Glucantime efficacy in the treatment of zoonotic cutaneous leishmaniasis.

Pentavalent antimony (SbV) compounds are still considered the first line of treatment for all forms of leishmaniasis. There have been reports of drug resistance and unresponsiveness to treatment with these drugs. We investigated the clinical response to treatment of cutaneous leishmaniasis with glucantime, the drug of choice for all forms of leishmaniasis in Iran. All individuals suspected of cutaneous leishmaniasis from October 2007 to March 2008 were included in the study if met specific criteria. After laboratory diagnosis and parasite identification by PCR, 43 patients agreed to participate and complete the protocol for treatment. Meglumine antimoniate (glucantime) was given at a dose of 20 mg/kg/day for 20 days (two 10-day periods) according to a World Health Organization (WHO) recommended protocol. Response to treatment was evaluated 6 weeks after initiation of treatment. Fifteen patients (34.9%) were clinically unresponsive to glucantime treatment while the remaining 28 patients (65.1%) responded to treatment. There were no statistically significant differences by occupation, gender, chronicity of the disease before starting treatment, number of lesions, or age between the glucantime sensitive and resistant patients. Our study showed a significant level of unresponsiveness to glucantime among patients with cutaneous leishmaniasis caused by Leishmania major in Iran. These findings highlight the need for new treatment regimens.

Comparison of three methods for diagnosis of cutaneous leishmaniasis.

BACKGROUND: Leishmaniasis is one of the infectious parasitic diseases of highest incidence in the world. Cutaneous Leishmaniasis (CL) has long been reported in Shiraz, Southern Iran. There is a need to find a sensitive and specific method for treatment and control of the disease. METHODS: We have compared the sensitivity of the conventional methods microscopy and cultivation of lesion scrapes against PCR amplification of parasite kinetoplast DNA from these samples. The samples (n=219) were obtained from the patients clinically suspected of CL. The smears were stained with Giemsa for microscopy and cultured in Novy-Nicolle-McNeal (NNN) blood agar for promastigote growth. For PCR, the dry smears were scraped off the slides and DNA was extracted. RESULTS: The positive rates from 219 specimens were 76.71%, 50.68%, and 93.61% for microscopy, cultivation, and PCR, respectively. The highest correlation was found between PCR and microscopy method (P=0.014). In PCR assay, 95.61%, 3.9%, and 0.49% of the samples were identified as Leishmania major, L. tropica, and dermatropic L. infantum, respectively. CONCLUSION: The PCR method appears to be the most sensitive for the diagnosis of CL and is valuable for identifying the other species of Leishmania with confusing dermatropic signs.

Rodent infection with Leishmania in a new focus of human cutaneous leishmaniasis, in northern Iran.

The incidence of zoonotic cutaneous leishmaniasis (ZCL), which is endemic in several parts of Iran, has recently increased in the rural areas of the northern district of Damghan, in Semnan province. Between 2001 and 2004, as part of an investigation of this worrying trend, wild rodents in this region were caught and checked, by the microscopical examination of liver and spleen smears, for leishmanial infection, to see which species were acting as 'reservoir' hosts. Overall 298 Nesokia indica, 29 Meriones libycus, 10 Mus musculus and two Microtus socialis were caught. Most of the N. indica (61%) and Me. libycus (52%) but none of the other rodents were found smear-positive for leishmanial amastigotes. When PCR was used to test scrapings from 50 of the smears (of which 25 had been found to harbour amastigotes, by microscopy), 29 (58%) of the smears were found positive for the kinetoplast DNA of Leishmania major; none was found positive for any other Leishmania species. Nesokia indica and Me. libycus are therefore incriminated as the main 'reservoir' hosts of L. major in Damghan.