Cutaneous New World leishmaniasis-sporotrichosis coinfection: report of 3 cases.

Three cases of coinfection with Leishmania and Sporothrix spp in the same lesion are described. The patients had ulcers with erythematous borders and regional lymphadenopathy. The diagnosis of leishmaniasis was accomplished by direct visualization of the amastigotes or culture of the promastigotes, or both. The diagnosis of sporotrichosis was proved in two cases by culture of Sporothrix schenckii and by the histopathologic features in one case. All patients had a positive sporotrichin test. Two patients responded successfully to oral potassium iodide. One patient received oral itraconazole 100 mg/day because of intolerance to iodides and was cured. To our knowledge coinfection with Leishmania and Sporothrix spp has not been reported. The use of empirical treatments for leishmaniasis such as poultices or puncturing of the lesion with thorns or woods splinters might introduce Sporothrix and explain the coinfection.

Lack of efficacy of mefloquine in the treatment of New World cutaneous leishmaniasis in Colombia.

In a nonblinded, therapeutic trial conducted in Colombia, 1.25-1.5 grams of mefloquine base given as a single oral dose or as 250 mg a day for 5-6 consecutive days was not efficacious in the treatment of New World cutaneous leishmaniasis. The drug had cured only 30.8 % of patients with leishmaniasis skin lesions by the 10th week after start of therapy as compared with a 27.9% complete cicatrization rate in historical controls treated with placebo tablets and an 86.3% cicatrization rate in historical controls who received meglumine antimoniate, 20 mg/ kg/day intramuscularly for 20 days, with no upper limit to daily dose. It is concluded that a single course treatment with mefloquine is not indicated as monotherapy in the treatment of Colombian cutaneous leishmaniasis primarily due to L. panamensis.