra Vasfi Marandi
- Dr. Marandi is with the Dermatology Department of Imam Khomeini Hospital Complex School of Medicine at Tehran University of Medical Science in Tehran, Iran
| | - Safoura Shakoei
- Drs. Saffarian and Shakoei are with the Dermatology Department of Imam Khomeini Hospital Complex and Razi Dermatology Hospital at Tehran University of Medical Science in Tehran, Iran
| | - Shahin Hamzelou
- Dr. Hamzelou is with the Dermatology Department of Imam Khomeini Hospital Complex and Razi Dermatology Hospital at Tehran University of Medical Science in Tehran, Iran
| | - Sima Rafati
- Dr. Rafati is with the Department of Immunotherapy and Leishmania Vaccine Research at the Pasteur Institute of Iran in Tehran, Iran
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Ullah W, Khan A, Niaz S, Al-Garadi MA, Nasreen N, Swelum AA, Ben Said M. Epidemiological survey, molecular profiling and phylogenetic analysis of cutaneous leishmaniasis in Khyber Pakhtunkhwa, Pakistan. Trans R Soc Trop Med Hyg 2024; 118:273-286. [PMID: 38055843 DOI: 10.1093/trstmh/trad086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/22/2023] [Accepted: 11/16/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Cutaneous leishmaniasis (CL), an emerging vector-borne ailment in Khyber Pakhtunkhwa (KPK), Pakistan, exhibits diverse spread patterns and outbreaks. METHODS To comprehend its epidemiology and identify parasite species, we conducted an active survey on suspected CL cases (n=8845) in KPK. RESULTS Microscopy and internal transcribed spacer-1 PCR-restriction fragment length polymorphism (RFLP) molecular techniques detected Leishmania spp. in blood samples. Phylogenetic analysis gauged genetic affinities with other areas. District Bannu displayed the highest CL impact (14.58%), while Swat had the lowest impact (4.33%) among cases. Annual blood examination rate, parasite incidence and slide positivity rate were 4.96 per 1000 people, 0.0233 and 0.047%, respectively. CL infections were prevalent in 1- to 20-y-olds, with males (57.17%) more vulnerable than females (42.82%). Single lesions occurred in 43.73% of patients, while 31.2% people had two lesions, 17.31% had three lesions and 7.74% had more than three lesions. Most had sand-fly exposure but lacked preventive measures like repellents and bed nets. Leishmania tropica was confirmed via RFLP analysis in amplified samples. Phylogenetic analysis unveiled genetic parallels between L. tropica of KPK and isolates from China, Iran, Afghanistan, India, Syria and Morocco. CONCLUSIONS Urgent comprehensive control measures are imperative. Early detection, targeted interventions and raising awareness of CL and sand-fly vectors are vital for reducing the disease's impact. International collaboration and monitoring are crucial to tackle Leishmania spp.'s genetic diversity and curtail its cross-border spread.
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Affiliation(s)
- Wasia Ullah
- Depart ment of Zoology, Abdul Wali Khan University, Khyber Pakhtunkhwa, Pakistan
| | - Adil Khan
- Department of Botany/Zoology, Bacha Khan University Charsadda, Khyber Pakhtunkhwa, Pakistan
- Department of Biology, Mountain Allison university, Sackville, new Brunswick, Canada
| | - Sadaf Niaz
- Depart ment of Zoology, Abdul Wali Khan University, Khyber Pakhtunkhwa, Pakistan
| | - Maged A Al-Garadi
- Department of Animal Production, College of Food and Agriculture Sciences, King Saud University, Riyadh 11451, Saudi Arabia
| | - Nasreen Nasreen
- Depart ment of Zoology, Abdul Wali Khan University, Khyber Pakhtunkhwa, Pakistan
| | - Ayman A Swelum
- Department of Animal Production, College of Food and Agriculture Sciences, King Saud University, Riyadh 11451, Saudi Arabia
| | - Mourad Ben Said
- Laboratory of Microbiology, National School of Veterinary Medicine of Sidi Thabet, University of Manouba, Manouba 2010, Tunisia
- Department of Basic Sciences, Higher Institute of Biotechnology of Sidi Thabet, University of Manouba, Manouba 2010, Tunisia
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Registre C, Soares RDOA, Rubio KTS, Santos ODH, Carneiro SP. A Systematic Review of Drug-Carrying Nanosystems Used in the Treatment of Leishmaniasis. ACS Infect Dis 2023; 9:423-449. [PMID: 36795604 DOI: 10.1021/acsinfecdis.2c00632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Leishmaniasis is an infectious disease responsible for a huge rate of morbidity and mortality in humans. Chemotherapy consists of the use of pentavalent antimonial, amphotericin B, pentamidine, miltefosine, and paromomycin. However, these drugs are associated with some drawbacks such as high toxicity, administration by parenteral route, and most seriously the resistance of some strains of the parasite to them. Several strategies have been used to increase the therapeutic index and reduce the toxic effects of these drugs. Among them, the use of nanosystems that have great potential as a site-specific drug delivery system stands out. This review aims to compile results from studies that were carried out using first- and second-line antileishmanial drug-carrying nanosystems. The articles referred to here were published between 2011 and 2021. This study shows the promise of effective applicability of drug-carrying nanosystems in the field of antileishmanial therapeutics, with the perspective of providing better patient adherence to treatment, increased therapeutic efficacy, reduced toxicity of conventional drugs, as well as the potential to efficiently improve the treatment of leishmaniasis.
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Affiliation(s)
- Charmante Registre
- Phytotechnology Laboratory, School of Pharmacy, Federal University of Ouro Preto, Ouro Preto, Minas Gerais 35400000, Brazil
| | - Rodrigo D O A Soares
- Immunopathology Laboratory, Research Center in Biological Sciences/NUPEB, Federal University of Ouro Preto, Ouro Preto, Minas Gerais 35400000, Brazil
| | - Karina T S Rubio
- Toxicology Laboratory, School of Pharmacy, Federal University of Ouro Preto, Ouro Preto, Minas Gerais 35400000, Brazil
| | - Orlando D H Santos
- Phytotechnology Laboratory, School of Pharmacy, Federal University of Ouro Preto, Ouro Preto, Minas Gerais 35400000, Brazil
| | - Simone P Carneiro
- Department of Pharmacy, Pharmaceutical Technology and Biopharmaceutics, Ludwig-Maximilians-University of Munich, 81377 Munich, Germany
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In vitro anti-Leishmania activity of new isomeric cobalt(II)complexes and in silico insights: Mitochondria impairment and apoptosis-like cell death of the parasite. J Inorg Biochem 2023; 240:112088. [PMID: 36630792 DOI: 10.1016/j.jinorgbio.2022.112088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/29/2022] [Accepted: 12/01/2022] [Indexed: 12/13/2022]
Abstract
The synthesis, physico-chemical characterization and in vitro antiproliferative activity against the promastigote form of Leishmania amazonensis of two new cobalt(II) coordination compounds (i.e. [Co(HL1)Cl2]0.4,2H2O (1) and [Co(HL2)(Cl)(CH3OH)](ClO4).2H2O (2)) are reported, where HL1 = 4-{3-[bis(pyridin-2-ylmethyl)amino]-2-hydroxypropoxy}-2H-chromen-2-one and HL2 = 7-{3-[bis(pyridin-2-ylmethyl)amino]-2-hydroxypropoxy}-2H-chromen-2-one. X-ray diffraction studies were performed for complex (2) and the structure of complex (1) was built through Density Functional Theory (DFT) calculations. Complex (1) presented no cytotoxicity to LLC-MK2, but complex (2) was toxic. IC50 against promastigotes of L. amazonensis for complex (1) were 4.90 (24 h), 3.50 (48 h) and 3. 80 μmol L-1 (72 h), and for complex (2) were 2.09, 4.20 and 2.80 μmol L-1, respectively. Due to the high toxicity presented by complex (2) against LLC-MK2 host cells, mechanistic studies, to shed light on the probable mode of leishmanicidal activity, were carried out only for the non-cytotoxic complex. Complex (1) was able to elevate mitochondrial membrane potential of the parasites after treatment. Transmission electron microscopy revealed typical apoptotic condensation of chromatin, altered kinetoplast and mitochondria structures, suggesting that apoptosis-like cell death of the protozoa is probably mediated by an apoptotic mechanism associated with mitochondrial dysfunction (intrinsic pathway). Molecular docking studies with complex (1) upon protein tyrosine phosphatase (LmPRL-1) suggests a plausible positive complex anchoring mainly by hydrophobic and hydrogen bond forces close to the enzyme's catalytic site. These promising results for complex 1 will prompt future investigations against amastigote form of L. amazonensis.
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Horev A, Sagi O, Zur E, Ben-Shimol S. Topical liposomal amphotericin B gel treatment for cutaneous leishmaniasis caused by Leishmania major: a double-blind, randomized, placebo-controlled, pilot study. Int J Dermatol 2022; 62:40-47. [PMID: 36040071 DOI: 10.1111/ijd.16407] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/26/2022] [Accepted: 08/10/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cutaneous leishmaniasis (CL) topical treatments may have low efficacy, while systemic treatments have adverse effects (AEs) and high cost. Since treatment options for CL nowadays have numerous disadvantages, an alternative topical treatment is vastly needed. We assessed liposomal amphotericin B gel (LAmB gel) treatment efficacy and safety. METHODS A randomized, double-blind, placebo-controlled trial. Adults with CL (PCR proven, ≤5 lesions) were randomized for 28 days with LAmB gel (cases) versus placebo gel (controls), followed by LAmB gel for 28 days (both groups). Lesion size, ulceration, induration, scarring, swelling, and AEs (pain, itch, erythema, discharge, fever, and urticaria) were assessed at days 1, 28, and 56. PCR was repeated at day 56. RESULTS Thirteen patients (four cases, nine controls) with 39 lesions (11 cases, 28 controls) caused by Leishmania major (L. major) were randomized. Ulcer, induration, scarring, and swelling were noted in 18%, 91%, 0%, and 27% of cases, respectively, versus 86%, 89%, 7%, and 54% of controls, respectively. At day 28, improvement rates were low in both groups. Induration improved comparing LAmB gel treatment for 56 days versus 28 days. Ulceration, induration, and swelling improved comparing all patients at 56 days versus 28 days. PCR turned negative in three of four cases and eight of nine controls. Mild, only local, AEs were reported in <30% of the patients. CONCLUSIONS LAmB gel is safe and may be considered as an alternative topical treatment for CL caused by L. major. Further, larger-scale studies are warranted to evaluate the long-term impact of LAmB gel on the management of CL.
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Affiliation(s)
- Amir Horev
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.,Pediatric Dermatology Service, Soroka University Medical Center, Beer Sheva, Israel
| | - Orli Sagi
- Parasitology Laboratory, Soroka University Medical Center, Beer Sheva, Israel
| | - Eyal Zur
- Compounding Solutions, Tel-Mond, Israel
| | - Shalom Ben-Shimol
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.,Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer Sheva, Israel
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Sridharan K, Sivaramakrishnan G. Comparative assessment of interventions for treating cutaneous leishmaniasis: A network meta-analysis of randomized clinical trials. Acta Trop 2021; 220:105944. [PMID: 33957088 DOI: 10.1016/j.actatropica.2021.105944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 03/28/2021] [Accepted: 04/26/2021] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Various interventions including laser therapy, heat therapy, and several drugs have been trialed in patients with cutaneous leishmaniasis. Due to the lack of an evidence-based comparison of all these interventions, we carried out the present network meta-analysis. METHODS Electronic databases were searched for randomized clinical trials evaluating the efficacy and safety of any interventions in patients with cutaneous leishmaniasis. The proportion of patients with complete cure was the primary outcome. The proportion of lesions cured at the end of treatment, the proportion of lesions with minimal/no response to treatment, and proportion of wounds with minimal/no change were the secondary outcomes. Random-effects modeling was used for generating pooled estimates. Rankogram plot was used for identifying the 'best intervention'. For interventions containing a combination of treatments, backslash (/) has been used for depicting the same. RESULTS One-hundred and thirty-one studies were included. Intralesional meglumine, topical paromomycin/gentamicin, topical paromomycin, parenteral sodium stibogluconate, topical honey/intralesional meglumine, topical liposomal amphotericin B, oral zinc sulphate, oral miltefosine, parenteral meglumine, heat therapy, topical liposomal azithromycin, intralesional meglumine/silver dressing, intralesional sodium stibogluconate, parenteral meglumine/intralesional meglumine, oral allopurinol/parenteral meglumine, topical trichloroacetic acid/heat therapy, oral zinc sulphate/oral ketoconazole, topical imiquimod/cryotherapy, intralesional meglumine/cryotherapy, topical herbal extract of Z-HE, parenteral pentamidine, topical trichloroacetic acid/intralesional meglumine, carbon-dioxide laser, topical recombinant granulocyte-macrophage colony-stimulating factor/parenteral meglumine, intralesional dapsone, carbon-dioxide laser/intralesional meglumine, moist wet dressing with sodium hypochlorite, parenteral sodium stibogluconate/intralesional recombinant granulocyte-macrophage colony-stimulating factor, oral dapsone, intralesional sodium stibogluconate/oral ketoconazole, intralesional sodium stibogluconate/parenteral sodium stibogluconate and electrocautery/moist wet dressing with sodium hypochlorite were observed with significantly greater proportion of patients with complete cure compared to placebo/untreated controls. Rankogram analysis revealed that parenteral pentamidine has the highest statistical probability of being the best in the pool. CONCLUSION We observed several interventions to be effective for treating cutaneous leishmaniasis. However, greater caution is required in interpreting the results as the estimates are likely to change with the advent of results from future studies.
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Affiliation(s)
- Kannan Sridharan
- Department of Pharmacology & Therapeutics, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain.
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Kammona O, Tsanaktsidou E. Nanotechnology-aided diagnosis, treatment and prevention of leishmaniasis. Int J Pharm 2021; 605:120761. [PMID: 34081999 DOI: 10.1016/j.ijpharm.2021.120761] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/10/2021] [Accepted: 05/27/2021] [Indexed: 02/06/2023]
Abstract
Leishmaniasis is a prevalent parasitic infection belonging to neglected tropical diseases. It is caused by Leishmania protozoan parasites transmitted by sandflies and it is responsible for increased morbidity/mortality especially in low- and middle-income countries. The lack of cheap, portable, easy to use diagnostic tools exhibiting high efficiency and specificity impede the early diagnosis of the disease. Furthermore, the typical anti-leishmanial agents are cytotoxic, characterized by low patient compliance and require long-term regimen and usually hospitalization. In addition, due to the intracellular nature of the disease, the existing treatments exhibit low bioavailability resulting in low therapeutic efficacy. The above, combined with the common development of resistance against the anti-leishmanial agents, denote the urgent need for novel therapeutic strategies. Furthermore, the lack of effective prophylactic vaccines hinders the control of the disease. The development of nanoparticle-based biosensors and nanocarrier-aided treatment and vaccination strategies could advance the diagnosis, therapy and prevention of leishmaniasis. The present review intends to highlight the various nanotechnology-based approaches pursued until now to improve the detection of Leishmania species in biological samples, decrease the side effects and increase the efficacy of anti-leishmanial drugs, and induce enhanced immune responses, specifically focusing on the outcome of their preclinical and clinical evaluation.
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Affiliation(s)
- Olga Kammona
- Chemical Process and Energy Resources Institute, Centre for Research and Technology Hellas, P.O. Box 60361, 57001 Thessaloniki, Greece.
| | - Evgenia Tsanaktsidou
- Chemical Process and Energy Resources Institute, Centre for Research and Technology Hellas, P.O. Box 60361, 57001 Thessaloniki, Greece
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Azim M, Khan SA, Ullah S, Ullah S, Anjum SI. Therapeutic advances in the topical treatment of cutaneous leishmaniasis: A review. PLoS Negl Trop Dis 2021; 15:e0009099. [PMID: 33657097 PMCID: PMC7928440 DOI: 10.1371/journal.pntd.0009099] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Cutaneous leishmaniasis has been endemic since decades. Millions of cases are reported worldwide specially in developing and underdeveloped countries. There are 2 major types of cutaneous leishmaniasis based on the causating species found in different regions of the world. These include New and Old World cutaneous leishmaniasis, which are self-healing, but if not treated, these may cause severe scars and many other complications like mucosal involvement. The conventional gold standard treatment for both types is mainly intralesional or parenteral administration of antimonial. Lately, a great deal of research has been done on development of topical treatment based on single agent or combination therapy. This review summarizes the current state of literature regarding therapeutic outcome of topical treatment against cutaneous leishmaniasis caused by different species in different regions.
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Affiliation(s)
- Marium Azim
- Department of Pharmacy, Institute of Chemical and Pharmaceutical Sciences, Kohat University of Science and Technology, Kohat, Khyber Pakhtunkhwa, Pakistan
- * E-mail: (MA); (SAK)
| | - Saeed Ahmad Khan
- Department of Pharmacy, Institute of Chemical and Pharmaceutical Sciences, Kohat University of Science and Technology, Kohat, Khyber Pakhtunkhwa, Pakistan
- * E-mail: (MA); (SAK)
| | - Saleem Ullah
- Department of Pharmacy, Institute of Chemical and Pharmaceutical Sciences, Kohat University of Science and Technology, Kohat, Khyber Pakhtunkhwa, Pakistan
| | - Shafiq Ullah
- Department of Pharmacy, Institute of Chemical and Pharmaceutical Sciences, Kohat University of Science and Technology, Kohat, Khyber Pakhtunkhwa, Pakistan
| | - Syed Ishtiaq Anjum
- Department of Zoology, Kohat University of Science and Technology, Kohat, Khyber Pakhtunkhwa, Pakistan
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Oliaee RT, Sharifi I, Bamorovat M, Keyhani A, Babaei Z, Salarkia E, Tavakoly R, Khosravi A, Mostafavi M, Sharifi F, Mousavi SM. The potential role of nicotinamide on Leishmania tropica: An assessment of inhibitory effect, cytokines gene expression and arginase profiling. Int Immunopharmacol 2020; 86:106704. [PMID: 32590317 DOI: 10.1016/j.intimp.2020.106704] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/30/2020] [Accepted: 06/11/2020] [Indexed: 11/26/2022]
Abstract
Leishmaniasis represents a major health concern worldwide which has no effective treatment modality. Nicotinamide (NAm) has been used for a wide range of applications from anticancer to antimicrobial usage. This study aimed to assess the effect of NAm combination on Leishmania tropica Inhibition, as well as on cytokines gene expression and arginase (ARG) activity in L. tropica-infected macrophages in an in vitro model. The leishmanicidal effects of NAm and Glucantime (meglumine antimoniate, MA) alone and in combination (NAm/MA) were evaluated using a colorimetric assay and macrophage model. Additionally, immunomodulatory effects and enzymatic activity were assessed by analyzing Th1 and Th2 cytokines gene expression and ARG level, respectively, in infected macrophages treated with NAm and MA, alone and in combination. Findings indicated that the NAm/MA combination demonstrated greater inhibitory effects on L. tropica promastigotes and amastigotes compared with each drug individually. Docking results proved the affinity of NAm to IFN-γ, which can affirm the increased levels of IFN-γ, IL-12p40 and TNF-α as well as reductions in IL-10 secretion with a dose-response effect, especially in the combination group. The NAm/MA combination also showed a significant reduction in the level of ARG activity at all concentrations used compared to each drug individually. These findings indicate higher effectiveness of NAm plus MA in reducing parasite growth, promoting immune response and inhibiting ARG level. This combination should be considered as a potential therapeutic regimen for treatment of volunteer patients with anthroponotic cutaneous leishmaniasis (ACL) in future control programs.
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Affiliation(s)
- Razieh Tavakoli Oliaee
- Leishmaniasis Research Center, Kerman University of Medical Sciences, Kerman, Iran; Basic Sciences in Infectious Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Iraj Sharifi
- Leishmaniasis Research Center, Kerman University of Medical Sciences, Kerman, Iran.
| | - Mehdi Bamorovat
- Leishmaniasis Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Alireza Keyhani
- Leishmaniasis Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Zahra Babaei
- Leishmaniasis Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Ehsan Salarkia
- Leishmaniasis Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Rahele Tavakoly
- Student Research Committee, School of Health, Kerman University of Medical Sciences, Kerman, Iran; Nutrition Research Center, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ahmad Khosravi
- Leishmaniasis Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahshid Mostafavi
- Leishmaniasis Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Fatemeh Sharifi
- Research Center of Tropical and Infectious Diseases, Kerman University of Medical Sciences, Kerman, Iran
| | - Seyed Mohammad Mousavi
- Research Center for Hydatid Disease in Iran, Kerman University of Medical Sciences, Kerman, Iran
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Dar MJ, Khalid S, McElroy CA, Satoskar AR, Khan GM. Topical treatment of cutaneous leishmaniasis with novel amphotericin B-miltefosine co-incorporated second generation ultra-deformable liposomes. Int J Pharm 2020; 573:118900. [DOI: 10.1016/j.ijpharm.2019.118900] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/08/2019] [Accepted: 11/20/2019] [Indexed: 01/21/2023]
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Mostafavi M, Sharifi I, Farajzadeh S, Khazaeli P, Sharifi H, Pourseyedi E, Kakooei S, Bamorovat M, Keyhani A, Parizi MH, Khosravi A, Khamesipour A. Niosomal formulation of amphotericin B alone and in combination with glucantime: In vitro and in vivo leishmanicidal effects. Biomed Pharmacother 2019; 116:108942. [PMID: 31152929 DOI: 10.1016/j.biopha.2019.108942] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 04/22/2019] [Accepted: 04/29/2019] [Indexed: 12/21/2022] Open
Abstract
This study aimed to evaluate the efficacy of glucantime and amphotericin B (AmB) encapsulated in niosome against cutaneous leishmaniasis (CL) using in vitro and in vivo models. The niosomal formulations of the drugs alone and in combination were prepared and characterized. Subsequent to the examination of their cytotoxicity, their efficacy was evaluated using an in vitro MTT assay, macrophage model, flow cytometry, and gene expression profiling. For evaluation of therapeutic effect of niosomal combination on the lesion induced by Leishmania major in inbred BALB/c mice, the size of lesions and number of parasites in spleen was assessed. The niosomal formulations demonstrated significantly greater inhibitory effects compared with the non-niosomal forms when the IC50 was considered. The niosomal combination showed an increase in the apoptotic values and gene expression levels of IL-12 and metacaspase and a decrease in the levels of IL-10 with a dose-response effect. The niosomal combination was also effective in reducing the lesion size and splenic parasite burden in mice. Our findings indicated that there is a synergistic effect between AmB and glucantime in niosomal form in the inhibition of intracellular and extracellular forms of L. tropica. Additionally, the in vivo results on L. major suggest that topical niosomal formulation could be useful in the treatment of CL.
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Affiliation(s)
- Mahshid Mostafavi
- Leishmaniasis Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Iraj Sharifi
- Leishmaniasis Research Center, Kerman University of Medical Sciences, Kerman, Iran.
| | - Saeedeh Farajzadeh
- Department of Pediatric dermatology, Kerman University of Medical Sciences, Kerman, Iran
| | - Payam Khazaeli
- Department of Pharmaceutics, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Elnaz Pourseyedi
- Pharmaceutics Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Sina Kakooei
- Oral and Dental Diseases Research Center, Dental School, Kerman University of Medical Sciences, Kerman, Iran
| | - Mehdi Bamorovat
- Center of Tropical and Infectious Diseases, Kerman University of Medical Sciences, Kerman, Iran
| | - Alireza Keyhani
- Leishmaniasis Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Maryam Hakimi Parizi
- Leishmaniasis Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Ahmad Khosravi
- Leishmaniasis Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Khamesipour
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
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Shirzadi MR. Lipsosomal amphotericin B: a review of its properties, function, and use for treatment of cutaneous leishmaniasis. Res Rep Trop Med 2019; 10:11-18. [PMID: 31118866 PMCID: PMC6500877 DOI: 10.2147/rrtm.s200218] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/23/2019] [Indexed: 02/01/2023] Open
Abstract
The genus Leishmania includes a number of protozoan parasites that cause a wide range of infections named leishmaniasis. Leishmaniasis may be appear in three clinical forms — cutaneous (CL), visceral, and mucocutaneous (MCL) — with variation in their presentation and severity: diffuse CL and post–kala-azar dermal leishmaniasis). The prevalent signs of CL are nonhealing ulcers on exposed skin, but infected patients may have other dermatologic symptoms. In the 1960s, amphotericin B deoxycholate was introduced as a second-line therapy for CL and MCL. However, widespread administration of the agent was prevented, due to its renal and systemic toxicity, high price, and obstacles to intravenous use in leishmaniasis-endemic regions. Amphotericin B binds to ergosterol in the photogenic cell membranes and causes changes in membrane permeability, leakage of ions, and finally cell death. Compared to amphotericin B deoxycholate, a higher dose of liposomal amphotericin B should be administered to show the treatment effect. A high percentage of liposomal amphotericin B is “fastened” in the liposome and not biologically effective. Amphotericin B deoxycholate has some toxic effects, and liposomal amphotericin B is meaningfully less toxic compared to it. Treatment options for CL are limited, due to variation in species causing CL and pharmacokinetic issues. Amphotericin B is effective against some particular forms of CL.
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Affiliation(s)
- Mohammad Reza Shirzadi
- Center for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran.,Center for Research of Endemic Parasites of Iran (CREPI), Tehran University of Medical Science, Tehran, Iran
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13
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Hakimi Parizi M, Pardakhty A, sharifi I, Farajzadeh S, Daie Parizi MH, Sharifi H, Keyhani AR, Mostafavi M, Bamorovat M, Ghaffari D. Antileishmanial activity and immune modulatory effects of benzoxonium chloride and its entrapped forms in niosome on Leishmania tropica. J Parasit Dis 2019; 43:406-415. [PMID: 31406406 PMCID: PMC6667517 DOI: 10.1007/s12639-019-01105-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/13/2019] [Indexed: 02/07/2023] Open
Abstract
Benzoxonium chloride is an anti-infective agent that is used as anti-septic drugs for disinfection of the mucus membrane, skin surface and anti-bacterial, and it is also found to be effective against cutaneous leishmaniasis. The present study aims to evaluate the leishmanicidal activity of benzoxonium chloride and niosomal forms against Leishmania tropica stages. Benzoxonium chloride niosomes were prepared by the thin film hydration method and evaluated for morphology, particle size and release study and encapsulation efficiency. This study measured the cytotoxicity, leishmanicidal activity against promastigote and intra macrophage amastigote, apoptosis, and mRNA transcripts by quantitative real time PCR (qPCR) of free solution and niosomal-encapsulated benzoxonium chloride. Span/Tween 60 niosomal formulation of benzoxonium chloride showed superior physical stability and high encapsulation efficiency (96%) than the other forms. Release from the formulations showed that the Span/Tween 60 containing drug had a milder gradient so that 10% of the drug was not released after 4 h. The benzoxonium chloride and niosomal forms inhibited the in vitro growth of promastigote and amastigote forms of L. tropica after 48 h of incubation and represented IC50 values of 90.7 ± 2.7 and 25.4 ± 0.6 μg/ mL, respectively. The rate of apoptosis in niosomal formulations was approximately equal to the positive control (meglumine antimoniate) at the same concentration. Also, an increase in the concentration of this drug reduced the expression of IL-10, but increased the expression of IL-12. The niosomal formulations provided improved anti-leishmanial activities of benzoxonium chloride and played an immunomodulatory role as the mode of action in the treatment of anthroponotic CL.
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Affiliation(s)
- Maryam Hakimi Parizi
- Leishmaniasis Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Abbas Pardakhty
- Pharmaceutics Research Center, Neuropharmacology Institute, Kerman University of Medical Sciences, PO Box 76175-493, Kerman, Iran
| | - Iraj sharifi
- Leishmaniasis Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Saeedeh Farajzadeh
- Department of Pediatric Dermatology, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Hamid Sharifi
- HIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Reza Keyhani
- Leishmaniasis Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahshid Mostafavi
- Leishmaniasis Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Mehdi Bamorovat
- Research Center of Tropical and Infectious Diseases, Kerman University of Medical Sciences, Kerman, Iran
| | - Daryoush Ghaffari
- Leishmaniasis Research Center, Kerman University of Medical Sciences, Kerman, Iran
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Gupta A, Sardana K, Ahuja A, Kishan Gautam R. Complete cure of a large complex cutaneous leishmaniasis with a nonethanolic lipid based-amphotericin B gel. Clin Exp Dermatol 2018; 44:807-810. [PMID: 30592076 DOI: 10.1111/ced.13883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2018] [Indexed: 11/29/2022]
Affiliation(s)
- A Gupta
- Department of Dermatology, PGIMER and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - K Sardana
- Department of Dermatology, PGIMER and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - A Ahuja
- Department of Pathology, PGIMER and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - R Kishan Gautam
- Department of Dermatology, PGIMER and Dr Ram Manohar Lohia Hospital, New Delhi, India
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15
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Makeen HA, Buraik MA, Menachery SJ, Alattas KM, Meraya AM. Evaluation of the Interventional Approaches in the Management of Cutaneous Leishmaniasis in Jazan: An Observational Study. Ann Dermatol 2018; 30:575-580. [PMID: 33911481 PMCID: PMC7992491 DOI: 10.5021/ad.2018.30.5.575] [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] [Received: 03/20/2018] [Revised: 05/13/2018] [Accepted: 06/07/2018] [Indexed: 01/19/2023] Open
Abstract
Background Cutaneous leishmaniasis is a tropical infection of public health importance. Numerous treatment approaches are in practice with variable degree of success however its management has no universal consensus or practice guidelines to follow. Objective Analyze the management of cutaneous leishmaniasis retrospectively at a central hospital of Jazan Province, Kingdom of Saudi Arabia to identify the current treatment pattern and compare the outcomes. Methods This cross-sectional study was conducted based on the hospital records of patients who attended the dermatology clinic for cutaneous leishmaniasis during the year 2012 to 2015. Results Forty three patients were included in the study. There was a male preponderance (65.1%) among the patients and 60.5% of them were of pediatric age group. Monotherapy was the initial choice for 58.1% of the patients. Intralesional sodium stibogluconate (SS-IL) was the most preferred treatment for initial therapy, as monotherapy and as part of combination therapy. A complete response was achieved in 22 patients (51.2%) with initial therapy. Among the different treatment groups, SS-IL+itraconazole showed significantly higher complete response rate compared to other treatments offered as initial therapy (p<0.01). Initial SS-IL monotherapy provided complete response in 41.2% patients receiving it, while itraconazole monotherapy provided complete response in 75% and 90.9% of the patients receiving initial itraconazole+SS-IL combination therapy with achieved complete response. Conclusion The findings and observations suggest that initial combination therapy with SS-IL+itraconazole significantly improved the complete response rates and thus reduced the need for additional or prolonged therapies.
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Affiliation(s)
- Hafiz A Makeen
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jazan University, Jazan, Saudi Arabia
| | - Mohammed A Buraik
- Departments of Dermatology and Pathology, King Fahd Central Hospital, Jazan, Saudi Arabia
| | | | - Khalid M Alattas
- Department of Dermatology, King Fahd Central Hospital, Jazan, Saudi Arabia
| | - Abdulkarim M Meraya
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jazan University, Jazan, Saudi Arabia
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Coêlho EDS, Lopes GLN, Pinheiro IM, Holanda JNPD, Alves MMDM, Carvalho Nogueira N, Carvalho FADA, Carvalho ALM. Emulgel based on amphotericin B and bacuri butter (Platonia insignis Mart.) for the treatment of cutaneous leishmaniasis: characterization and in vitro assays. Drug Dev Ind Pharm 2018; 44:1713-1723. [DOI: 10.1080/03639045.2018.1492610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Elvilene de Sousa Coêlho
- Postgraduate Program of Pharmaceutical Sciences (PPGCF), Federal University of Piauí, Teresina, Brazil
| | - Gláucia Laís Nunes Lopes
- Postgraduate Program of Pharmaceutical Sciences (PPGCF), Federal University of Piauí, Teresina, Brazil
| | - Iluska Martins Pinheiro
- Postgraduate Program of Pharmaceutical Sciences (PPGCF), Federal University of Piauí, Teresina, Brazil
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17
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López-Carvajal L, Vélez I, Arbeláez MP, Olliaro P. Eligibility criteria and outcome measures adopted in clinical trials of treatments of cutaneous leishmaniasis: systematic literature review covering the period 1991-2015. Trop Med Int Health 2018. [PMID: 29524291 DOI: 10.1111/tmi.13048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To document the sources of heterogeneity in outcomes and shortcomings in trial designs reported by previous systematic reviews. METHODS Systematic review of clinical trials of CL treatments published since 1991, to assess and compare eligibility criteria and outcome measures in trials (any type of treatment) of CL (any form) reported before and after the publication of the CONSORT statement. RESULTS We identified 106 eligible trials published between 1991 and 2015, 74% after the 2001 CONSORT statement; 58% (n = 63) were on Old-World CL and 37% (n = 40) in New-World CL; overall, 11 531 patients enrolled in 243 treatment groups on 30 different treatments. Both requirements and definitions for eligibility and outcome criteria varied. Compliance with CONSORT requirements increased for studies published after the 2010 update. As for entry criteria, 94% of studies had a requirement for sex (74% of those enrolling also women excluded those who were pregnant or lactating), 69% for age (variable age ranges), 99% parasitological confirmation, 43% prior duration of illness (14% excluded cases with previous episodes), 46% defined the number, 28% the size and 13% the type of lesions (27% with restrictions as to their anatomical location). Follow-up ranged 1-24 months, with 14% and 91% of studies, respectively, having defined initial and final cure. CONCLUSIONS This review documents changes in reporting before and after the publication of the CONSORT statement. Lack of standardisation, compounded with the small number of trials relative to the magnitude of the disease in its multiple forms, and with the range of treatments tested explains why evidence to inform treatment guidelines is generally weak for CL. Adopting standardised methodologies will improve the quality and consistency of clinical trials, and ultimately yield better treatments for CL.
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Affiliation(s)
- Liliana López-Carvajal
- Programa de Estudio y Control de Enfermedades Tropicales, Universidad de Antioquia, Medellín, Colombia
| | - Iván Vélez
- Programa de Estudio y Control de Enfermedades Tropicales, Universidad de Antioquia, Medellín, Colombia
| | | | - Piero Olliaro
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases, Geneva, Switzerland.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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18
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Heras‐Mosteiro J, Monge‐Maillo B, Pinart M, Lopez Pereira P, Reveiz L, Garcia‐Carrasco E, Campuzano Cuadrado P, Royuela A, Mendez Roman I, López‐Vélez R. Interventions for Old World cutaneous leishmaniasis. Cochrane Database Syst Rev 2017; 12:CD005067. [PMID: 29192424 PMCID: PMC6485999 DOI: 10.1002/14651858.cd005067.pub5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Cutaneous leishmaniasis, caused by a parasitic infection, is considered one of the most serious skin diseases in many low- and middle-income countries. Old World cutaneous leishmaniasis (OWCL) is caused by species found in Africa, Asia, the Middle East, the Mediterranean, and India. The most commonly prescribed treatments are antimonials, but other drugs have been used with varying success. As OWCL tends to heal spontaneously, it is necessary to justify the use of systemic and topical treatments. This is an update of a Cochrane Review first published in 2008. OBJECTIVES To assess the effects of therapeutic interventions for the localised form of Old World cutaneous leishmaniasis. SEARCH METHODS We updated our searches of the following databases to November 2016: the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS. We also searched five trials registers and checked the reference lists of included studies for further references to relevant randomised controlled trials (RCTs). We wrote to national programme managers, general co-ordinators, directors, clinicians, WHO-EMRO regional officers of endemic countries, pharmaceutical companies, tropical medicine centres, and authors of relevant papers for further information about relevant unpublished and ongoing trials. We undertook a separate search for adverse effects of interventions for Old World cutaneous leishmaniasis in September 2015 using MEDLINE. SELECTION CRITERIA Randomised controlled trials of either single or combination treatments in immunocompetent people with OWCL confirmed by smear, histology, culture, or polymerase chain reaction. The comparators were either no treatment, placebo/vehicle, and/or another active compound. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias and extracted data. We only synthesised data when we were able to identify at least two studies investigating similar treatments and reporting data amenable to pooling. We also recorded data about adverse effects from the corresponding search. MAIN RESULTS We included 89 studies (of which 40 were new to this update) in 10,583 people with OWCL. The studies included were conducted mainly in the Far or Middle East at regional hospitals, local healthcare clinics, and skin disease research centres. Women accounted for 41.5% of the participants (range: 23% to 80%). The overall mean age of participants was 25 years (range 12 to 56). Most studies lasted between two to six months, with the longest lasting two years; average duration was four months. Most studies were at unclear or high risk for most bias domains. A lack of blinding and reporting bias were present in almost 40% of studies. Two trials were at low risk of bias for all domains. Trials reported the causative species poorly.Here we provide results for the two main comparisons identified: itraconazole (200 mg for six to eight weeks) versus placebo; and paromomycin ointment (15% plus 10% urea, twice daily for 14 days) versus vehicle.In the comparison of oral itraconazole versus placebo, at 2.5 months' follow up, 85/125 participants in the itraconazole group achieved complete cure compared to 54/119 in the placebo group (RR 3.70, 95% CI 0.35 to 38.99; 3 studies; 244 participants). In one study, microbiological or histopathological cure of skin lesions only occurred in the itraconazole group after a mean follow-up of 2.5 months (RR 17.00, 95% CI 0.47 to 612.21; 20 participants). However, although the analyses favour oral itraconazole for these outcomes, we cannot be confident in the results due to the very low certainty evidence. More side effects of mild abdominal pain and nausea (RR 2.36, 95% CI 0.74 to 7.47; 3 studies; 204 participants) and mild abnormal liver function (RR 3.08, 95% CI 0.53 to 17.98; 3 studies; 84 participants) occurred in the itraconazole group (as well as reports of headaches and dizziness), compared with the placebo group, but again we rated the certainty of evidence as very low so are unsure of the results.When comparing paromomycin with vehicle, there was no difference in the number of participants who achieved complete cure (RR of 1.00, 95% CI 0.86, 1.17; 383 participants, 2 studies) and microbiological or histopathological cure of skin lesions after a mean follow-up of 2.5 months (RR 1.03, CI 0.88 to 1.20; 383 participants, 2 studies), but the paromomycin group had more skin/local reactions (such as inflammation, vesiculation, pain, redness, or itch) (RR 1.42, 95% CI 0.67 to 3.01; 4 studies; 713 participants). For all of these outcomes, the certainty of evidence was very low, meaning we are unsure about these results.Trial authors did not report the percentage of lesions cured after the end of treatment or speed of healing for either of these key comparisons. AUTHORS' CONCLUSIONS There was very low-certainty evidence to support the effectiveness of itraconazole and paromomycin ointment for OWCL in terms of cure (i.e. microbiological or histopathological cure and percentage of participants completely cured). Both of these interventions incited more adverse effects, which were mild in nature, than their comparisons, but we could draw no conclusions regarding safety due to the very low certainty of the evidence for this outcome.We downgraded the key outcomes in these two comparisons due to high risk of bias, inconsistency between the results, and imprecision. There is a need for large, well-designed international studies that evaluate long-term effects of current therapies and enable a reliable conclusion about treatments. Future trials should specify the species of leishmaniasis; trials on types caused by Leishmania infantum, L aethiopica, andL donovani are lacking. Research into the effects of treating women of childbearing age, children, people with comorbid conditions, and those who are immunocompromised would also be helpful.It was difficult to evaluate the overall efficacy of any of the numerous treatments due to the variable treatment regimens examined and because RCTs evaluated different Leishmania species and took place in different geographical areas. Some outcomes we looked for but did not find were degree of functional and aesthetic impairment, change in ability to detect Leishmania, quality of life, and emergence of resistance. There were only limited data on prevention of scarring.
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Affiliation(s)
- Julio Heras‐Mosteiro
- Rey Juan Carlos UniversityDepartment of Preventive Medicine and Public Health & Immunology and MicrobiologyAvda. Atenas s/nAlcorcónMadridSpain28922
- Ramón y Cajal University HospitalDepartment of Preventive Medicine and Public HealthMadridSpain
| | - Begoña Monge‐Maillo
- Ramón y Cajal University HospitalTropical Medicine & Clinical Parasitology, Infectious Diseases DepartmentCarretera de Colmenar Viejo km. 9,100MadridSpain28034
| | - Mariona Pinart
- c/o Cochrane Skin Group, The University of Nottingham, Nottingham, UKNottinghamUK
| | - Patricia Lopez Pereira
- Ramón y Cajal University HospitalDepartment of Preventive Medicine and Public HealthMadridSpain
| | | | - Emely Garcia‐Carrasco
- National Referral Centre for Tropical DiseasesInfectious Diseases DepartmentCtra Colmenar, Km 9,100.MadridSpain28034
| | - Pedro Campuzano Cuadrado
- Rey Juan Carlos UniversityDepartment of Preventive Medicine and Public Health & Immunology and MicrobiologyAvda. Atenas s/nAlcorcónMadridSpain28922
| | - Ana Royuela
- Biomedical Sciences Research Institute,Hospital Universitario Puerta de Hierro‐MajadahondaDepartment of BiostatisticsMajadahondaSpain28222
| | - Irene Mendez Roman
- The University of Nottinghamc/o Cochrane Skin GroupA103, King's Meadow CampusLenton LaneNottinghamSpainNG7 2NR
| | - Rogelio López‐Vélez
- Ramón y Cajal University HospitalTropical Medicine & Clinical Parasitology, Infectious Diseases DepartmentCarretera de Colmenar Viejo km. 9,100MadridSpain28034
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Heras‐Mosteiro J, Monge‐Maillo B, Pinart M, Lopez Pereira P, Garcia‐Carrasco E, Campuzano Cuadrado P, Royuela A, Mendez Roman I, López‐Vélez R. Interventions for Old World cutaneous leishmaniasis. Cochrane Database Syst Rev 2017; 11:CD005067. [PMID: 29149474 PMCID: PMC6486265 DOI: 10.1002/14651858.cd005067.pub4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cutaneous leishmaniasis, caused by a parasitic infection, is considered one of the most serious skin diseases in many low- and middle-income countries. Old World cutaneous leishmaniasis (OWCL) is caused by species found in Africa, Asia, the Middle East, the Mediterranean, and India. The most commonly prescribed treatments are antimonials, but other drugs have been used with varying success. As OWCL tends to heal spontaneously, it is necessary to justify the use of systemic and topical treatments. This is an update of a Cochrane Review first published in 2008. OBJECTIVES To assess the effects of therapeutic interventions for the localised form of Old World cutaneous leishmaniasis. SEARCH METHODS We updated our searches of the following databases to November 2016: the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS. We also searched five trials registers and checked the reference lists of included studies for further references to relevant randomised controlled trials (RCTs). We wrote to national programme managers, general co-ordinators, directors, clinicians, WHO-EMRO regional officers of endemic countries, pharmaceutical companies, tropical medicine centres, and authors of relevant papers for further information about relevant unpublished and ongoing trials. We undertook a separate search for adverse effects of interventions for Old World cutaneous leishmaniasis in September 2015 using MEDLINE. SELECTION CRITERIA Randomised controlled trials of either single or combination treatments in immunocompetent people with OWCL confirmed by smear, histology, culture, or polymerase chain reaction. The comparators were either no treatment, placebo/vehicle, and/or another active compound. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias and extracted data. We only synthesised data when we were able to identify at least two studies investigating similar treatments and reporting data amenable to pooling. We also recorded data about adverse effects from the corresponding search. MAIN RESULTS We included 89 studies (of which 40 were new to this update) in 10,583 people with OWCL. The studies included were conducted mainly in the Far or Middle East at regional hospitals, local healthcare clinics, and skin disease research centres. Women accounted for 41.5% of the participants (range: 23% to 80%). The overall mean age of participants was 25 years (range 12 to 56). Most studies lasted between two to six months, with the longest lasting two years; average duration was four months. Most studies were at unclear or high risk for most bias domains. A lack of blinding and reporting bias were present in almost 40% of studies. Two trials were at low risk of bias for all domains. Trials reported the causative species poorly.Here we provide results for the two main comparisons identified: itraconazole (200 mg for six to eight weeks) versus placebo; and paromomycin ointment (15% plus 10% urea, twice daily for 14 days) versus vehicle.In the comparison of oral itraconazole versus placebo, at 2.5 months' follow up, 85/125 participants in the itraconazole group achieved complete cure compared to 54/119 in the placebo group (RR 3.70, 95% CI 0.35 to 38.99; 3 studies; 244 participants). In one study, microbiological or histopathological cure of skin lesions only occurred in the itraconazole group after a mean follow-up of 2.5 months (RR 17.00, 95% CI 0.47 to 612.21; 20 participants). However, although the analyses favour oral itraconazole for these outcomes, we cannot be confident in the results due to the very low certainty evidence. More side effects of mild abdominal pain and nausea (RR 2.36, 95% CI 0.74 to 7.47; 3 studies; 204 participants) and mild abnormal liver function (RR 3.08, 95% CI 0.53 to 17.98; 3 studies; 84 participants) occurred in the itraconazole group (as well as reports of headaches and dizziness), compared with the placebo group, but again we rated the certainty of evidence as very low so are unsure of the results.When comparing paromomycin with vehicle, there was no difference in the number of participants who achieved complete cure (RR of 1.00, 95% CI 0.86, 1.17; 383 participants, 2 studies) and microbiological or histopathological cure of skin lesions after a mean follow-up of 2.5 months (RR 1.03, CI 0.88 to 1.20; 383 participants, 2 studies), but the paromomycin group had more skin/local reactions (such as inflammation, vesiculation, pain, redness, or itch) (RR 1.42, 95% CI 0.67 to 3.01; 4 studies; 713 participants). For all of these outcomes, the certainty of evidence was very low, meaning we are unsure about these results.Trial authors did not report the percentage of lesions cured after the end of treatment or speed of healing for either of these key comparisons. AUTHORS' CONCLUSIONS There was very low-certainty evidence to support the effectiveness of itraconazole and paromomycin ointment for OWCL in terms of cure (i.e. microbiological or histopathological cure and percentage of participants completely cured). Both of these interventions incited more adverse effects, which were mild in nature, than their comparisons, but we could draw no conclusions regarding safety due to the very low certainty of the evidence for this outcome.We downgraded the key outcomes in these two comparisons due to high risk of bias, inconsistency between the results, and imprecision. There is a need for large, well-designed international studies that evaluate long-term effects of current therapies and enable a reliable conclusion about treatments. Future trials should specify the species of leishmaniasis; trials on types caused by Leishmania infantum, L aethiopica, andL donovani are lacking. Research into the effects of treating women of childbearing age, children, people with comorbid conditions, and those who are immunocompromised would also be helpful.It was difficult to evaluate the overall efficacy of any of the numerous treatments due to the variable treatment regimens examined and because RCTs evaluated different Leishmania species and took place in different geographical areas. Some outcomes we looked for but did not find were degree of functional and aesthetic impairment, change in ability to detect Leishmania, quality of life, and emergence of resistance. There were only limited data on prevention of scarring.
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Affiliation(s)
| | - Begoña Monge‐Maillo
- Ramón y Cajal University HospitalTropical Medicine & Clinical Parasitology, Infectious Diseases DepartmentCarretera de Colmenar Viejo km. 9,100MadridSpain28034
| | - Mariona Pinart
- c/o Cochrane Skin Group, The University of Nottingham, Nottingham, UKNottinghamUK
| | - Patricia Lopez Pereira
- Ramón y Cajal University HospitalDepartment of Preventive Medicine and Public HealthMadridSpain
| | - Emely Garcia‐Carrasco
- National Referral Centre for Tropical DiseasesInfectious Diseases DepartmentCtra Colmenar, Km 9,100.MadridSpain28034
| | - Pedro Campuzano Cuadrado
- Rey Juan Carlos UniversityDepartment of Preventive Medicine and Public Health & Immunology and MicrobiologyAvda. Atenas s/nAlcorcónMadridSpain28922
| | - Ana Royuela
- Biomedical Sciences Research Institute,Hospital Universitario Puerta de Hierro‐MajadahondaDepartment of BiostatisticsMajadahondaSpain28222
| | - Irene Mendez Roman
- The University of Nottinghamc/o Cochrane Skin GroupA103, King's Meadow CampusLenton LaneNottinghamSpainNG7 2NR
| | - Rogelio López‐Vélez
- Ramón y Cajal University HospitalTropical Medicine & Clinical Parasitology, Infectious Diseases DepartmentCarretera de Colmenar Viejo km. 9,100MadridSpain28034
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20
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Brito NC, Rabello A, Cota GF. Efficacy of pentavalent antimoniate intralesional infiltration therapy for cutaneous leishmaniasis: A systematic review. PLoS One 2017; 12:e0184777. [PMID: 28926630 PMCID: PMC5604971 DOI: 10.1371/journal.pone.0184777] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background The mainstays of cutaneous leishmaniasis (CL) treatment, in several world regions, are pentavalent antimony (Sbv) compounds administered parenterally, despite their recognized toxicity, which requires frequent laboratory monitoring and complicates their use in areas with scarce infrastructure. As result of these drawbacks, the WHO Expert Committee on leishmaniasis has expanded the recommendations for the use of local therapies, including Sbv intralesional infiltration (IL-Sbv), as CL therapy alternatives even in the New World. However, the efficacy of these approaches has never been compiled. The aim of this study was to critically and systematically assess the efficacy of IL-Sbv for CL treatment. Methodology The PRISMA guidelines for systematic reviews and the Cochrane manual were followed. The sources used were the MEDLINE and LILACS databases and the International Clinical Trials Registry Platform of the World Health Organization. The outcome of interest was a clinical cure, defined as complete re-epithelialization of all lesions. The IL-Sbv pooled cure rate was estimated for several subgroups and direct comparisons were performed when possible. Results Thirty nine articles (40 studies) involving 5679 patients treated with IL-Sbv infiltration were included. In direct comparison, only three studies involving 229 patients compared IL-Sbv infiltration versus placebo and no difference was observed (OR: 1,9; 95%IC 0,93 to 3,82) based on cure rate 69.6% (95%CI 17.6–96.1%) and 83,2% (95%CI 66–92.7%) for placebo and IL-Sbv, respectively. In an alternative and non-comparative analysis, gathering all study arms using the intervention, the pooled IL-Sbv efficacy rate was 75% (95%CI 68–81%). In the Old World, the observed overall IL-Sbv efficacy rate was 75% (95%CI 66–82%), and the cure rates were significantly higher with sodium stibogluconate (SSG) than with meglumine antimoniate (MA): 83% (95%CI 75–90%) versus 68% (95%CI 54–79%), p = 0.03. Studies directly comparing IL-Sbv with topical 15% paromomycin ointment, IL hypertonic saline, radiofrequency-induced heat therapy, topical trichloroacetic acid and cryotherapy showed no significant difference in efficacy between the interventions. The analyses suggested a higher efficacy of IL-Sbv combined with cryotherapy (81.8%, 95%IC 62.4–92.4%) when compared with IL-Sbv alone (53.3%, 95%IC 46.1–66%), OR: 3.14 (95%CI 1.1–8.9), p = 0.03. In the New World, the global IL-Sbv efficacy was 77%(95%CI 66–85%). In contrast with the Old World, a significant difference favoring MA in relation to SSG was observed: 61% (95%CI 49–73%) versus 82% (95%CI 70–89%).By comparing IL infiltration schedules, it was determined that patients submitted to IL-Sbv treatments longer than 14 days had higher cure rates. Conclusions Despite the high heterogeneity and low methodological quality of studies, an indirect comparison shows that the antimony infiltration efficacy rate is similar to that reported for antimony systemic use. The evidence gathered thus far is insufficient to identify the ideal IL therapeutic regime or estimate the rates of adverse events and mucosal late complications.
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Affiliation(s)
- Nayara Castelano Brito
- Pesquisas Clínicas e Políticas Públicas em Doenças Infecto-Parasitárias–Centro de Pesquisas René Rachou—Fundação Oswaldo Cruz, Fiocruz, Belo Horizonte, Minas Gerais, Brazil
| | - Ana Rabello
- Pesquisas Clínicas e Políticas Públicas em Doenças Infecto-Parasitárias–Centro de Pesquisas René Rachou—Fundação Oswaldo Cruz, Fiocruz, Belo Horizonte, Minas Gerais, Brazil
| | - Gláucia Fernandes Cota
- Pesquisas Clínicas e Políticas Públicas em Doenças Infecto-Parasitárias–Centro de Pesquisas René Rachou—Fundação Oswaldo Cruz, Fiocruz, Belo Horizonte, Minas Gerais, Brazil
- * E-mail:
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Varikuti S, Oghumu S, Saljoughian N, Pioso MS, Sedmak BE, Khamesipour A, Satoskar AR. Topical treatment with nanoliposomal Amphotericin B reduces early lesion growth but fails to induce cure in an experimental model of cutaneous leishmaniasis caused by Leishmania mexicana. Acta Trop 2017; 173:102-108. [PMID: 28602835 DOI: 10.1016/j.actatropica.2017.06.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 05/30/2017] [Accepted: 06/07/2017] [Indexed: 01/08/2023]
Abstract
Leishmania mexicana infection causes localized skin lesions that can lead to tissue damage and permanent disfigurement if not resolved. Currently, recommended treatments include intravenous administration of Amphotericin B, which is undesirable due to the associated cost and patient burden related to receiving regular injections. In this study, we evaluated the effect of topical treatment with a nanoliposomal formulation of Amphotericin B that is penetrable to the skin (SinaAmphoLeish 0.4%) in mice infected with L. mexicana by using ulcerated (BALB/c) and non-ulcerated (129SVE) models. BALB/c mice received a 4 week treatment following ulcerated lesion development, while 129SVE mice received a 10 week treatment beginning at week 5 post-infection. Although mice from both models showed comparable susceptibility to L. mexicana infection after topical treatment with SinaAmphoLeish relative to controls, 129SVE mice displayed a transient decrease in lesion sizes which eventually became similar to control mice. On other hand this treatment resulted in no reduction in the lesion sizes in BALB/c mice. 129SVE treated mice exhibited greater IFN-γ, IL-4, and IL-10 cytokine levels and higher T-cell proliferation in re-stimulated draining lymph node cells. BALB/c mice showed no differences in cytokine responses between treated and control mice. These findings indicate that topical SinaAmphoLeish treatment is not likely to be effective in the treatment of cutaneous leishmaniasis caused by L. mexicana.
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Affiliation(s)
- Sanjay Varikuti
- Department of Pathology, The Ohio State University Medical Center, Columbus, OH, USA
| | - Steve Oghumu
- College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Noushin Saljoughian
- Department of Pathology, The Ohio State University Medical Center, Columbus, OH, USA
| | - Marissa S Pioso
- Department of Pathology, The Ohio State University Medical Center, Columbus, OH, USA
| | - Bren E Sedmak
- Department of Pathology, The Ohio State University Medical Center, Columbus, OH, USA
| | - Ali Khamesipour
- Center for Research and Training in Skin Diseases and Leprosy Tehran University of Medical Sciences, Tehran, Iran
| | - Abhay R Satoskar
- Department of Pathology, The Ohio State University Medical Center, Columbus, OH, USA; Department of Microbiology, The Ohio State University, Columbus, OH, USA.
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22
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Paniz-Mondolfi AE, Talhari C, García Bustos MF, Rosales T, Villamil-Gomez WE, Marquez M, Pérez Alvarez AM, Tálamo Sánchez AI, Rodriguez-Morales AJ. American cutaneous leishmaniasis in infancy and childhood. Int J Dermatol 2017; 56:1328-1341. [PMID: 28741648 DOI: 10.1111/ijd.13664] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 03/12/2017] [Accepted: 04/25/2017] [Indexed: 12/26/2022]
Abstract
Infant and young child skin diseases are among the most common features of morbidity throughout the tropics. Because the skin is directly exposed to the environment, it is considerably affected by climatic and local conditions such as vectors and microorganisms, as in the case of leishmaniasis. In America the observed magnitude of cutaneous leishmaniasis in children has led to the study of increased risk of exposure of this group due to the possibility of peri- and intradomiciliary transmission. The present review pretends to make a concrete approach all through the broad and main figures of this parasitic disease, including the clinical, physiopathological, epidemiological, diagnostic, and therapeutic aspects, in order to be used as a practical source of reference for pediatricians leading with tropical cutaneous pathology in the region.
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Affiliation(s)
- Alberto E Paniz-Mondolfi
- Department of Infectious Diseases and Tropical Medicine/Infectious Diseases Pathology Laboratory, Hospital Internacional, Barquisimeto, Venezuela.,Laboratory of Biochemistry, Instituto de Biomedicina/IVSS, Caracas, Venezuela
| | - Carolina Talhari
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Universidade Nilton Lins, Manaus, Amazonas, Brasil
| | - María F García Bustos
- Instituto de Patología Experimental, Facultad de Ciencias de la Salud, Universidad Nacional de Salta, Salta, Argentina
| | | | - Wilmer E Villamil-Gomez
- Infectious Diseases and Infection Control Reserch Group, Hospital Universitario de Sincelejo, Sincelejo, Sucre, Colombia
| | - Marilianna Marquez
- Department of Infectious Diseases and Tropical Medicine/Infectious Diseases Pathology Laboratory, Hospital Internacional, Barquisimeto, Venezuela.,Universidad Centroccidental Lisandro Alvarado (UCLA), Barquisimeto, Venezuela
| | - Alexandra M Pérez Alvarez
- Department of Infectious Diseases and Tropical Medicine/Infectious Diseases Pathology Laboratory, Hospital Internacional, Barquisimeto, Venezuela
| | - Alejandra I Tálamo Sánchez
- Department of Infectious Diseases and Tropical Medicine/Infectious Diseases Pathology Laboratory, Hospital Internacional, Barquisimeto, Venezuela.,Universidad Centroccidental Lisandro Alvarado (UCLA), Barquisimeto, Venezuela
| | - Alfonso J Rodriguez-Morales
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia
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Potential Challenges of Controlling Leishmaniasis in Sri Lanka at a Disease Outbreak. BIOMED RESEARCH INTERNATIONAL 2017. [PMID: 28630867 PMCID: PMC5467302 DOI: 10.1155/2017/6931497] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The present works reviewed the existing information on leishmaniasis in Sri Lanka and in other countries, focusing on challenges of controlling leishmaniasis in the country, in an outbreak. Evidence from recent studies suggests that there is a possibility of a leishmaniasis outbreak in Sri Lanka in the near future. Difficulty of early diagnosis due to lack of awareness and unavailability or inadequacy of sensitive tests are two of the main challenges for effective case management. Furthermore, the absence of a proper drug for treatment and lack of knowledge about vector biology, distribution, taxonomy and bionomics, and reservoir hosts make the problem serious. The evident potential for visceralization in the cutaneous variant of L. donovani in Sri Lanka may also complicate the issue. Lack of knowledge among local communities also reduces the effectiveness of vector and reservoir host control programs. Immediate actions need to be taken in order to increase scientific knowledge about the disease and a higher effectiveness of the patient management and control programs must be achieved through increased awareness about the disease among general public and active participation of local community in control activities.
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Gardenier JC, Chopra VK, Filicori F, Murphy J, Greenway A, Gallagher JJ, Bessey PQ, Houng A, Eachempati SR, Barie PS. Angioinvasive Mold in the Surgical and Burn Intensive Care Unit: A Case Series and Review of the Literature. ACTA ACUST UNITED AC 2016. [DOI: 10.1089/crsi.2016.0016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Jason C. Gardenier
- Department of Surgery, Division of Burns, Trauma, Acute and Critical Care, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Vinod K. Chopra
- Department of Surgery, Division of Burns, Trauma, Acute and Critical Care, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Filippo Filicori
- Department of Surgery, Division of Burns, Trauma, Acute and Critical Care, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Jennifer Murphy
- Department of Surgery, Division of Burns, Trauma, Acute and Critical Care, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Andrew Greenway
- Department of Surgery, Division of Burns, Trauma, Acute and Critical Care, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - James J. Gallagher
- Department of Surgery, Division of Burns, Trauma, Acute and Critical Care, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Palmer Q. Bessey
- Department of Surgery, Division of Burns, Trauma, Acute and Critical Care, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Abraham Houng
- Department of Surgery, Division of Burns, Trauma, Acute and Critical Care, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Soumitra R. Eachempati
- Department of Medicine, Division of Medical Ethics, Weill Cornell Medicine, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Philip S. Barie
- Department of Medicine, Division of Medical Ethics, Weill Cornell Medicine, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
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25
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McGwire BS, Satoskar AR. Treatment Options for Leishmaniasis. CURRENT CLINICAL MICROBIOLOGY REPORTS 2016. [DOI: 10.1007/s40588-016-0048-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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26
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Alcántara-Reifs CM, Garnacho-Saucedo G, Salido-Vallejo R, Vélez García-Nieto A. Topical Amphotericin B for the treatment of localized cutaneous leishmaniasis. Dermatol Ther 2016; 30. [PMID: 27636906 DOI: 10.1111/dth.12402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 06/21/2016] [Accepted: 07/26/2016] [Indexed: 11/30/2022]
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Mushtaq S, Dogra D, Dogra N. Clinical Response with intralesional Amphotericin B in the treatment of old world cutaneous leishmaniasis: a preliminary report. Dermatol Ther 2016; 29:398-405. [PMID: 27477764 DOI: 10.1111/dth.12377] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Cutaneous leishmaniasis (CL) is a vector-borne tropical disease caused by a heterogeneous group of protozoan parasites that belong to the genus Leishmania. With an annual incidence of 1.5 million new cases, CL is a global health concern mainly in developing countries. The treatment options for CL are numerous but none is optimal. Pentavalent antimonials despite their side effects remain the preferred choice since decades. Alternate new treatment options are being explored to expand the therapeutic armamentarium of CL. In this study, we intend to describe our therapeutic experience with intralesional amphotericin B in the treatment of CL in a series of Indian patients, hitherto not commonly used in old world CL (OWCL). We also endeavour to review the literature on the use of amphotericin B in OWCL. Five consecutive patients diagnosed with cutaneous leishmansis at the out-patient department of Dermatology, Government Medical College, Jammu were treated with weekly injections of intralesional amphotericin B (2.5 mg/mL). Treatment response was assessed at each visit and the cases were followed up for 6 months. All the five patients responded well to the treatment and remained recurrence-free during follow-up. Intralesional amphotericin B was found to be safe and effective treatment for OWCL. Large randomized control trials need to be conducted to establish its efficacy.
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Affiliation(s)
- Sabha Mushtaq
- Department of Dermatology, Venereology & Leprology, SMGS Hospital, Government Medical College, Jammu, Jammu & Kashmir, India
| | - Devraj Dogra
- Department of Dermatology, Venereology & Leprology, SMGS Hospital, Government Medical College, Jammu, Jammu & Kashmir, India
| | - Naina Dogra
- Department of Dermatology, Venereology & Leprology, SMGS Hospital, Government Medical College, Jammu, Jammu & Kashmir, India
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Rajabi O, Layegh P, Hashemzadeh S, Khoddami M. Topical liposomal azithromycin in the treatment of acute cutaneous leishmaniasis. Dermatol Ther 2016; 29:358-363. [DOI: 10.1111/dth.12357] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Omid Rajabi
- Department of Drug and Food Control, School of Pharmacy; Mashhad University of Medical Sciences; Mashhad Iran
- Targeted Drug Delivery Research Center, School of Pharmacy; Mashhad University of Medical Sciences; Mashhad Iran
| | - Pouran Layegh
- Cutaneous Leishmaniasis Research Center, Department of Dermatology; Mashhad University of Medical Sciences; Mashhad Iran
| | - Sara Hashemzadeh
- Cutaneous Leishmaniasis Research Center, Department of Dermatology; Mashhad University of Medical Sciences; Mashhad Iran
| | - Mohsen Khoddami
- Department of Dermatology; Mashhad University of Medical Sciences; Mashhad Iran
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29
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Van Bocxlaer K, Yardley V, Murdan S, Croft SL. Drug permeation and barrier damage in Leishmania-infected mouse skin. J Antimicrob Chemother 2016; 71:1578-85. [PMID: 26903275 DOI: 10.1093/jac/dkw012] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 01/08/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Pathological disorder can disrupt the barrier integrity of the skin, thereby altering the drug delivery from topical formulations to the target site. Cutaneous leishmaniasis (CL) is an infection of the dermal layers of the skin and manifests as a variety of skin lesions from defined nodular forms to plaques and chronic ulcers. The aim of this work was to characterize the physiology and barrier integrity of the Leishmania-infected BALB/c mouse skin and how they impacted delivery of drugs into the skin. METHODS A histological evaluation of the structural differences between uninfected and infected skin was performed using haematoxylin/eosin, elastic Van Gieson and Iba-1 stains. As a CL nodule developed and progressed, the skin pH, hydration and trans-epidermal water loss (TEWL) were recorded. Finally, Franz diffusion cells were used to evaluate the influence of the infection on drug delivery through the skin. RESULTS We found: (i) structural changes in both the epidermal and dermal layers due to the ingress of inflammatory cells, as shown by immunohistochemistry; (ii) a significant increase in TEWL; and (iii) significantly higher permeation of the model permeants caffeine and ibuprofen and the antileishmanial drugs buparvaquone and paromomycin, for Leishmania-infected skin compared with uninfected skin. The infection had no measurable influence on skin pH and hydration. CONCLUSIONS We report profound changes in the skin barrier physiology, function and permeability to drugs of Leishmania-infected skin.
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Affiliation(s)
- Katrien Van Bocxlaer
- Department of Pharmaceutics, UCL School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK Department of Infection and Immunology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Vanessa Yardley
- Department of Infection and Immunology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Sudaxshina Murdan
- Department of Pharmaceutics, UCL School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK
| | - Simon L Croft
- Department of Infection and Immunology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Alavi-Naini R, Fazaeli A, O'Dempsey T. Topical Treatment Modalities for Old World Cutaneous Leishmaniasis: A Review. Prague Med Rep 2015; 113:105-18. [DOI: 10.14712/23362936.2015.26] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Diagnosis and therapy of cutaneous leishmaniasis (CL) can be difficult due to the variability of the clinical pictures and resistance to therapy. There is no vaccine currently available for CL. The aim of the present review is to describe different topical treatment modalities for old world CL. The mainstays of treatment for old world CL are pentavalent antimony compounds which are administered parenterally or intralesionally. New topical treatment alternatives have been available within the past few years. Amongst several treatments used topically, physical therapies including cryotherapy, heat therapy and CO2 laser are promising for the treatment of old world CL. Along with that, other randomized placebo controlled trials should be designed to find new effective therapeutic regimens.
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Khoshneviszadeh R, Fazly Bazzaz BS, Housaindokht MR, Ebrahim-Habibi A, Rajabi O. UV Spectrophotometric Determination and Validation of Hydroquinone in Liposome. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2015; 14:473-8. [PMID: 25901154 PMCID: PMC4403063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The method has been developed and validated for the determination of hydroquinone in liposomal formulation. The samples were dissolved in methanol and evaluated in 293 nm. The validation parameters such as linearity, accuracy, precision, specificity, limit of detection (LOD) and limit of quantitation (LOQ) were determined. The calibration curve was linear in 1-50 µg/mL range of hydroquinone analyte with a regression coefficient of 0.9998. This study showed that the liposomal hydroquinone composed of phospholipid (7.8 %), cholesterol (1.5 %), alpha ketopherol (0.17 %) and hydroquinone (0.5 %) did not absorb wavelength of 293 nm if it diluted 500 times by methanol. The concentration of hydroquinone reached 10 µg/mL after 500 times of dilution. Furthermore, various validation parameters as per ICH Q2B guideline were tested and found accordingly. The recovery percentages of liposomal hydroquinone were found 102 ± 0.8, 99 ± 0.2 and 98 ± 0.4 for 80%, 100% and 120% respectively. The relative standard deviation values of inter and intra-day precisions were <%2. LOD and LOQ were 0.24 and 0.72 µg/mL respectively.
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Affiliation(s)
- Rabea Khoshneviszadeh
- Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran.
| | - Bibi Sedigheh Fazly Bazzaz
- Biotechnology Research Center, Drug and Food Control Department, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
| | | | - Azadeh Ebrahim-Habibi
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran. ,Biosensor Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Omid Rajabi
- Drug and Food Control Department, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.,
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Goyonlo VM, Vosoughi E, Kiafar B, Nahidi Y, Momenzadeh A, Taheri AR. Efficacy of intralesional amphotericin B for the treatment of cutaneous leishmaniasis. Indian J Dermatol 2014; 59:631. [PMID: 25484415 PMCID: PMC4248523 DOI: 10.4103/0019-5154.143571] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Antimoniate compounds have been used as gold standard treatment for cutaneous leishmaniasis since many years ago, but with increase in incidence of drug as well as individual contraindications, more attention has been given to alternative treatments. AIM The aim of this study was to evaluate the efficacy of intralesional amphotericin B as an alternative treatment for cutaneous leishmaniasis in Mashhad, Iran, during 2007-2009. MATERIALS AND METHODS Non-random sampling from both sexes and without any age limitation of cases eligible for this alternative treatment was done. Size and induration of lesions were measured before beginning and weakly during the treatment. Amphotericin B (2 mg/ml) was injected into lesions weekly for up to 12 weeks and the cases were followed up for the treatment responses, possible side effects and recurrence of the disease. RESULTS A total of 93 patients with a mean age of 20.81 ± 15.26 years were included in this study. At the end of 12(th) week, 61.4% of the patients were recovered completely (more than 90% reduction in size and induration), 21.6% had partial remission (60-90% reduction in size and induration), and 17% had less than 60% reduction in size and induration of skin lesions. Injection side effects were insignificant and did not lead to premature discontinuation of treatment in any patients. CONCLUSION Weekly intralesional injection of amphotericin B looks promising, considering the fact that most of the patients in this study were resistant to antimoniates.
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Affiliation(s)
- Vahid Mashayekhi Goyonlo
- Department of Dermatology, Cutaneous Leishmaniasis Research Center, School of Medicine, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Elham Vosoughi
- Department of Dermatology, Cutaneous Leishmaniasis Research Center, School of Medicine, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bita Kiafar
- Department of Dermatology, Cutaneous Leishmaniasis Research Center, School of Medicine, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Yalda Nahidi
- Department of Dermatology, Cutaneous Leishmaniasis Research Center, School of Medicine, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Akram Momenzadeh
- Department of Dermatology, Cutaneous Leishmaniasis Research Center, School of Medicine, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ahmad Reza Taheri
- Department of Dermatology, Cutaneous Leishmaniasis Research Center, School of Medicine, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Abstract
INTRODUCTION Leishmaniasis broadly manifests as visceral leishmaniasis (VL), cutaneous leishmaniasis (CL) and mucocutaneous leishmaniasis. The treatment of leishmaniasis is challenging and the armamentarium of drugs is small, duration of treatment is long, and most drugs are toxic. AREAS COVERED A literature search on treatment of leishmaniasis was done on PubMed. Single dose of liposomal amphotericin B (L-AmB) and multidrug therapy (L-AmB + miltefosine, L-AmB + paromomycin (PM), or miltefosine + PM) are the treatment of choice for VL in the Indian subcontinent. A 17-day combination therapy of pentavalent antimonials (Sb(v)) and PM remains the treatment of choice for East African VL. L-AmB at a total dose of 18 - 21 mg/kg is the recommended regimen for VL in the Mediterranean region and South America. Treatment of CL should be decided by the severity of clinical lesions, etiological species and its potential to develop into mucosal leishmaniasis. EXPERT OPINION There is an urgent need to implement a single-dose L-AmB or combination therapy in the Indian subcontinent. Shorter and more acceptable regimens are needed for the treatment of post - kala-azar dermal leishmaniasis. Combination therapy with newer drugs needs to be tested in Africa. Due to the toxicity of systemic therapy, a trend toward local treatment for New World CL is preferred in patients without risk of mucosal disease.
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Affiliation(s)
- Shyam Sundar
- Banaras Hindu University, Institute of Medical Sciences, Department of Medicine , Varanasi , India +91 542 2369632 ;
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Carvalho AM, Magalhães A, Carvalho LP, Bacellar O, Scott P, Carvalho EM. Immunologic response and memory T cells in subjects cured of tegumentary leishmaniasis. BMC Infect Dis 2013; 13:529. [PMID: 24206576 PMCID: PMC3870979 DOI: 10.1186/1471-2334-13-529] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 11/01/2013] [Indexed: 11/29/2022] Open
Abstract
Background The main clinical forms of tegumentary leishmaniasis are cutaneous leishmaniasis (CL) and mucosal leishmaniasis (ML). L.braziliensis infection is characterized by an exaggerated production of IFN-gamma and TNF-alpha, cytokines involved in parasite destruction, but also in the pathology. Maintenance of an antigen-specific immune response may be important for resistance to re-infection and will contribute for vaccine development. In the present work we investigated the immune response in CL and ML cured individuals. Methods Participants in the present study included 20 CL and 20 ML patients, who were evaluated prior to, as well as 2 to 15 years after therapy. IFN-gamma, IL-2 and TNF-alpha production were determined by ELISA in supernatants of mononuclear cells stimulated with soluble L.braziliensis antigen (SLA). The frequency of memory CD4+ T cell populations was determined by FACS. Results Here we show that the majority of CL and ML patients did not produce in vitro IFN-gamma in response to SLA after cure. In the cured individuals who responded to SLA, effector memory (CD45RA-CCR7-) CD4+ T cells were the ones producing IFN-gamma. Because a large percent of CL and ML cured patients lost SLA-induced IFN-gamma production in peripheral blood, we performed Leishmania skin test (LST). A positive LST was found in 87.5% and 100% of CL and ML cured individuals, respectively, who did not produce IFN-gamma or IL-2 in vitro. Conclusion This study shows that in spite of losing in vitro antigen-specific response to Leishmania, cured CL and ML subjects retain the ability to respond to SLA in vivo. These findings indicate that LST, rather than IFN-gamma production, may be a better assessment of lasting immunity to leishmaniasis in human studies, and thus a better tool for assessing immunization after vaccine. Furthermore, in cured individuals which maintains Leishmania-specific IFN-gamma production, effector memory CD4+ T cells were the main source of this cytokine.
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Affiliation(s)
| | | | | | | | | | - Edgar M Carvalho
- Serviço de Imunologia, Hospital Universitário Prof, Edgard Santos, Universidade Federal da Bahia, Salvador, Rua João das Botas s/n, Canela 40110-160, BA, Brazil.
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Abstract
INTRODUCTION Leishmaniasis broadly manifests as visceral leishmaniasis (VL), cutaneous leishmaniasis (CL) and mucocutaneous leishmaniasis (MCL). The treatment of VL is challenging. The duration of treatment is long, and drugs are toxic thereby needing monitoring and hospitalization. AREAS COVERED Novel therapies such as single dose of liposomal amphotericin B (L-AmB) and multidrug therapy are important breakthrough for VL in the Indian subcontinent and have been recommended as the treatment of choice in this region. African Leishmania donovani is less susceptible to L-AmB, miltefosine and paromomycin as compared to the Indian strains, and the treatment of choice remains a 17-day combination therapy of pentavalent antimonials (SB(v)) and paromomycin. L-AmB at a total dose of 18 - 21 mg/kg is the recommended regimen in the Mediterranean region and South America. It is also the treatment of choice for HIV-VL coinfection. Treatment of CL should be decided by the clinical lesions, etiological species and its potential to develop into mucosal leishmaniasis. A literature search on treatment of leishmaniasis was done on PubMed and through Google. EXPERT OPINION There is an urgent need for exploratory studies with short course, highly efficient regimens such as single dose L-AmB or combination therapy for all the endemic regions of VL. Shorter and more acceptable regimens are needed for the treatment of post-kala-azar dermal leishmaniasis. Treatment of CL remains one of the neglected areas of leishmaniasis as data are scarce and drawn from uncontrolled studies.
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Affiliation(s)
- Shyam Sundar
- Banaras Hindu University, Institute of Medical Sciences, Department of Medicine, Varanasi 221 005, India.
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