ABSTRACT
@#Leishmaniasis is a widely spread zoonotic disease caused by the bite of infected sandflies, particularly in developing countries. Cutaneous leishmaniasis can have a diverse range of presentations, ranging from minor skin nodules to significant mucosal damage. However, nose involvement is infrequent. Our report highlights a 15-year-old female patient with a persistent skin lesion on her nose for three months, which is a rare manifestation of cutaneous leishmaniasis. The lesion started as a raised spot with a brownish-red color and a crust but eventually developed into an ulcer that spread over the entire lobe of the nose and even moved toward the eye. Microscopic examination revealed the presence of Leishmania amastigotes, and a biopsy confirmed a diagnosis of cutaneous leishmaniasis. The patient received daily intravenous sodium stibogluconate doses of 9 mg/kg for 20 days, and three weeks later, there was a significant clinical improvement, with the ulcer beginning to heal and no more amastigotes visible on microscopic examination. It is crucial to keep cutaneous leishmaniasis in mind as a possible diagnosis for patients with skin lesions, even in regions where the condition is not prevalent.
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In the absence of effective vector control measures and vaccines against leishmaniasis, effective chemotherapy remains the mainstay of treatment. Identification of post-kala-azar dermal leishmaniasis (PKDL) is important due to the long and toxic treatment and the fact that PKDL patients may serve as a reservoir for visceral leishmaniasis (VL). This retrospective study was done to assess the outcome of pharmacotherapy in post-kala-azar dermal leishmaniasis (PKDL) patients in a specialty public hospital in Kolkata. Methods: The hospital records of all consecutive PKDL patients admitted at Calcutta School of Tropical Medicine (CSTM), Kolkata during the last five years - 2010-2014, were reviewed and the relevant information inputs as documented studied to realize the noted objectives. Clinical presentation on admission including presence of co-infections (particularly HIV), trends and patterns of treatment regimens and rationale thereof, if available; treatment (anti-leishmaniasis) outcomes in reference to efficacy, safety and tolerability, fatality like serious complications and mortality and adverse drug reactions (for anti-leishmaninal drugs primarily), if any was noted. Results: PKDL cases presented with insidious onset skin lesions of different types without much systemic illness. 2 out of 19 cases presented with fever and 2 other cases had mild anemia. PKDL cases presented with 4 types of skin lesions. Multiple macular or hyppigmented macular lesions were commonest, 8 out of 19 cases (42.10%). In PKDL cases treatment outcome was difficult to say unless parasitologically declared negative, though clinically regression of the lesions were visible in all cases. Tolerability was least with AmB followed by SSG and best with miltefosine. Conclusion: So, it can be concluded from this study that in this institute PKDL were treated with conventional and liposomal AmB as well as with SSG, miltefosine and combination therapy. Among the regimens short course L-AmB was found to be the most efficacious and tolerable in respect to ADRs and hospital stay.
ABSTRACT
El miltefosine (Impávido(r)) es un medicamento de componente antineoplásico que ha encontrado efectividad muy alta contra la leishmaniasis mucocutánea y visceral en el mundo, y se ha convertido en una opción muy atractiva para pacientes con enfermedades de fondo y tratamientos de base que contraindican el uso de amoniato de meglumina (Glucantime(r)) o stibogluconato de sodio (Pentostam(r)). Seguidamente se presenta el caso de un paciente de 78 años con antecedentes de diabetes mellitustipo 2, hipertenso, anticoagulado con warfarina por una fibrilación auricular crónica, que inició una dermatosis ulcerosa de bordes violáceos elevados, única en el hélix del oído derecho, de evolución crónica asociada a múltiples ulceraciones en la mucosa nasal. La biopsia cutánea se reportó como inespecífica, pero como la sospecha clínica era alta de leishmaniasis, se realizó una reacción de cadena polimerasa de tejido de mucosa nasal que fue reportada positiva por Leishmania panamensis. Por las comorbilidades y el tratamiento del paciente se decidió tratarlo con miltefosine (Impávido(r)).
Miltefosine (Impavido(r)) is an anticancer medicine that has been found highly effective against mucocutaneous and visceral leishmaniasis worldwide, making it a very attractive option for patients with underlying diseases and treatments that contraindicate the use of glucamine antimoniate (Glucantime(r)) or sodium stibogluconate (Pentostam(r)). Here we present the case of a 78 years old male, with a history of type 2 diabetes mellitus, high blood preasure, anticoagulated with warfarin for chronic atrial fibrillation, who started with a solitary cutaneous ulcer of purplish edges on the right ear helix of chronic evolution associated with multiple ulcerations on the nasal mucosa. Skin biopsy was reported as nonspecific, but as clinical suspicion of leishmaniasis was high, a polymerase chain reaction of nasal mucosa tissue was performed for Leishmania with positive results for Leishmania panamensis. Due to comorbidities and the treatment of our patient we decided to use miltefosine (Impavido(r)) for 2 months with very good results.
Subject(s)
Humans , Male , Aged , Aged , Antineoplastic Agents , Diabetes Mellitus , Leishmaniasis, Mucocutaneous , MeglumineABSTRACT
Background: Cutaneous leishmaniasis in India is mainly confi ned to the deserts of Rajasthan; some cases have been reported from the dry north-western half of the Indo-Gangetic plain, including Punjab, Himachal Pradesh, Delhi and Varanasi. Aims: To highlight a new focus of cutaneous leishmaniasis in the Jammu division of Jammu and Kashmir State, previously a non-endemic area. This report presents the clinico-epidemiological and investigative results of 120 new cases of cutaneous leishmaniasis detected between November 2012 and October 2013. Methods: The clinical diagnosis of cutaneous leishmaniasis was made using criteria proposed by Bari and Rahman. It was further confi rmed by the demonstration of Leishman-Donovan bodies in Leishman stained slit skin smears and skin biopsy specimens, and/or by a satisfactory response to intra-lesional sodium stibogluconate given weekly for 4 weeks. Serial clinical photographs were taken before giving injections and at the end of the 6th week. Results: There were 67 females and 53 males with an age range of 8 months to 80 years. The most frequently affected site was the face. Lesions were most commonly of the nodulo-ulcerative type. The number of lesions ranged from 1 to 4. Farmers (28.1%), homemakers (27.2%) and students (27.2%) were signifi cantly over-represented among the occupations (P < 0.001). Skin smears and biopsies were positive for Leishman-Donovan bodies in 50.8% and 44.2% cases, respectively. Conclusions: There is a new focus of cutaneous leishmaniasis in Jammu division which deserves urgent attention from the public health angle. Further epidemiological studies are warranted to establish the identity of the vector and the strain of Leishmania involved.
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Background: Post kala-azar dermal leishmaniasis (PKDL) is a recognized dermatologic complication of successfully treated visceral leishmaniasis (VL). PKDL lesions are suspected to be important reservoirs for VL transmission in Sudan. Prolonged treatment schedules, feeling of general well-being and the social stigmata of PKDL prevent most patients seeking treatment. The mainstay of treatment is cardiotoxic sodium stibogluconate (SSG) for 60-120 days. Recently, liposomal amphotericin B (Ambisome®) and immunochemotherapy gave promising results. Ambisome® is expensive and difficult to prepare under field conditions. Paromomycin/SSG combination has been shown to be safe, efficacious and can save time in VL treatment. This study aims to prove that Paromomycin/SSG combination can cure and reduce PKDL treatment duration. Methods: We are reporting nine cases of patients with PKDL lesions of ≥6 months duration who were diagnosed by clinical signs, histopathological/immunohistochemical and PCR. Results: Patients’ mean age was 11.7 ± 4.3 years. A third of the patients (3/9; 33.3%) who failed previous SSG treatment of 2-3 months duration responded completely to 40 days of paromomycin/SSG combination. The majority of patients (5/9; 55.6%) responded completely to 30 days of the combination. One patient (1/9; 11.1%) relapsed following 30 days paromomycin/SSG combination. Conclusion: It was concluded that paromomycin/SSG combination for 30 days is time-saving, safe and efficacious for PKDL treatment.
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Cutaneous leishmaniasis (CL), an uncommon disorder in South-East Asia, including Bangladesh, often presents as granulomatous plaque on the exposed areas, with a high index of suspicion required for diagnosis. Here we report the first imported case of CL caused by Leishmania tropica in a migrant Bangladeshi worker in the Kingdom of Saudi Arabia (KSA). The case, initially suspected as a case of cutaneous tuberculosis, arrived at specimens reception unit (SRU) of diagnostic labs of icddr,b being referred by the physician for ALS testing for tuberculosis. At his arrival in the SRU, one of the health personnel of the unit who used to work in KSA suspected him as a case of CL. The diagnosis was confirmed by smear microscopy which revealed plenty of amastigotes within macrophages. PCR was performed to confirm the species. He was treated with sodium stibogluconate at Shahid Suhrawardy Medical College Hospital, Dhaka.
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Cutaneous leishmaniasis is a skin infection caused by the Leishmania species, an intracellular protozoan parasite that is transmitted by various species of female sandflies. According to the geographic distribution and vectors, leishmaniasis is classified as Old World or New World cutaneous leishmaniasis. In Korea, 24 cases of Old World cutaneous leishmaniasis have been reported, but New World cutaneous leishmaniasis has not been reported as yet. A 37-year-old man presented with a 3-month history of a painful and erythematous nodule with two satellite papules on the left postauricular area and a papule on the left arm after traveling to the Amazon region in Brazil. After we performed skin biopsies of the lesions, diagnosis of cutaneous leishmaniasis was made by the histopathological findings. After intralesional injection of sodium stibogluconate (Pentostam(R), GlaxoSmithKline) twice a week for 4 weeks, the lesions improved with scarring. Herein, we discuss this case of New World cutaneous leishmaniasis that was successfully treated with intralesional injection of sodium stibogluconate (Pentostam(R)) in Korea.
Subject(s)
Female , Humans , Antimony , Antimony Sodium Gluconate , Arm , Biopsy , Brazil , Cicatrix , Injections, Intralesional , Korea , Leishmania , Leishmaniasis , Leishmaniasis, Cutaneous , Parasites , Psychodidae , SkinABSTRACT
Cutaneous leishmaniasis is a skin infection caused by the Leishmania species, an intracellular protozoan parasite that is transmitted by various species of female sandflies. According to the geographic distribution and vectors, leishmaniasis is classified as Old World or New World cutaneous leishmaniasis. In Korea, 24 cases of Old World cutaneous leishmaniasis have been reported, but New World cutaneous leishmaniasis has not been reported as yet. A 37-year-old man presented with a 3-month history of a painful and erythematous nodule with two satellite papules on the left postauricular area and a papule on the left arm after traveling to the Amazon region in Brazil. After we performed skin biopsies of the lesions, diagnosis of cutaneous leishmaniasis was made by the histopathological findings. After intralesional injection of sodium stibogluconate (Pentostam(R), GlaxoSmithKline) twice a week for 4 weeks, the lesions improved with scarring. Herein, we discuss this case of New World cutaneous leishmaniasis that was successfully treated with intralesional injection of sodium stibogluconate (Pentostam(R)) in Korea.
Subject(s)
Female , Humans , Antimony , Antimony Sodium Gluconate , Arm , Biopsy , Brazil , Cicatrix , Injections, Intralesional , Korea , Leishmania , Leishmaniasis , Leishmaniasis, Cutaneous , Parasites , Psychodidae , SkinABSTRACT
Las políticas de vigilancia epidemiológica en Colombia han hecho énfasis en el diagnóstico y el tratamiento oportuno de la leishmaniasis en cualquiera de sus formas (visceral, cutánea o mucocutánea), sin embargo, no existe control sobre las reacciones adversas que pueden presentar los pacientes medicados con los antimoniales pentavalentes, fármacos usados en el país para tratar esta enfermedad tropical. A pesar de ser medicamentos empleados durante décadas, sus mecanismos de acción no están del todo establecidos y en parte tampoco sus reacciones adversas, sin embargo, es de suma importancia prevenirlas y saber como actuar en caso de presentarse. El caso reportado muestra como reacción adversa cardiotoxicidad secundaria a tratamiento con estibogluconato de sodio en una paciente con diagnóstico de leishmaniasis cutánea, asociado a hipokalemia; en una cuidadosa comparación con casos reportados y estudios epidemiológicos se puede establecer una asociación de antimoniales y síndrome de QT largo como primer paso de la cascada letal de cardiotoxicidad.
Surveillance policies in Colombia have emphasized diagnosis and timely treatment of leishmaniasis in any of its forms (visceral, cutaneous or mucocutaneous), however there is no control on adverse reactions that may occur in patients taking pentavalent antimonials, drugs used in the country to try this tropical disease. Despite being drugs used for decades, their action mechanisms are not fully established and neither their adverse reactions, all the same, it is extremely important to prevent them and know what to do if it presents. The reported case shows as adverse reaction, secondary cardiotoxicity to sodium stibogluconate treatment in a patient with diagnosis of cutaneous leishmaniasis associated with hypokalemia, in close comparison with case reports and epidemiological studies it can be set an association of antimony and long QT syndrome as the first step of the cascade lethal cardiotoxicity.
Subject(s)
Humans , Female , Aged , Cardiotoxins , Antimony Sodium Gluconate , Leishmaniasis , Long QT Syndrome , Epidemiological Monitoring , ColombiaABSTRACT
Cutaneous leishmaniasis (CL) is a vector borne disease caused by various species of Leishmania parasite. CL is endemic in the Thar desert of Rajasthan state and Himachal Pradesh in India. Immune suppression caused by human immunodeficiency virus (HIV) infection is associated with atypical clinical presentation of CL which responds poorly to the standard treatment and causes frequent relapses. We are reporting three cases of localized and disseminated CL due to Leishmania tropica which failed to respond to conventional intralesional/intramuscular sodium stibogluconate (SSG) injections. Initially, we did not think of HIV infection because CL is endemic in this region. When patients did not respond to SSG injections, we performed enzyme-linked immunosorbent assay (ELISA) tests for HIV and they turned out to be HIV positive. Our report showed that CL is emerging as an opportunistic infection associated with HIV/AIDS and may be the first manifestation in HIV positive patients in an endemic area.
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Background and Aims: A retrospective analysis of treatment outcome using recommended dose of sodium stibogluconate (SSG) alone and in combination with other antileishmanial drugs in adults with post-kala-azar dermal leishmaniasis (PKDL) attending as outpatients. Methods: A total of 61 patients seen over ten years were included in the report. All had polymorphic lesions. Diagnosis was based on clinical picture, hailing from kala-azar (KA) endemic area, exclusion of other dermatoses, histopathology, and therapeutic response. Patients were distributed into two groups: Group I (n = 32), where SSG was given intravenously; in Group II (n = 29), they were allocated to one of four categories using SSG in combination with other drugs. In the first category, SSG was given along with allopurinol (n = 10); in second with rifampicin (n = 6); and in third with both allopurinol and rifampicin (n = 5). In the fourth category, SSG was administered with an immunomodulator (n = 8), Mw vaccine, known to enhance host Th1 response. Results: Only 12 out of 61 patients completed treatment till histopathologic evidence of cure, five in Group I and seven in Group II, no patient being from third category. None had taken SSG without interruptions. Time taken for papulonodules to subside was similar in both groups, but erythema and induration subsided earlier in Group II. Group I patients attained cure after 120 injections while in Group II it took 95 injections in SSG + allopurinol and Mw vaccine categories respectively, and 110 with SSG + rifampicin. Nevertheless this was insufficient to facilitate compliance. Poor performance and high dropouts related to long duration of therapy, thrombophlebitis, difficulty in accessing veins, disabling rheumatic side-effects and practical problems. Liver, renal and pancreatic functions and ECG remained normal. Conclusion: No major advantage was obtained using allopurinol, rifampicin or Mw vaccine along with SSG as compared to SSG alone.