Electrocardiographic changes in patients with cutaneous leishmaniasis treated with systemic glucantime

<p><b>INTRODUCTION</b>Antimonial compounds are regarded as the treatment of choice for cutaneous leishmaniasis (CL). Systemic administration of these drugs has some side effects including cardio toxicity and electrocardiogram (EKG) changes. The objective of our study was to evaluate EKG changes in the patients with CL treated with systemic glucantime.</p><p><b>MATERIALS AND METHODS</b>One hundred and thirty-one patients were enrolled in this prospective study. All of the selected patients had confirmed CL and were candidates for treatment with systemic glucantime. The patients were treated with systemic glucantime and EKG was performed before, during (weekly) and 1 month after cessation of the treatment. All of the collected data were analysed using SPSS software.</p><p><b>RESULTS</b>The most common change was prolonged QT interval that was seen in 19% of the patients. ST depression occurred in 6.1% of the patients. Minimal ST elevation occurred in 3% and inverted T was observed in 7.4% of the patients. Single premature atrial contraction (PAC) and single premature ventricular contraction (PVC) occurred in 0.7% and 2.29% of patients, respectively. Bradycardia was observed in 10.6% and left bundle branch block in 0.7% of the patients. All of these changes reversed after stopping the treatment except 1 case with left bundle branch block that lasted for 1 month after the treatment.</p><p><b>CONCLUSIONS</b>Our results showed that treatment with glucantime can induce many ECG changes as QT prolongation have significant risk. We suggest that ECG monitoring should be performed in high-risk patients undergoing glucantime treatment with special attention to ECG changes mostly prolonged QT interval.</p>

Successful Treatment of Lupoid Cutaneous Leishmaniasis with Glucantime and Topical Trichloroacetic Acid (A Case Report)

Lupoid leishmaniasis is a unique form of cutaneous leishmaniasis characterized by unusual clinical features and a chronic relapsing course, mostly caused by infection with Leishmania tropica. In this clinical form, 1-2 yr after healing of the acute lesion, new papules and nodules appear at the margin of the remaining scar. Herein, we describe a case of this clinical form that was resistant to 2 courses of treatments: systemic glucantime and then a combination therapy with allopurinol and systemic glucantime. However, marked improvement was seen after a combination therapy with topical trichloroacetic acid solution (50%) and systemic glucantime, and there were no signs of recurrence after 1 yr of follow-up.

Distribution Frequency of Pathogenic Bacteria Isolated from Cutaneus Leishmaniasis Lesions

Cutaneous leishmaniasis (CL) is a parasitic disease characterized by single or multiple ulcerations. Secondary bacterial infections are one of the complications that can increase the tissue destruction and the resulting scar. To better determine the incidence of real secondary bacterial infections in CL, we designed the current study. This was a cross-sectional study performed in Skin Diseases and Leishmaniasis Research Centre, Isfahan, Iran. A total of 1,255 patients with confirmed CL enrolled in the study. Sterile swaps were achieved for ulcer exudates and scraping was used for non-ulcerated lesions. All samples were transferred to tryptic soy broth medium. After 24 hr of incubation at 37degrees C they were transferred to eosin methylene blue agar (EMB) and blood agar. Laboratory tests were used to determine the species of bacteria. Among 1,255 confirmed CL patients, 274 (21.8%) had positive cultures for secondary bacterial infections. The bacteria isolated from the lesions were Staphylococcus aureus in 190 cases (69.3%), coagulase negative Staphylococcus in 63 cases (23.0%), E. coli in 10 cases (3.6%), Proteus sp. in 6 cases (2.2%), and Klebsiella sp. in 5 cases (1.9%). The results show that the overall incidence of secondary bacterial infections in the lesions of CL was 21.8%, considerably high. The incidence of secondary bacterial infections was significantly higher in ulcerated lesions compared with non-ulcerated lesions.

[Palpebral leishmaniasis with trichiasis: a case report]

Cutaneous leishmaniasis is a parasitic hyperendemic disease in Isfahan. Its lesions can be solitary or multiple depending on the number of insect bites and is usually seen exposed areas. The possibility of insect bite on palpebral area is rare due to the protection by eyelashes and palpebral motion. In this area, lesions are usually presented as chalazion, dacryocystitis and rarely ulcerative and cancerous forms. As there is a chance of dissemination of the parasite to conjunctiva, cornea and sclera from the adjacent skin, and it is also possible that scarring of cutaneous leishmaniasis may cause some ophthalmologic side effects, this kind of leishmaniasis can potentially be very serious for eyes. In this report, a 13 year old boy with upper and lower palpebral cutaneous leishmaniasis who consequently developed conjunctivitis and trichiasis is presented. This patient responded to treatment with systemic glucantime, but ultimately developed conjunctival and palpebral scar, exposure keratitis and loss of eyelashes

Comparison of insulin resistance in obese women with and without acanthosis nigricans

Acanthosis nigricans [AN] is characterized by hyperpigmented velvety plaques of body folds and neck. Insulin can have a role in the pathogenesis of this disease and hyperinsulinemia as a consequence of insulin resistance may stimulate the formation of the characteristic plaques of AN. In this study insulin resistance was compared in obese women with and without AN. Glucose tolerance test [GTT] and fasting blood insulin were measured in two groups of obese women [BMI>30 kg/m[2]] with AN [32 cases] and without AN [34 cases] and insulin resistance was determined using HOMA formula. The mean fasting blood insulin in two groups with and without AN were 15.5 +/- 8.5 and 12.2 +/- 4.1 micro IU/mL; respectively [P<0.05]. The mean of insulin resistance in two groups with and without AN were 3.5 +/- 1.9 and 2.6 +/- 0.9; respectively [P<0.05]. The results of GTT showed that the mean fasting blood sugar was 89.5 +/- 12 mg/dl and following using glucose were 144 +/- 7 mg/dl after 30 minutes, 132 +/- 45 mg/dl after 60 minutes, 107 +/- 30 mg/dl after 120 minutes in persons with AN and in the other group were 87 +/- 8, 130 +/- 3, 122 +/- 26 and 100 +/- 26 mg/dl; respectively. The difference between two groups was only significant after 60 minutes. Acanthosis nigricans maybe a marker of insulin resistance in obese women

effect of combination therapy with systemic meglumine antimoniate [Glucantime] and pentoxifylline in the treatment of cutaneous leishmaniasis

Cutaneous leishmaniasis is a common parasitic disease in Iran specially in Isfahan. The first line of treatment for this disease are antimonial compounds, however, because of the increasing unresponsiveness and significant side effects alternative therapeutic measures have been advocated. This study was performed to evaluate the efficacy of meglumine antimoniate [Glucantime] plus pentoxifylline in the treatment of cutaneous leishmaniasis. This double blind randomized controlled clinical trial with simple sampling was performed on 64 patients with cutaneous leishmaniasis referred to Skin Diseases and Leishmaniasis Research Center. The patients were randomly divided in two groups. One group was treated with systemic Glucantime combined with pentoxifylline and the other group was treated with Glucantime plus placebo for 20 days and the patients were followed up for 3 months. The response to treatment was categorized into complete improvement [the lesions had been flattened, there was no induration and epidermal creases had been appeared], partial improvement [reduction in the size of the lesions, but without appearance of epidermal creases] and poor response [no reduction in the size of lesions]. Of 64 participants 32 patients in trial group and 31 patients in control group were followed for 3 months. After this time complete improvement, partial improvement and poor response to treatment were 8 1.3%, 12.5% and 6.2% in trial group and 52%, 29% and 19% in control group; respectively[P=0.04]. We also observed no adverse effects due to pentoxifylline. Combined therapy with Glucantime plus pentoxifylline was more effective than Glucantime alone

Patch test results in patients with clinical diagnoses of contact and/or atopic dermatitis in Isfahan

Patch testing is an important diagnostic tool to confirm allergic contact dermatitis. Determination of the validity and usefulness of a standard patch test allergen series with consideration of age, sex and race difference can reduce diagnostic errors in patients with allergic contact dermatitis. This study was done to determine the frequency of contact sensitization to 28 common allergens in patients with clinical diagnoses of contact and/or atopic dermatitis. Materials and In a cross sectional study during 6 months, 250 patients with contact and/or atopic dermatitis were patch tested with DKG standard patch test series and evaluated after 24, 48 and 72 hours after application of patch test. Data were analyzed using SPSS. 11 software by X[2], Fisher's exact and t tests. Positive patch test results were seen in 32% of all evaluated patients. 45.8% of patients with age above 40 years and 28.0% of patient with age below 40 years had a positive patch test. Potassium dichromate and nikel sulfate were the most common allergens in our study. In this study only 13 of 18 [46.4%] tested allergens showed positive reaction. Low positive rate of standard DKG series in this study shows that allergen series of standard patch test should be revised based on reginal conditions, allergens and social habits

comparison between intralesional hypertonic sodium chloride solution and meglumine antimoniate [Glucantime] injections in the treatment of cutaneous leishmaniasis

Different local and systemic modalities are suggested in the treatment of cutaneous leishmaniasis, but the pentavalent antimony compounds are still considered as the first line of treatment. Regarding to increase in clinical drug resistance and adverse effects, efforts to find a more effective and safer drug is continuing. The objective of this study was to compare the effect of intralesional hypertonic sodium chloride solution and intralesional meglumine antimoniate injections in the treatment of cutaneous leishmaniasis. This randomized controlled clinical trial with simple sampling method was performed on 72 patients with cutaneous leishmaniasis. The patients were randomly divided in to two groups. One group was treated with intralesional hypertonic sodium chloride solution and the other one was treated with intralesional meglumine antimoniate injections at weekly intervals for 6 to 10 weeks. All patients were followed for 6 months after treatment. After six weeks of treatment, complete improvement, partial improvement, and no response to treatment were 33.3%, 45% and 22% in meglumine antimoniate group and 26%, 23% and 51% in trial group, respectively. In both groups complete improvement was observed in lesions smaller than 2 cm [2]. In lesions with partial improvement the treatment was continued up to 10 weeks and all patients were followed for six months. After six months ultimate cure rate was 52% in meglumine antimoniate group and 25% in hypertonic sodium chloride solution group. Injections of hypertonic sodium chloride solution has less efficacy in comparison with intralesional meglumine antimoniate in treatment of cutaneous leishmaniasis, but considering the good response in primary small lesions, it can be used as an alternative therapy in some special cases including small lesions and allergic reactions to meglumine antimoniate

[Disseminated cutaneous leishmaniasis on lymphedema following radiotherapy: a case report]

Cutaneous leishmaniasis[CL] is a parasitic disease, which is hyperendemic in Isfahan, usually caused by L.major and L.tropica. Herein we report a patient with post-mastectomy lymphedema on right upper limb accompanying with the lesions of cutaneous leishmaniasis on the right and left forearms. Following radiotherapy, the lesions on the limb with lymphedema were disseminated. But the lesions on left side showed no change. This finding may be the result of immune disorder due lymphedema and radiotherapy