Monitoring the response of patients with cutaneous leishmaniasis to treatment with pentamidine isethionate by quantitative real-time PCR, and identification of Leishmania parasites not responding to therapy.

BACKGROUND: Leishmania (Viannia) guyanensis is believed to be the principal cause of cutaneous leishmaniasis (CL) in Suriname. This disease is treated with pentamidine isethionate (PI), but treatment failure has increasingly been reported. AIM: To evaluate PI for its clinical efficacy, to compare parasite load, and to assess the possibility of treatment failure due to other infecting Leishmania species. METHODS: Parasite load of patients with CL was determined in skin biopsies using real-time quantitative PCR before treatment and 6 and 12 weeks after treatment. Clinical responses were evaluated at week 12 and compared with parasite load. In parallel, molecular species differentiation was performed. RESULTS: L. (V.) guyanensis was the main infecting species in 129 of 143 patients (about 90%). PI treatment led to a significant decrease (P < 0.001) in parasite counts, and cured about 75% of these patients. Treatment failure was attributable to infections with Leishmania (Viannia) braziliensis, Leishmania (Leishmania) amazonensis and L. (V.) guyanensis (1/92, 1/92 and 22/92 evaluable cases, respectively). There was substantial agreement beyond chance between the parasite load at week 6 and the clinical outcome at week 12, as indicated by the κ value of 0.61. CONCLUSIONS: L. (V.) guyanensis is the main infecting species of CL in Suriname, followed by L. (V.) braziliensis and L. (L.) amazonensis. Furthermore, patient response to PI can be better anticipated based on the parasite load 6 weeks after the treatment rather than on parasite load before treatment.

[Anaphylactic reactions to chlorhexidine during urinary catheterisation]. / Anafylactische reacties op chloorhexidine bij blaaskatheterisaties.

Three men of 65, 41 and 54 years old respectively, developed an anaphylactic reaction during a medical procedure. Two were under general anaesthesia and the third was undergoing urinary catheterisation. After allergy tests chlorhexidine, an ingredient in the gel which was used during the urinary catheterisation procedure, was found to be the causative agent in all three men. Following treatment the clinical course was good. Chlorhexidine is a widely used antiseptic and disinfectant. Despite multiple publications on anaphylactic reactions mostly during surgery under general anaesthesia or urological procedures, chlorhexidine is often initially overlooked as a cause of anaphylaxis. All three men had had previous reactions to chlorhexidine, however, not enough attention was paid to this fact, or it was not thought of.