[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

Frequency of resistance to systemically administered meglumine antimoniate [Glucantime] in patients with acute cutaneous leishmaniasis: a cross-sectional study

Pentavalent antimony compounds are the first line of treatment for cutaneous leishmaniasis. Clinical resistance to pentavalent antimony in the form of meglumine antimoniate [Glucantime] has been recognized as a problem in leishmaniasis. Herein, clinical response to Glucantime was studied in patients suffering from cutaneous leishmaniasis. In a cross-sectional study 370 patients with cutaneous leishmaniasis were treated with systemic Glucantime, 50 mg/kg/day, for 2 to 3 weeks. They were visited weekly for 3 weeks and also followed up for 3 months after treatment was completed. The clinical and parasitological response to this treatment was evaluated, and classified into partial and complete response and failure to treatment. Two hundred forty-seven men and 123 women were followed up. The mean age was 36.7 +/- 16 years. There were 64.1% partial response after 2 weeks and 73% partial response at the third week of treatment. 11.6% of lesions were not cured after 3 weeks of treatment and 8.1% were not still cured 12 weeks thereafter. Clinical resistance to Glucantime is an important problem. The mechanisms of resistance and using drug combinations are needed to be considered

[ efficacy of topical treatment with concentrated boiled extract and hydroalcoholic extract of cassia fistula in comparison with intralesional injection of glucantime in the treatment of acute leishmaniasis]

Cutaneous leishmaniasis is an endemic disease in Iran. Although there are many different treatments for this disease, there is not any effective treatment yet. Since there has been a number of different reports on the effectiveness of Cassia fistula plant in the treatment of leishmaniasis, the efficacy of concentrated boiled extract and hydro alcoholic extract of Cassia fistula on the leishmaniasis disease was compared with intralesional injection of Glucantime in this study. In this randomized clinical trial a total of 165 patients, 6 to 60 years old, who had a positive leishmania smear refered to the Isfahan Skin and Leishmaniasis Research Center were divided into three groups using list of random numbers and were treated with: concentrated boiled extract of Cassia fistula, hydroalcholic extract of Cassia fistula, or intralesional injection of Glucantime. The patients were treated for 4 weeks and followed for three months after the study started. The efficacy of treatment was reported as complete cure, partial improvement and no improvement on the basis of clinical and parasitological evidence. In the present study 63/6% of patients treated with the concentrated boiled extract, 52/7% of the hydroalcoholic extract and 45/5% of the Glucantime group were men. 22 patients [40%] of the concentrated boiled extract of Cassia fistula, 20 pateints [36/4%] of the hydroalcoholic extract of Cassia fistula group and 36 patients [65/5%] of the Glucantime group showed complete cure. The efficacy in the third group was much more than the first [P<0.02] and second groups [P<0.005], but there was not any difference between concentrated boiled extract and hydroalcoholic extract of Cassia fistula. The results of this study showed that this plant might be used topically along with Glucantime for decreasing the time and dose of treatment with Glucantime

comparative study on the efficacy of combination therapy with omeprazole and low dose systemic meglumine antimoniate [Glucantime] and the full dose systemic meglumine antimoniate in the treatment of cutaneous leishmaniasis

Pentavalent antimony compounds are the first line of treatment of cutaneous leishmaniasis. However, because of their potential toxic effects attempts to find more effective and safer drugs still is in function. The objective of this study was to compare the efficacy of oral omeprazole and low dose systemic meglumine antimoniate [MA] and full dose systemic MA in the treatment of cutaneous leishmaniasis. A double blind clinical trial was performed on 150 patients with cutaneous leishmaniasis. The patients were randomly divided to three groups: l]intramuscular injections of MA [60 mg/kg/day] and oral placebo for three weeks; 2] intramuscular injections of MA [30 mg/kg/day] and oral omeprazole [40 mg/day] for three weeks; 3] intramuscular injections of MA [30 mg/kg/day] and oral placebo for three weeks. All patients were visited every two weeks from the beginning of the trial up to 6 weeks and then at 8 and 12 weeks. The effectiveness of the treatment was classified in three levels as complete response, partial response and failure. Data were analyzed by SPSS software version 10 by using X [2], Mann-Whitney, Kaplan-Mayer and ANOVA t tests. Three months after the treatment, complete response and partial response in group one [43 patients] were 93% and 0%, respectively, which were significantly higher than other two groups [P<0.05]. Complete response and partial response were 88.9% and 2.8% in group two [36 patients], and 80% and 2.2% in group three [45 patients], respectively. Efficacy of the treatment in group two was significantly higher than group three [P<0.05]. Although oral omeprazole and low dose of systemic MA showed less efficacy in comparison to standard dose of systemic MA in treatment of cutaneous leishmaniasis, it can be considered as an alternative therapy in high risk patients [such as patients with heart, kidney and/or liver disease] under close supervision of specialized physician