Decreased effect of glucantime in cutaneous leishmaniasis complicated with secondary bacterial infection

Background:

Glucantime is regarded as the first-line treatment of cutaneous leishmaniasis (CL); however, failure to treatment is a problem in many cases.

Aim:

The aim was to evaluate the therapeutic effect of glucantime in CL complicated with secondary bacterial infection compared to uncomplicated lesions.

Methods:

This experimental study was performed in Skin Diseases and Leishmaniasis Research Center, Isfahan, Iran. A total of 161 patients enrolled in the study had CL confirmed by positive smear of lesions. All the patients were treated with systemic glucantime for 3 weeks and followed for 2 months. Response to treatment was defined as loss of infiltration, reepithelization, and negative smear. Depending on the results of bacterial cultures, the lesions were divided into two groups and the efficacy of glucantime was compared.

Results:

A total of 123 patients (76.4%) were negative, and 38 patients (23.6%) were positive for secondary bacterial infection. In groups with negative bacterial culture response to treatment was 65% (80 patients) and in the other positive group, it was 31.6% (12 patients), with a difference (χ² = 13.77, P < 0.01).

Conclusion:

Therapeutic effect of glucantime showed a decrease in CL lesions with secondary bacterial infection. Therefore, in the cases of unresponsiveness to treatment, the lesions should be evaluated for bacterial infection, before repeating the treatment.

Treatment of localized psoriasis with a topical formulation of zinc pyrithione

BACKGROUND

Psoriasis is a common chronic condition of the skin that is resistant to many therapies.

AIM

To test the efficacy of a topical formulation of zinc pyrithione in an emollient base compared with an emollient alone in the treatment of psoriasis.

METHODS

This was a randomized double-blind clinical trial. Patients with localized psoriasis involving less than 10% of body skin areas were enrolled in the study. They were randomly allocated to one of two treatment groups. Group A was treated with emollient cream containing 0.25% zinc pyrithione and group B was treated with emollient cream alone twice daily for 3 months. Response to treatment was assessed using PASI scores.

RESULTS

Of 60 participants, 30 patients in group A and 30 patients in group B completed the study. The mean PASI scores before and after treatment were 3.4±1.8 and 0.9±1.3 in group A (p<0.01), and 4.3±2 and 3.9±1.3 in group B (p>0.05), and there was a significant difference between the two groups' mean PASI scores at the end of the study (p<0.01). The differences in the mean PASI scores before and after treatment were 2.4±2 and 0.4±0.1 in groups A and B, respectively (p<0.01).

CONCLUSION

A topical formulation of zinc pyrithione can be used to treat localized psoriasis.

Isolation of bacteria causing secondary bacterial infection in the lesions of Cutaneous Leishmaniasis

Background:

Cutaneous Leishmaniasis (CL) is a parasitic disease characterized by single or multiple ulcerations. Secondary bacterial infection is one of the complications of the disease that can increase the tissue destruction and the resulting scar.

Objective:

To effectively determine the incidence of real secondary bacteria infection in cutaneous leishmaniasis, we designed the current study.

Methods and Materials:

This was a cross-sectional study performed in Skin Diseases and Leishmaniasis Research Centre, Isfahan, Iran. In this study, 854 patients with confirmed CL were enrolled. Samples were taken from all the patients. Sterile swaps were achieved for the ulcer exudates and scraping was used for nonulcerated lesions. All the samples were transferred to tryptic soy broth medium. After 24 h of incubation in 37°C, they were transferred to eosin methylene blue agar (EBM) and blood agar. Laboratory tests were used to determine the species of bacteria. All of the collected data were analyzed by SPSS software and chi-square.

Results:

Among 854 patients with confirmed cutaneous leishmaniasis, 177 patients (20.7%) had positive cultures for secondary bacterial infection. Bacteria isolated from the lesions were as follows: Staphylococcus aureus - 123 cases (69.4%), coagulase negative Staphylococcus - 41 cases (23.1%), E. coil - 7 cases (3.9%), Proteus - 3 cases (1.7%) and Klebsiella - 3 cases (1.7%).

Conclusions:

The incidence of secondary bacterial infection in lesions of CL was 20.7%. The most common isolated pathogen was Staphylococcus aureus. The incidence of secondary bacterial infection was significantly more in the ulcerated lesions as compared with nonulcerated lesions (P = 0.00001).

Efficacy of local heat therapy by radiofrequency in the treatment of cutaneous leishmaniasis, compared with intralesional injection of meglumine antimoniate

BACKGROUND

Cutaneous leishmaniasis (CL) is a serious public health problem in many tropical and subtropical regions of the world. Treatment of CL can prevent disfiguring scars.

AIM

The efficacy of local heat therapy by radiofrequency (RF) was compared with intralesional injection of meglumine antimoniate in the treatment of CL.

METHODS

This was a randomized clinical trial. Patients with antroponotic cutaneous leishmaniasis (ACL) in the Isfahan province of Iran were enrolled in the study if the examination of a smear from a suspected CL lesion was confirmed positive for Leishmania. Patients were randomly allocated to one of two treatment groups. Group A was treated by heat therapy by RF at 50 degrees C for 30 s once weekly for 4 weeks, and group B was treated with intralesional injection of meglumine antimoniate once weekly for 4 weeks. Follow-up lasted 6 months. Response to treatment was classified as complete (lesions flattened, no induration, and epidermal creases had appeared), partial (reduction in lesion size, but without the appearance of epidermal creases) and poor (no reduction in lesion size).

RESULTS

Of 117 participants, 57 patients with 83 lesions in group A and 60 patients with 94 lesions in group B completed the study and were followed up for 6 months. Complete, partial and poor response to treatment were 80.7%, 12% and 7.3% in group A, and 55.3%, 21.27% and 23.40% in group B, respectively (P = 0.001). In both groups, there was no relapse in patients with complete response after 6 months of follow-up.

CONCLUSIONS

Heat therapy with thermogenerator RF can be used as an efficacious treatment in the lesions of CL. It is more effective than the conventional treatment with intralesional meglumine antimoniate injection.

Effect of combination therapy with systemic glucantime and pentoxifylline in the treatment of cutaneous leishmaniasis

INTRODUCTION

Cutaneous leishmaniasis is a common parasitic disease in Iran, especially in Isfahan. First line treatment for this disease is antimonial compounds; however, owing to the intermittent failure of this treatment and its significant side-effects alternative therapeutic measures have been advocated.

OBJECTIVE

Evaluating the efficacy of pentoxifylline plus glucantime in the treatment of cutaneous leishmaniasis.

METHODS

This double-blind, randomized, controlled clinical trial with simple sampling was performed on 64 patients with cutaneous leishmaniasis referred to the Skin Diseases & Leishmaniasis Research Center from an endemic foci of L. major in Isfahan. The patients randomly were divided into two groups. One group was treated with systemic Glucantime (20 mg pentavalent antimony/kg/day) combined with pentoxifylline (400 mg three times daily) and the other group were treated with Glucantime (20 mg pentavalent antimony/kg/day) plus placebo (three tablets daily) for 20 days. Follow up lasted 3 months. Response to treatment was grouped as complete improvement (lesions had been flattened, no induration, and epidermal creases had appeared), partial improvement (reduction in lesion size, but without the appearance of epidermal creases) and poor response (no reduction in lesion size).

RESULTS

Of 64 participants, 32 patients in the trial group and 31 patients in the control group were followed for 3 months. One patient in group B discontinued withdrew. After this time, complete improvement, partial improvement and poor response to treatment were 81.3%, 12.5% and 6.2% in the trial group and 51.6%, 29% and 19.4% in the control group, respectively. We also observed no adverse effect resulting from pentoxifylline.

DISCUSSION

The result obtained by two therapeutic methods indicates that combined therapy with Glucantime and pentoxifylline is more effective than Glucantime alone (P < 0.05).

Ocular leishmaniasis: a case report

Cutaneous leishmaniasis (CL) is a protozoal disease which is endemic in Iran usually caused by Leishmaniasis major and Leishmaniasis tropica and transmitted by the bite of a sandfly. In Isfahan province CL is highly prevalent and we observe some unusual clinical features of disease. The eyelid is rarely involved possibly because the movement of the lids prevents the fly vector from biting the skin in this region. We report a case of ocular leishmaniasis with eyelid and conjunctival involvement that had simulated chalazion and was complicated with trichiasis. The patient was diagnosed by direct smear, culture, and PCR from the lesions. He was treated with systemic sodium stibogluconate (20 mg/kg/day) for 20 days and subsequently surgery for trichiasis. The patient was clinically cured with this treatment, however the disease had left complications, including palpebral and conjanctival scaring, corneal opacity, and eyelash loss.