Comparative efficacy of intralesional sodium stibogluconate (SSG) alone and its combination with intramuscular SSG to treat localized cutaneous leishmaniasis: Results of a pilot study.

BACKGROUND: Intralesional sodium stibogluconate (SSG) has become first line therapy for localized cutaneous leishmaniasis (LCL). AIMS: This study compares the efficacy of intralesional SSG given alone with that of intralesional SSG combined with intramuscular SSG. METHODS: Thirty-two patients aged between 5-56 years were included in the study. The first group received three injections of intralesional SSG on alternate days while the other group received three injections of intralesional SSG similar to the first group and the rest of the calculated dose as a simultaneous, intramuscular injection. Patients were followed up every four weeks to assess for cure/ the need for repeating the treatment. RESULTS: Five patients from group 1 having small nodular lesions of < six months duration were cured after 1-2 treatment cycles. However, six patients with mucosal lesions, large lesions and lesions of > six months duration needed 3-5 treatment schedules. Most plaques and mucosal lesions in seven patients in group 2 cleared with two treatment cycles. CONCLUSION: Intralesional combined with intramuscular SSG appears more effective in LCL and gave qualitatively superior healing than intralesional SSG given alone.

Incidence of megaloblastic anaemia and its correction in leishmaniasis--a prospective study at BPKIHS hospital, Nepal.

Fifty (50) cases of Leishmaniasis were included in a prospective study after making the diagnosis based on the demonstration of L D Bodies on bone marrow aspirate. Hemoglobin (Hb) and total leucocyte count (TLC) were less than 10 gm/dl and 4000 per/ml respectively in 22 out of 50 cases. Among 50 cases, 30 showed macrocytic red cell and hypersegmented neutrophils on peripheral blood smear as features of megaloblastic anemia. Out of 30 cases of leishmaniasis with megaloblastic anemia, 10 cases showed decreased reticulocyte count. Bone marrow aspiration cytology showed megaloblastic maturation in erythroid series and giant metamyelocytes in myeloid series in all 30 cases of leishmaniasis with megaloblastic changes. Bone marrow iron was also increased in these cases. However megakaryocyte was normal in all. Among 30 cases of leishmaniasis with megaloblastic changes, 15 cases were treated with sodium antimony gluconate (SAG) only and other 15 with SAG, folic acid and Vit. B12. Rest 20 cases of leishmaniasis without megaloblastic changes were also treated with SAG only. After treatment with SAG alone as well as with SAG, folic acid and vit. B12, hemoglobin and TLC improved in all 50 cases. Of 15 cases of leishmaniasis with megaloblastic changes, who were treated with SAG, folic acid and vit. B12, the reticulocyte count reached at peak on the 7th day and normalized at the end of 4th week. Red blood cells (RBC) also became normocytic normochromic and neutrophils became normal on peripheral blood smear. But no change was observed in reticulocyte count, RBC and white blood cell (WBC) morphology on peripheral blood smear in cases of leishmaniasis without megaloblastic changes and other 15 cases of leishmaniasis with megaloblastic changes, who received SAG only.

Eficacia y tolerabilidad del Glucantime versus Estibogluconato Sódico en Leishmaniosis de enero de 1999 a diciembre del 2001 en el C. S. San Camilo, Pozuzo-Oxapampa, Pasco / Effectiveness and tolerated of the Glucantime versus sódico estibogluconato in leishmaniosis of January of 1999 to December of the 2001 in C.S. San Camilo, Pozuzo-Oxapampa, Pasco

Estudio prospectivo de pacientes con diagnóstico de Leishmaniosis del Centro de Salud San Camilo de Pozuzo. Se comparó Glucantime 20 mg Base/Kg/día IM durante 20 días-dosis máxima 1275 mg/día-administrado de enero de 1999 a diciembre de 2000 vs. Estibogluconato de Sodio 20 mg Base/Kg/día IM durante 30 días -dosis máxima 1,500 mg/día-de enero a diciembre de 2001. En 173 pacientes con Leishmaniosis, 116 L. Cutánea (67.05 por ciento) y 57 L. Cutaneomucosa (32.95 por ciento). De 135 tratados con Glucantime (78.03 por ciento) y 38 con Estibogluconato de Sodio (21.96 por ciento), 45 con Glucantime (33.3 por ciento) y 25 con Estibogluconato de Sodio (65.78 por ciento) presentaron reacciones adversas; seis con Glucantime (4.44 por ciento) y cuatro con Estibogluconato de Sodio (10.53 por ciento) abandonaron el tratamiento. Recayeron 15 pacientes con Glucantime (10 L. Cutaneomucosa y 05 L. Cutánea) y dos pacientes con Estibogluconato de Sodio, (01 L. Cutaneomucosa y 01 L. Cutánea). Ambos Antimoniales Pentavalentes demostraron eficacia relativa similar llegando al proceso de cicatrización de la lesión con frotis negativo en controles posteriores al tratamiento. El tratamiento con Glucantime fue mejor tolerado por menor presencia de efectos adversos y escasos abandonos.

In a prospective study of patients with leishmaniasis diagnosed at the San Camilo of Pozuzo Health Center, we compared two treatments: glucantime 20 mg Base/kg/ day IM for 20 days, with a maximum dose of 1275 mg/ day (treatment performed from January 1999 to December 2000), versus sodium stibogluconate 20 mg Base/kg/ day IM for 30 days, with a maximum dose of 1500 mg/day (treatment performed from January to December 2001). Of the 173 leishmaniasis patients, 116 had L. cutanea (67.05%) and 57 had L. cutaneomucosa (32.95%). Of the 135 patients treated with glucantime (78.03%) and 38 with sodium stibogluconate (2l.96%), 45 (33.3%) and 25 (67.78%) respectively, presented adverse reactions. Six patients under treatment with glucantime (4.44%) and 4 treated with sodium stibogluconate (10.53%) discontinued treatment. Fifteen patients under glucantime (l0 affected with L. Cutaneomucosa and 5 with L. Cutanea) and 2 patients with sodium stibogluconate (one with L. Cutaneomucosa and one with L. Cutanea) relapsed. Both pentavalent antimonial showed relative similar efficiency achieving complete healing of lesions and negative frotis in posterior controls after treatment. Treatment with glucantime was best tolerated due to less adverse effects and fewer desertions.

Pneumocystis carinii pneumonia, pulmonary tuberculosis and visceral Leishmaniasis in an adult HIV negative patient

This is a case report of a 29 year old male with pneumocystis pneumonia and tuberculosis, and who was initially suspected of having HIV infection, based on risk factor analyses, but was subsequently shown to be HIV negative. The patient arrived at the hospital with fever, cough, weight loss, loss of appetite, pallor, and arthralgia. In addition, he was jaundiced and had cervical lymphadenopathy and mild heptosplenomegaly. He had interstitial infiltrates of the lung, sputum smears positive for Mycobacterium tuberculosis and Pneumocytis carinii, and stool test were positive for Strongyloides stercoralis and Schistosoma mansoni. He was diagnosed as having AIDS, and was treated for tuberculosis, pneumocystosis, and strongyloidiasis with a good response. The patient did not receive anti-retroviral therapy, pending outcome of the HIV tests. A month later, he was re-examined and found to have worsening hepatosplenomegaly, pancytopenia, fever, and continued weight loss. At this time, it was determined that his HIV ELISA antibody tests were negative. A bone marrow aspirate wasdone and revealed amastigotes of leishmanis, and a bone marrow culture was positive for Leishmanis species. He was treated with pentavalent antimony, 20 mg daily for 20 days, with complete remission of symptoms and weight gain. This case demonstrates that immunosupression from leishmaniosis and tuberculosis may lead to pneumocystosis, and be misdiagnosed as HIV infection. The occurrence of opportunistic infections in severely ill patients without HIV must always be considered and alternate causes of immunosupression sought.

Leishmaniose tegumentar americana: do histórico aos dias de hoje / Cutaneous american leishmaniasis: from the beginning until nowadays

Sintética revisäo sobre leishmaniose tegumentar americana enfatizando aspectos históricos, características do ciclo da leishmaniose, relaçäo vetor-parasita-hospedeiro, epidemiologia, formas clínicas, diagnóstico, técnicas laboratoriais e tratamento

Leishmaniasis americana en la infancia / Infantile american leishmaniasis

Desde 1972 a 1997 hemos detectado 302 enfermos con leishmaniasis americana; 64 casos (21,19 por ciento) corresponden a la infancia. El diagnóstico se basó en la clínica, estudios parasitológicops. Prevalencia del sexo masculino con 54,69 por ciento y en las formas clínicas, las cutáneas puras representan el 93,75 por ciento. Consideramos a los antimoniales pentavalentes como la droga de elecciín para el tratameinto de esta enfermedad. En la actulidad la leishmaniasis americana constituye un serio problema de alto contenido social, médico y sanitario por los desmontes que se relaizan en el norte de nuestra provincia

A thirty day course of sodium stibogluconate for treatment of Kala-azar in Nepal.

Twenty-seven cases of Kala-azar were treated with sodium stibogluconate at a dose of 20 mg/kg/day for 20 days (group A) and an equal number of cases were treated with the same dose but for a longer duration of 30 days (group B). Clinical and laboratory evaluation of these cases were carried out before and after therapy, during a follow up of cases every month, upto 6 months. Renal and liver function tests and electrocardiography were carried out of monitor any toxic effect of the drug during therapy. The cure rates of patients were 77.78% and 92.59% in group A and B cases respectively. Six and two patients in group A and B respectively were unresponsive to the treatment and showed relapse. Results of the study show that treatment of cases of Kala-azar with sodium stibogluconate in a dosage of 20 mg/kg/day for a longer period of 30 days is effective with a higher cure rate and minimum side effects, for treatment of cases of Kala-azar in this eastern part of Nepal, endemic for the disease.

Nuevos aportes clínico-patológicos y terapéuticos en leishmaniasis / New development on the clinical, pathological and therapeutics aspects of leishmaniasis

La leshmaniasis es producida por un protozoo, trasmitida por muchos mosquitos hematófagos (Lutzomia brasiliensis), artrópodos (Rhipicephalus turanicus) y probablemente triatomideos (Triatoma infestans, Pansterongilus infestans). En Bolivia existen tres formas de leishmaniasis: cutánea, mucocutánea y visceral, producidas por el mismo agente etiológico, con tres diferentes fases evolutivas relacionadas con mecanismos inmunológicos dependientes de muchos factores. Las tres responden a diversas drogas, a veces inespecíficas, que son empleadas para otras enfermedades (plasmodios, trichomonas, giardias, hongos y bacilos de Koch). Las sales antimoniales pentavalentes son las más comúnmente usadas, con resultados variables, a veces adversos, por su toxicidad, ineficacia ineficiencia y, sobre todo, resistencia y difícil manejo. Se ha demostrado que la L. cutánea tratada con glucantime, anfotericina B y otros presenta posteriormente lesiones mucocutáneas. Por otro lado, leishmaniosos que curaron espontáneamente han mostrado lesiones secundarias en forma ocasional. Lo que demuestra que en esta enfermedad existe una falla inmunológica, razón por la que usamos un inmunomodulador (DECARIS-clorhidrato de levamisol-, que es un antiparasitario), con buenos resultados (95 por ciento de éxito), sobre todo por su bajo costo, uso cómodo y efectos colaterales mínimos. Finalmente concluimos que en el momento actual no existe un leishmanicida eficaz para el tratamiento de esta enfermedad. El tratamiento inmunológico parece ser muy prometedor

efficacy of different dosage regimens of pentavalent antimony on cutaneous leishmaniasis in mice

The efficacy of different dosage regimens of sodium stibogluconate [SSG], a pentavalent antimony [sb] agent in the treatment of cutaneous leishmaniasis [CL] in male Balb/c mice was investigated. Mice with CL were divided into four groups. Mice in group 1, were injected intramuscularly with saline [control] and those in groups 2, 3 and 4 were injected with a total daily dose of 300 mg Sb/kg :300 once 150 twice and 100 thrice mg sb/kg respectively daily for 10 days. None of the mice in groups 1 or 4 was cured, however the cure rates in groups 2 and 3 were 50% and 33%, respectively. Lesion size was reduced by 89% in group 2 as compared to 56% and 16% in groups 3 and 4 respectively. Peak plasma antimony level [C[max]]was determined in another 3 groups of mice that were given 300, 150 and 100 mg sb/kg. The C[max] were: 34.3, 15.9 and 8.4 micro g /ml in groups 1.2 and 3 respectively. Those of groups 1 and 2 but not 3 were within the in vitro ED50 range [12-20 mg/1] of SSG. In conclusion, higher cure and healing rates as well as a more effective antimony plasma level are obtained when the total daily requirements of SSG is given as a single dose. This regimen should, thus be used instead of divided doses when treating CL

Evaluation of amphotericin B as a first line drug in comparison to sodium stibogluconate in the treatment of fresh cases of kala-azar.

A total of 150 patients of kala-azar matched for age and sex and parasitologically proved were randomly allocated to two equal treatment groups. Patients in one group received amphotericin B(AMB) in a dose of 1 mg/kg body weight (BW) on alternate days starting with 0.05 mg/kg/bw on first day with daily increments, till a total dose of 20 mg/kg/bw was given; the patients in the second group received sodium stibogluconate (SAG) in the dose of 20 mg/kg/bw, im daily for 30 days. The efficacy, safety and cost-effectiveness of the two drugs were compared. Apparent cure (afebrile at the end of therapy) in 75 (100%) and 69 (92%) patients and ultimate cure (no relapse in six months of follow up) in 75 (100%) and 60 (80%) patients occurred in the AMB and SAG groups respectively. The difference between the ultimate cure in the two groups was significant (P < 0.001). Six (8%) and 9(12%) patients of SAG group showed primary (with no response to SAG during treatment) and secondary unresponsiveness (with no response to SAG after relapse) respectively and they were cured with amphotericin B.(ABSTRACT TRUNCATED AT 250 WORDS)

Avaliaçäo do tratamento da leishmaniose cutâneo-mucosa com três esquemas diferentes de antimoniais pentavalentes / Evaluation of the treatment with antimonials in American mucocutaneous Leishmaniasis

Um grupo de 87 pacientes de leishamniose tegumentar americana foi tratado com antimoniais pentavalentes pelos três seguintes esquemas: A - N-metil-glucamina (Glucantime) 28 mg/Kg/dia de SbV, durante 10 a 12 dias, em três séries, com intervalo de 15 dias (40 casos); B - N-metil-gucamina (22 casos) ou estibogluconato de sódio (Pentostam) (quatro casos) 20mg/Kg/dia de Sb V, durante 14 a 85 dias, com duraçäo média de 30 dias; C - Estibogluconato de sódio 10mg/Kg/dia de Sb V, durante 30 dias (21 casos). O diagnóstico clínico foi confirmado por esfregaço, histopatologia, inoculaçäo em hamster (para pesquisa do parasita) e teste intradérmico de Montenegro. A reaçäo de imunofluorescência indireta utilizada no controle de cura foi realizada antes e ao fim do tratamento e de seis em seis meses após o tratamento até a negativaçäo. O esquema A mostrou-se eficaz na forma cutânea (cura clínica em 13 de 14 casos) e menos ativo na forma mucosa (cura de 15 em 26 casos). Com o esquema B houve cura em 12 de 14 casos da forma cutânea e em 11 de 12 casos da forma mucosa. No esquema C observou-se cura clínica em um de três casos da forma cutânea e em 11 de 18 casos da forma mucosa. O teste exato de Fischer näo revelou diferença significativa a nível de 0.01 entre os três esquemas para a forma cutânea, enquanto para a forma mucosa o esquema B foi o mais eficaz. Sessenta e sete por cento dos pacientes referiram queixas clínicas no decurso do tratamento (artralgia, mialgia, anorexia, náuseas e vômitos, por ordem de freqüência). Aumento das transaminases ou da fosfatase alcalina foi verificado em 24% dos pacientes. Anormalidades eletrocardiográficas foram observadas em 22% (distúrbios de repolarizaçäo, bradicardia sinusal ou alteraçäo de onda T). Entretanto os efeitos colaterais observados excepcionalmente levaram à interrupçäo do tratamento