ABSTRACT
Antimony compounds are first line treatments for cutaneous leishmaniasis. The prognosis of the disease varies depending on the type of medicine and species. We aimed to determine the species responsible for cutaneous leishmaniasis in patients referred to Skin Diseases and Leishmaniasis Research Center in Isfahan and Bam Health Center (Kerman) in order to follow and assess the complete healing of the lesions. A total of 40 skin lesions samples were collected from patients with cutaneous leishmaniasis (CL) form January 2014 to 2015. Dermal scrapings were analyzed by examination of Giemsa-stained smears. Parasites were cultured and isolated in NNN and RPMI 1640 medium and DNA was extracted. We used PCR-RFLP assays of ITS1 genes for direct identification of Leishmania species. Treatment process was assessed after a treatment period with glucantime and healing of the studied cases was followed up. All the samples from Isfahan and Bam regions were L. major and L. tropica species respectively. In patients infected with L. major and L. tropica treated with glucantime, the shortest healing period was 40 days in 5(25%) and 60 days in 3(15.8%) patients, respectively and the longest healing period was 100 days in 1 (5%) and 160 days in 1 (5.3%) patient, respectively. The mean complete healing periods in patients with L. tropica and L. major were 100 and 58 days, respectively (P<0.001). Average recovery period for people with dry cutaneous leishmaniasis is longer than average recovery period for people with wet cutaeous leishmaniasis.
ABSTRACT
Break-through symptoms (BTS) in multiple sclerosis (MS) patients on beta-interferon (beta-IFN) monotherapy are most frequently treated with a brief administration of steroids. Here, we report the results of monitoring serum immunologic markers recorded at three-month intervals for 1.5 years in responders to beta-INF 1a (Avonex) monotherapy (n =21) and MS patients placed on Avonex with prednisone (n =83) and Avonex, prednisone and azathioprine (AZA) (n =21) because of BTS. Compared to 23 healthy controls, patients on Avonex monotherapy and Avonex with prednisone, in individuals on Avonex, prednisone and AZA, a significant decrease in serum concentration of soluble intercellular adhesion molecule-1 (sICAM-1) (P=0.001) was established. Combined therapy with Avonex, prednisone and AZA was associated with a significant increase in the serum level of interleukin (IL)10 (P <0.001). Compared to Avonex monotherapy, combined therapy suppressed the serum level of IL12p40, antagonized elevation in the serum concentration of soluble IL2 receptor (sIL2R) and inhibited an increase in the serum soluble CD95 (sCD95) molecule. In patients studied, no significant differences in the serum level of IL18 and tumor necrosis factor-alpha (TNF-alpha) were established. These findings are important in understanding some of the immunoregulatory mechanisms induced by combined therapy in MS.
