Erysipeloid cutaneous leishmaniasis: treatment with a new, topical, pure herbal extract.

Fourteen consecutive cases of erysipeloid cutaneous leishmaniasis were seen and evaluated. There were 13 females and one male patient with a mean age of 59 years. Diagnosis was based on clinical grounds and the presence of amastigotes in the lesions. Patients were divided into acute and chronic groups, with chronicity being defined as a disease duration of more than a year. All cases were treated with a fresh preparation of a herbal mixture, namely "Z-HE". The paste was applied once daily for 5 consecutive days and thereafter every 2 weeks, as needed, for a maximum period of 3 months. Two patients didn't appear for their regular follow up, the remaining 12 cases were followed up for more than a year after termination of therapy. Eleven (92%) of patients had complete healing in a matter of 1 to 7 months with no relapse after 12 months of follow up. In spite of a successful initial clinical response, the remaining one patient with the acute type of ECL had a subsequent relapse. Otherwise the acute and chronic cases had similar responses to therapy and outcome. No drug related side effect was noted. The high success rate, low cost, ease of preparation, and lack of toxicity makes "Z-HE" a promising new drug. Further investigations are needed to illuminate its mechanism(s) of action and also controlled trials are recommended to confirm its efficacy.

Time- and dose-limiting erysipeloid rash confined to areas of lymphedema following treatment with gemcitabine--a report of three cases.

Gemcitabine is a deoxycytidine analog with broad antitumor activity. Its main toxicities include myelosuppression, flu-like symptoms, bronchospasms and mild skin rash. We report three cases, in which the patients developed time- and dose-limiting erysipeloid skin reactions confined to areas of impaired lymphatic drainage after application of gemcitabine. Three patients with metastatic tumors (breast cancer, endometrial cancer and non-small cell lung cancer) received weekly infusions of gemcitabine (1000 mg/m2). All patients suffered from lymphedema of different origin and developed an erysipeloid erythema 40-48 h after chemotherapy within their preexisting lymphedema. Genuine erysipela was ruled out by laboratory tests and clinical observation. The skin reaction was repeatedly observed and faded after 14 days without specific treatment. Although the pathogenesis of the observed reaction is unclear, it is suspected that the skin symptoms were caused by gemcitabine or its metabolites. Gemcitabine is usually metabolized fast and excreted renally. In areas with impaired lymphatic drainage pharmakocinetics might be altered: inactivation happens slower and the drug might accumulate in the s.c. and cutaneous tissue, thus increasing local toxicity. Clinical judgement and biochemical parameters can help to tell apart genuine erysipela and the erysipeloid reaction.

[Experimental study on erysipeloid arthritis in the rabbit after blockage of lymph drainage]. / Experimentelle Untersuchungen zur Rotlauf-Arthritis beim Kaninchen nach zusätzlicher Lymphabflussblockade.

The lymph drainage was radically blocked in 29 rabbits. One to three days after the operation Erysipelothrix rhusiopathiae was inoculated subcutaneously into the animals. Some control animals were injected with agents of erysipelas and some only with the sterile solution without additional blockade of the lymph drainage. Light and electron microscopy as well as immuno-histological tests showed that the erysipelas arthritis developing in rabbits closely resembles human rheumatoid arthritis with exsudative-necrotising changes of the synovial membrane, proliferation of synovial cells and subsynovial, perivascular plasmacell, and lymphocyte infiltration. The changes were not intensified by the additional blockade of the lymph drainage, when comparing the side with lymph drainage blockade and the non-operated side. The results may be explained by a marked pathogenetic importance of the erysipelas infection in comparison to the relatively mild, lymphostate dependent alterations as well as by mobilisation of macrophages on the operated side.

Reacção leprotica erysipelatoide

O autor começa salientando a confusão que commumente alguns leprologos estabelecem entre a erysipela verdadeira e um tipo de reação leprotica de aspecto erysipelatoide. Cita os autores que ligeiramente têm se referido ao assumpto como Leloir, Gaucher e Bensaude, Zambaco Pachá, Klingmuller, Miclache, e Sylvio Cremer; em seguida faz um breve estudo clinico desse accidente. Trata do diagnostico differencial entre a erysipela estreptococcica e essa reação; affirma que o prognostico é benigno e que até, ás vezes, determina a regressão das lesões leproticas das regiões attingidas pela reacção. Quanto ao tratamento, visando uma evolução mais rapida e um alivio prompto aos doentes acha que o sulfon amido diamino azobenzol (Prontosil) dá resultados excellentes, principalmente quando a reação se localiza nos membros inferiores em que a injecção intra arterial (arteria femural) é bem indicada e perfeitamente viavel. Descreve 16 observações e conclue: A chamada erysipela habitualmente frequente em doentes de lepra é uma variedade de reação leprotica de aspecto erysipelatoide. Sómente em doente de lepra cutanea (lepromatosa) se manifesta a reacção erysipelatoide. O sulfon amido diamino azobenzol (Prontosil) tem se mostrado bastante efficaz na therapeutica dessa reacção.