RESUMO
Liposomal-amphotericin B (L-AmB) is used for cutaneous leishmaniasis (CL); however, its treatment failure has not yet been described in detail. A 58-year-old man returned from the Republic of Venezuela with a cutaneous ulcer on his left lower leg. The causative pathogen was Leishmania braziliensis. We started L-AmB 3 mg/kg/day for 6 days; however, the ulcer did not resolve. The patient was successfully retreated with a higher dose L-AmB 4 mg/kg/day 9 times (total, 36 mg/kg). If L-AmB fails to treat CL and other therapeutics cannot be used, increasing the L-AmB dose is a viable option.
Assuntos
Anfotericina B/uso terapêutico , Antiprotozoários/uso terapêutico , Leishmania braziliensis/isolamento & purificação , Leishmaniose Cutânea/diagnóstico , Anfotericina B/administração & dosagem , Antiprotozoários/administração & dosagem , Diagnóstico Diferencial , Relação Dose-Resposta a Droga , Humanos , Leishmaniose Cutânea/complicações , Leishmaniose Cutânea/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Retratamento , Falha de TratamentoRESUMO
Cutaneous leishmaniasis (CL) is gaining attention as a public health problem. We present two cases of CL imported from Syria and Venezuela in Japan. We diagnosed them as CL non-invasively by the direct boil loop-mediated isothermal amplification method and an innovative sequencing method using the MinION™ sequencer. This report demonstrates that our procedure could be useful for the diagnosis of CL in both clinical and epidemiological settings.
Assuntos
Doenças Transmissíveis Importadas/diagnóstico , Leishmania braziliensis/isolamento & purificação , Leishmania tropica/isolamento & purificação , Leishmaniose Cutânea/diagnóstico , Técnicas de Amplificação de Ácido Nucleico/veterinária , Análise de Sequência de DNA , Pré-Escolar , Doenças Transmissíveis Importadas/parasitologia , Humanos , Japão , Leishmaniose Cutânea/parasitologia , Masculino , Pessoa de Meia-Idade , Nanoporos , Síria , VenezuelaRESUMO
A 53-year-old Japanese woman who was working as a volunteer in the Commonwealth of Dominica in the Caribbean islands presented with a high-grade fever and severe incapacitating generalized arthralgia. The Asian genotype of the chikungunya virus was confirmed using reverse transcription-PCR and serology, based on the presence of a specific neutralization titer and immunoglobulin M antibodies. She was diagnosed with post-chikungunya chronic arthritis based on persistence of her polyarthritis for 3 months and the presence of rheumatoid factor, immunoglobulin G-rheumatoid factor, and matrix metalloproteinase-3. Chikungunya virus should be considered as a causative pathogen in travelers returning from Caribbean islands. Clinicians should consider chikungunya fever in the differential diagnosis of patients who complain of chronic arthritis and have a history of travel to an endemic area.