Karyosystematic and morphometric characterization of the rodents as reservoir hosts of zoonotic cutaneous leishmaniasis in an endemic focus of Isfahan Province, Iran.

BACKGROUND & OBJECTIVES: Rodents belonging to Gerbillinae subfamily are the main reservoir hosts of zoonotic cutaneous leishmaniasis (ZCL) in Iran. Regarding the important role of these rodents in the maintenance of Leishmania major in the nature, their identification with morphometric, cytogenetic and molecular methods seems to be essential. The karyotype study of these species, captured from a new focus of zoonotic cutaneous leishmaniasis located in the south of Isfahan Province was carried out in 2007. METHODS: Twenty specimens containing seventeen Meriones persicus and three Nesokia indica were captured from Mobarakeh rural district south of Isfahan. Giemsa-stained karyotypes of these two species were prepared from bone marrow chromosome preparations. Systematic important characters of the body and cranium (incisors, molars, occipitonasal, condylobasal, zygomatic, tympanic bullae, etc.) of these rodents were studied. Cranium size was measured using a Vernier calipers. RESULTS: Specimens of M. persicus and N. indica had 2n = 42. The karyotype study of these species included metacentric, sub-metacentric and acrocentric chromosomes. Morphological studies were completely matched with the reported characters of these species and further confirmed the diagnoses. INTERPRETATION & CONCLUSION: Based on the results of this study, M. persicus and N. indica are two completely differentiated rodents species that were collected from a new focus and they can also be differentiated morphologically.

A comparative study between the efficacy of systemic meglumine antimoniate therapy with standard or low dose plus oral omeprazole in the treatment of cutaneous leishmaniasis.

BACKGROUND & OBJECTIVES: Pentavalent antimony compounds are the first line of drugs in the treatment of cutaneous leishmaniasis. However, because of their potential toxic effects, many investigations are performed to find an effective and safe treatment for cutaneous leishmaniasis patients. Our objective in this investigation was to compare the effect of oral omeprazole and low dose systemic meglumine antimoniate (MA) and standard dose of systemic MA in the treatment of cutaneous leishmaniasis. METHODS: This was a randomized double-blinded clinical trial. In 150 patients with cutaneous leishmaniasis who were randomly divided into three groups and were treated with: (i) MA 60 mg/kg/day/ IM and oral placebo for three weeks; (ii) MA 30 mg/kg/day/IM and oral omeprazole 40 mg/day for three weeks; and (iii) MA 30 mg/kg/day/IM and oral placebo for three weeks. All the patients were visited every two weeks from the beginning of the trial up to six weeks and then at 8 and 12 weeks. The effectiveness of the treatment was classified in three levels as complete response, partial response and no response. Data were analyzed by SPSS 10 using KI square, Mann-Whitney, Kaplan-Mayer and ANOVA tests. RESULTS: Rate of complete response for three months (12 weeks) after starting the treatments was 93% for the group treated with standard dose of glucantime and placebo, 89% for the group treated with omeprazole and low dose glucantime and 80% for the group treated with low dose glucantime and placebo and these differences were significant (p < 0.05). The highest response rate was for the group treated with standard dose of glucantime and placebo. INTERPRETATION & CONCLUSION: Although oral omeprazole and low dose of systemic MA showed less efficacy in comparison to standard dose of systemic MA in the treatment of cutaneous leishmaniasis, it still can be considered as a replacement therapy in high risk patients (such as patients with heart, kidney and/or liver disease) under close supervision of physician.

Comparison of Thymus vulgaris (Thyme), Achillea millefolium (Yarrow) and propolis hydroalcoholic extracts versus systemic glucantime in the treatment of cutaneous leishmaniasis in balb/c mice.

BACKGROUND & OBJECTIVES: Leishmaniasis is a parasitic disease transmitted by sand flies. Many investigations are performed to find an effective and safe treatment for leishmaniasis. In this study, we evaluated the efficacy of herbal extracts of Thymus vulgaris (Thyme) and Achillea millefolium (Yarrow), propolis hydroalcoholic extract and systemic glucantime against cutaneous leishmaniasis in Balb/c mice. METHODS: A total of 45 mice were randomised into five groups each including nine mice. They were treated with pure ethanol 70 degrees, systemic glucantime, Achillea millefolium hydroalcoholic extract, Thymus vulgaris hydroalcoholic extract and propolis hydroalcoholic extract for six weeks. The statistical tests including student t-test were used for analysis. Data were analyzed by SPSS software, ver 13.00. RESULTS: Mean of ulcer size reduction were -17.66, -22.57, 43.29, 36.09 and 43.77% for the alcohol, glucantime, yarrow, thyme and propolis groups, respectively. The results were suggestive that Thymus vulgaris, Achillea millefolium and propolis hydroalcoholic extracts were significantly more effective in reduction of ulcer size as compared with glucantime (p = 0.006, 0.002 and 0.008, respectively). INTERPRETATION & CONCLUSION: Our results are suggestive that Thymus vulgaris, Achillea millefolium and propolis extracts are effective for treatment of cutaneous leishmaniasis in mice. Regarding these results, we suggest that efficacy of these extracts alone or in combination are evaluated against human cutaneous leishmaniasis as a randomized clinical trial.

Disseminated subcutaneous nodules caused by Pseudallescheria boydii in an atopic patient.

We present a 40-year-old woman with atopic dermatitis and multiple purulent subcutaneous nodules of 20 years' evolution. The biopsy material was cultured and revealed Pseudallescheria boydii. The patient was treated with oral itraconazole for 4 months and incision and drainage of the lesions. Afterwards the patient remained asymptomatic and no new lesions were detected.

Evaluation of CO laser efficacy in the treatment of cutaneous leishmaniasis.

BACKGROUND: Cutaneous leishmaniasis is a common disease in Iran, especially in the north-east, central and southern parts of the country. Many treatments have been suggested for this disease but none is completely effective and without side-effects such as pain, arthralgia and renal or cardiac complications. Lasers have been used for treatment of several skin diseases since 1970, and CO(2) lasers are now being used for treatment of leishmaniasis. In this study, a CO(2) laser (Sonic 500 machine) was used as a source of a continuous CO(2) laser wave. METHODS: A total of 123 patients (68 female and 55 male) with 183 lesions were treated with the CO(2) laser. The maximum power was 100 W and the pulse width was 0.5-5 s. For the control group, 110 patients (with 250 lesions) were treated with glucantime 50 mg/kg/day for 15 days and, after 15 days of rest, this treatment was repeated (Glucantime Amps, 1.5 g in a 50-mL solution, was used). For follow-up, the patients were visited 1, 3, 4, 8, 12 and 24 weeks after treatment and any complications, recurrences or other wound characteristics were recorded. In the second group, Finally, all collected data were analyzed statistically. RESULTS: Statistical analysis with the chi(2) test showed that treatment with the CO(2) laser was more effective than treatment with glucantime (P = 0.0007). Complications were also seen less often with the laser treatment than with glucantime and were limited to the ulcer site. The CO(2) laser was more effective in treating cutaneous leishmaniasis than glucantime (1.12 times), had fewer side-effects (4.5% vs. 24%) and resulted in a shorter healing time (1 month vs. 3 months), and treatment could be applied in a single session. CONCLUSIONS: The results of this and previous studies suggest that cutaneous leishmaniasis can be treated effectively with CO(2) laser if those providing the treatment are sufficiently experienced. Laser treatment is more cost-effective than other treatments and can be used as first-line therapy for cutaneous leishmaniasis (wet and dry types).

Cutaneous anthrax associated with facial palsy: case report and literature review.

BACKGROUND: Anthrax is primarily an animal disease. Bacillus anthracis, the causal agent in anthrax, is a Gram-positive rod. Humans can acquire anthrax by industrial exposure to infected animals or animal products. METHODS: Reported here is the case of a 48-year-old male farm worker from Iran with a history of direct contact with herds. He presented after 6 days of fever with toxicity and a crusted ulcer on the face that was later confirmed bacteriologically to be cutaneous anthrax. He was treated with large doses of intravenous penicillin and corticosteroids along with multiple subcutaneous epinephrine injections that were used to control the infection and massive facial edema. RESULTS: After 14 days, he partially recovered; however, ipsilateral facial nerve palsy developed and persisted despite therapeutic efforts. CONCLUSION: It is not possible to conclude whether early diagnosis and treatment of anthrax results in a lower risk of complications. Facial palsy can be added to the list of variable complications of the cutaneous effects of anthrax.