Bases for a treatment of cutaneous leishmaniasis with moderate hyperthermia.

INTRODUCTION: Regional hyperthermia at between 38 and 39.5 °C has been used to treat inflammatory processes and, occasionally, skin infections. In areas where leishmaniasis is endemic, hot compresses are applied as anti-parasitic treatment. OBJECTIVE: To identify the bases of leishmaniasis thermal treatment in order to properly regulate it. METHODS: In vitro-cultured Leishmania mexicana parasites were incubated for variable periods at 37 and then at 25 °C. The parasites were then stained with Annexin V-FITC to detect apoptosis induction and with propidium iodide for viability. Post-treatment growth curves and cell cycle identification with anti-cyclin antibodies were performed. RESULTS: After 30 minutes of exposure to a temperature of 37 °C, a variable proportion of parasites lost their characteristic oval shape and became spherical, without refringence and with condensed nuclei, with these changes suggesting apoptosis, which was confirmed by Annexin V-FITC staining. The number of parasites that underwent apoptosis was proportional to exposure time. Parasites in which apoptosis was observed were stained with anti-cyclin antibodies. CONCLUSIONS: Constant, regulated and physiological elevation of temperature for more than 30 minutes induces apoptosis of in vitro-cultured L. mexicana parasites when they are in an active phase of the cell cycle.

INTRODUCCIÓN: La hipertermia regional entre 38 y 39.5 °C ha sido empleada para tratar procesos inflamatorios y, ocasionalmente, infecciones cutáneas. En zonas endémicas de leishmaniosis se aplican compresas calientes como tratamiento antiparasitario. OBJETIVO: Conocer las bases del tratamiento térmico de la leishmaniosis para regularlo adecuadamente. MÉTODOS: Parásitos Leishmania mexicana cultivados in vitro fueron incubados por periodos variables de 37 °C y después a 25 °C.. Los parásitos se tiñeron con anexina V-FITC y yoduro de propidio para detectar inducción de apoptosis y su viabilidad. Se realizaron curvas de crecimiento postratamiento e identificación del ciclo celular con anticuerpos anticiclinas. RESULTADOS: Después de 30 minutos de exposición a una temperatura de 37 °C, un porcentaje variable de parásitos perdieron su característica forma ovalada y se tornaron esféricos, sin refringencia y con núcleos condensados, cambios que sugirieron apoptosis, la cual fue confirmada mediante tinción con anexina V-FITC. La cantidad de parásitos en proceso de apoptosis fue proporcional al tiempo de exposición. Los parásitos en los que se observó apoptosis se tiñeron con anticuerpos anticiclinas. CONCLUSIONES: La elevación constante, regulada y fisiológica de la temperatura por más de 30 minutos induce apoptosis de parásitos Leishmania mexicana cultivados in vitro, cuando se encuentran en fase activa en el ciclo celular.

Cutaneous leishmaniasis control in Alta Verapaz (northern Guatemala): evaluating current efforts through stakeholders' experiences.

BACKGROUND: Cutaneous leishmaniasis (CL), endemic in Guatemala, mostly affects poor people living in the northern region. A national control program that includes surveillance, diagnose, and treatment offered free of cost by the Ministry of Health (MoH) has been in place since 2003. However, the incidence is increasing and treatment rates are not optimal, suggesting that current efforts are not being effective. This study aimed to understand barriers and facilitators of CL control in Guatemala as experienced and perceived by key stakeholders in order to comprehend what works well and does not and suggest evidence-informed interventions. METHODS: The study was conducted in the Cobán municipality, the most endemic of Guatemala, situated in the Department of Alta Verapaz. Data were collected during May and June 2019 via focus groups and semi-structured interviews with key stakeholders, including local and national health personnel and residents of four communities of the endemic region. Thematic and content analysis of the collected data was conducted using NVIVO. RESULTS: Three overarching issues hamper the effectiveness of current CL efforts: resource scarcity, treatment challenges, and knowledge-action gaps. Scarce economic resources from the MoH and community residents negatively impact incidence, detection of cases and treatment rates in that preventive action is insufficient and healthcare access is low. In addition, local health workers often lack specialized CL training and access to the national CL control guidelines. With regards to the population living in the study area, misunderstanding of disease causation, shame associated with CL lesions, treatment pain fear, and long (often uncertain) waiting times for diagnose and treatment negatively affect people's willingness to seek help, treatment adherence, and their trust on the healthcare provided. CONCLUSIONS: Culturally sensitive CL preventive action must be developed. Given the scarce economic resources available for CL control in the country, the involvement of trained community health workers and the inclusion of thermotherapy as a treatment option is also advised. Other cost-effective actions include: ensuring all health workers receive CL training and have access to national CL control guidelines, improving national procurement system to avoid treatment shortages, and provision of motorized vehicles to increase active surveillance and treatment rates.

Manipulation of cutaneous leishmaniasis lesions: case series in a peruvian hospital. / Manipulación de lesiones en pacientes con leishmaniasis cutánea: serie de casos en un hospital peruano.

In cutaneous leishmaniasis endemic areas it is a common practice for patients to manipulate their lesions with traditional treatments as a first therapeutic option. A case series study was conducted in order to describe the frequency and the variations of the patient manipulation of cutaneous leishmaniasis lesions at the Cayetano Heredia Hospital. The study included 124 patients with cutaneous leishmaniasis. From the patient population it was found that 54% (67/124) manipulated their lesions. Of this, 92.5% (62/67) did so with chemicals, and 43.3% (29/67) with plants. The most frequent local changes reported by patients were increased lesion size in 35.8% (24/67) and increased inflammation in 28.4% (19/67). Manipulation by patients decreased the positivity of the parasitological diagnosis in those patients with ulcerative lesions.

En áreas endémicas de leishmaniasis cutánea es común que los pacientes manipulen sus lesiones con tratamientos tradicionales como primera opción terapéutica. Con el objetivo de describir la frecuencia y los cambios de la manipulación de lesiones de leishmaniasis cutánea de pacientes en el Hospital Cayetano Heredia, se realizó un estudio tipo serie de casos. Se incluyeron 124 pacientes con leishmaniasis cutánea. El 54% (67/124) manipuló sus lesiones; el 92,5% (62/67) lo hizo con productos químicos, y el 43,3% (29/67), con plantas. Los cambios locales más frecuentemente reportados por los pacientes fueron aumento de tamaño de la lesión en el 35,8% (24/67) e incremento de inflamación en el 28,4% (19/67). La manipulación disminuyó la positividad del diagnóstico parasitológico en aquellos pacientes con lesiones ulcerativas.

Looking for NTDs in the skin; an entry door for offering patient centered holistic care.

INTRODUCTION: The majority of neglected tropical diseases (NTDs) have established primary skin manifestations or associated clinical feature. Skin NTDs often result in physical impairment and disfigurement, which can lead to disability. Skin diseases have been proposed as an entry point for integrated NTDs control. However, the magnitude and overlap of skin NTDs is poorly understood. METHODOLOGY: An institution-based cross-sectional study was done using medical records of dermatology patients between July 2017 and June 2018 in a dermatology service in Northeast Ethiopia. A total of 661 patient records were selected using simple random sampling. RESULTS: A total of 656 complete records were included in analysis. Skin NTDs constituted 17.2% (n = 113) of the overall of skin diseases. Of skin NTDS, cutaneous leishmaniasis (n = 40; 35.4%), leprosy (n = 38; 33.6%), and scabies (n = 31; 27.4%) were the most common. Additionally, there were four cases of mycetoma. Of the non NTDs, poverty-related infections such as superficial fungal (n = 118; 21.1%) and bacterial (n = 33; 5.2%) infections were also frequent. Tinea capitis was the most common superficial fungal infections. Impetigo and cellulitis were the predominant bacterial infections. CONCLUSIONS: Skin NTDsand other poverty related skin infections were common at the dermatology service. Dermatological services could act as a good entry point for integrated management of skin NTDs. Future studies should assess how different preventive strategies like contact tracing, early diagnosis and mass drug administration can be integrated.

Manipulación de lesiones en pacientes con leishmaniasis cutánea: serie de casos en un hospital peruano / Manipulation of cutaneous leishmaniasis lesions: case series in a peruvian hospital

RESUMEN En áreas endémicas de leishmaniasis cutánea es común que los pacientes manipulen sus lesiones con tratamientos tradicionales como primera opción terapéutica. Con el objetivo de describir la frecuencia y los cambios de la manipulación de lesiones de leishmaniasis cutánea de pacientes en el Hospital Cayetano Heredia, se realizó un estudio tipo serie de casos. Se incluyeron 124 pacientes con leishmaniasis cutánea. El 54% (67/124) manipuló sus lesiones; el 92,5% (62/67) lo hizo con productos químicos, y el 43,3% (29/67), con plantas. Los cambios locales más frecuentemente reportados por los pacientes fueron aumento de tamaño de la lesión en el 35,8% (24/67) e incremento de inflamación en el 28,4% (19/67). La manipulación disminuyó la positividad del diagnóstico parasitológico en aquellos pacientes con lesiones ulcerativas.

ABSTRACT In cutaneous leishmaniasis endemic areas it is a common practice for patients to manipulate their lesions with traditional treatments as a first therapeutic option. A case series study was conducted in order to describe the frequency and the variations of the patient manipulation of cutaneous leishmaniasis lesions at the Cayetano Heredia Hospital. The study included 124 patients with cutaneous leishmaniasis. From the patient population it was found that 54% (67/124) manipulated their lesions. Of this, 92.5% (62/67) did so with chemicals, and 43.3% (29/67) with plants. The most frequent local changes reported by patients were increased lesion size in 35.8% (24/67) and increased inflammation in 28.4% (19/67). Manipulation by patients decreased the positivity of the parasitological diagnosis in those patients with ulcerative lesions.

Overview of herbal and traditional remedies in the treatment of cutaneous leishmaniasis based on Traditional Persian Medicine.

This study aims to describe the herbal and traditional remedies in the treatment of cutaneous leishmaniasis (CL) with an overview on related available evidence in modern medicine. This study is a review that focuses on the most important Traditional Persian Medicine (TPM) sources including Avicenna's Canon of Medicine, Jorjani's Zakhira-yi Kharazmshahi, and Aazam-Khan's Eksir-e-Aazam, as well as pertinent information from Embase, PubMed, Scopus, Scientific Information Database, and Google Scholar by using the keywords salak, rish-e-balkhi, cutaneous leishmaniasis, and leishmaniasis for selected remedies. Several oral and topical herbal remedies, such as Vitis vinifera L. (Unripe grapes), Berberis vulgaris L., Rheum ribes L., Santalum album L., Cinnamomum camphora (L.) J.Presl (Camphor), Brassica nigra (L.) K. Koch, Crocus sativus L., Juniperus excelsa M. Bieb, honey, and Alum root, were mentioned in TPM resources for the treatment of CL. Furthermore, cauterization, cupping, and leech therapy were considered for this purpose. In this review, some evidence-based studies will also be presented that have demonstrated the therapeutic properties of some of these products. In conclusion, the sages of TPM have recommended several systemic or topical medications, in addition to physical procedures, for treatment of CL, all of which could be a base for conducting further research on its efficacy.

An electrochemical genosensor for Leishmania major detection based on dual effect of immobilization and electrocatalysis of cobalt-zinc ferrite quantum dots.

Identification of Leishmania parasites is important in diagnosis and clinical studies of leishmaniasis. Although epidemiological and clinical methods are available, they are not sufficient for identification of causative agents of leishmaniasis. In the present study, quantum dots of magnetic cobalt-zinc ferrite (Co0.5Zn0.5Fe2O4) were synthesized and characterized by physicochemical methods. The quantum dots were then employed as an electrode modifier to immobilize a 24-mer specific single stranded DNA probe, and fabrication of a label-free, PCR-free and signal-on electrochemical genosensor for the detection of Leishmania major. Hybridization of the complementary single stranded DNA sequence with the probe under the selected conditions was explored using methylene blue as a redox marker, utilizing the electrocatalytic effect of the quantum dots on the methylene blue electroreduction process. The genosensor could detect a synthetic single stranded DNA target in a range of 1.0×10(-11) to 1.0×10(-18)molL(-1) with a limit of detection of 2.0×10(-19)molL(-1), and genomic DNA in a range of 7.31×10(-14) to 7.31×10(-6)ngµL(-1) with a limit of detection of 1.80×10(-14)ngµL(-1) with a high selectivity and sensitivity.

Leishmaniasis.

Infections with Leishmania spp. rank among the top three most common travel-associated dermatoses. Depending on the country where the infection was acquired and the patient's immune status, different disease manifestations may be observed. Ninety percent of cases present as cutaneous leishmaniasis, but the infection may also affect internal organs (visceral leishmaniasis). Without treatment, the latter is often fatal. Intermediate types include recurrent, diffuse, or mucocutaneous forms. Nodular lesions on exposed skin with a tendency to ulcerate over time in combination with a travel history should therefore prompt workup for leishmaniasis. The diagnosis is made through histology, parasite culture, and PCR using biopsy material. Therapeutic options range from local therapies in cases with singular lesions to systemic therapy in patients with more severe forms. The present review discusses the most important clinical features, details about diagnostic measures, and current therapeutic approaches.

[Traditional treatments in an endemic area of american cutaneous Leishmaniasis in Peru]. / Tratamientos tradicionales utilizados en un área endémica de Leishmaniasis cutánea en el Perú.

In order to know the first-choice treatment by villagers of an endemic area of Cutaneous Leishmaniasis (CL) prior to medical attention in a health care center, a cross sectional study was realized in Pichupampa town. A census was made in order to collect demographic data and previous history of CL. 254 participants were surveyed. 41.7% (106/254) of the village had CL at least once in their lives and only half of them went to a health center to seek for primary care. 76/106 (71.7%) used some traditional treatment as their first choice and only 23.6% (25/106) subjects went to a health-care center without manipulation of their lesions. It's evident that a high percentage (71.7%) of people potentially infected by CL manipulate and treat their lesions with traditional treatments prior to professional health-care, actions that could interfere with the diagnosis and effectiveness of the program implemented by the Health Ministry.

A cluster of four cases of cutaneous leishmaniasis by Leishmania donovani in Cyprus: a case series.

INTRODUCTION: Leishmaniasis is endemic in more than 95 countries and is the only tropical/subtropical vector-borne disease that has been endemic in Southern Europe for decades. To the best of our knowledge, this is the first case of cutaneous leishmaniasis by Leishmania donovani in a child and the first cluster with adult cases reported in Europe. CASE PRESENTATION: We describe a familial cluster of four cutaneous leishmaniasis cases among Greek Cypriots caused by L. donovani in a Paphos village, in Cyprus. A 6-year-old boy (Case number 1) had a persistent lesion in the left angle of his upper lip, a 60-year-old woman (Case number 2) presented with a 2 cm-diameter glabella lesion on her forehead, a 60-year-old man (Case number 3) developed a lesion on his moustache area and a 40-year-old woman (Case number 4) had a lesion on her neck. In Case number 3 the lesion was self-cured; the other cases recovered after surgical resection followed by liposomal amphotericin B (Case numbers 1 and 4) or thermotherapy and liposomal amphotericin B (Case number 2). CONCLUSIONS: This familial cluster of cutaneous leishmaniasis, due to the anthroponotic L. donovani, shows that the sand fly species responsible for transmitting this parasite species is found in the area around the three neighbouring houses involved. The factors favourable for the survival, spread and contact of the vector with people could be assessed in this area for the establishment of preventative measures to safeguard public health.

Evidências clínicas e imunológicas da eficácia do tratamento da leishmaniose cutânea com baixas doses de antimonial pentavalente na manutenção de cura por longo tempo / Evidence from clinical and immunological effectiveness of cutaneous leishmaniasis treatment with low doses of pentavalent antimony in curing maintained for a long time

O tratamento para leishmaniose cutânea (LC) utilizando antimoniais foi iniciado em 1912, no Brasil. O uso da forma pentavalente (Sb5+) se iniciou na década de 1940, e apesar de ainda ser eficaz para curar a LC efeitos adversos graves podem acontecer. Outras opções de tratamento, como pentamidina e anfotericina B também são de administração parenteral. Na tentativa de reduzir os efeitos adversos dos Sb5+, esquemas terapêuticos em doses baixas já evidenciaram ser seguros no tratamento da LC no Rio de Janeiro, sejam doses de apenas 5mg Sb5+/kg/dia por 30 dias (DB), aplicação intralesional (IL) ou em esquema de uso de uma ampola três vezes por semana (2ª/4ª/6ª) até a cura clínica...

Antimony therapy was first used to treat cutaneous leishmaniasis (CL) in 1912.Pentavalent antimonial (Sb5+) compounds were introduced as leishmaniasis therapy in the 1940s and are still efficient in curing CL, but they may cause serious adverse effects. Although there are other options for CL treatment, such as pentamidine and amphotericin B, similar to Sb5+, these drugs are also administered parenterally. To reduce the adverse effects of antimony, low-dose therapies were attempted and were proven safe in curing CL in patients in the state of Rio de Janeiro. Different schedules as 5mgSb5+/day/30 days (LowD), intralesional therapy (IL), or use of one ampoule three-times-a-week until clinical cure were proven to be efficient to cure CL...

Influência do estado nutricional na evolução clínica e terapêutica de adultos e idosos com leishmaniose tegumentar americana / Influence of the nutritional status in the clinical and therapeutical evolution in adults and elderly with american tegumentary leishmaniasis

O objetivo deste estudo foi descrever o estado nutricional de pacientes adultos e idosos com leishmaniose tegumentar americana (LTA). Foi realizado um estudo longitudinal em 68 pacientes adultos e idosos com LTA atendidos no Laboratório de Vigilância em Leishmanioses – Instituto de Pesquisa Clínica Evandro Chagas – Fiocruz, no período de 2009 a 2012. A avaliação nutricional foi realizada através do peso, altura, Índice de Massa Corporal e albumina sérica. A evolução clínica(epitelização e cicatrização das lesões) foi avaliada até dois anos após o tratamento de LTA. A maioria da amostra era composta por homens (71%), adultos (73%), com renda familiar de 1 a 5salários mínimos (79%) e com grau de instrução fundamental incompleto (48,5%). A forma predominante da LTA foi a cutânea (72%) e 39% apresentaram comorbidades, sendo a hipertensão arterial a mais frequente (30,8%). As intercorrências clínicas e nutricionais mais prevalentes foram:redução recente na ingestão de alimentos (23,9%), obstrução nasal (22,1%), úlcera oral (14,7%),anorexia + disfagia (13,2% cada) e odinofagia (10,3%). O tempo de cicatrização foi de 145,50 ±87,84 dias para lesões cutâneas e 172,89 ± 123 dias para lesões mucosas. Foram observados baixo peso em 10% e hipoalbuminemia em 12% dos pacientes...

The objective of this study is to describe the nutritional status of adult and elderly patients with American Tegumentary Leishmaniasis (ATL). It was conducted a longitudinal study in 68 adult andelderly patients with ATL treating at the Laboratório de Vigilância em Leishmanioses (Surveillance Leishmaniasis Laboratory) at the Instituto de Pesquisa Clínica Evandro Chagas (Evandro Chagas Clinical Research Institute)-Fiocruz, from 2009 to 2012. The nutritional assessment was performedusing weight, height, the Body Mass Index (BMI) and blood albumin levels. The clinical evolution(epithelialization, and wound healing) was measured up to two years after ATL treatment. Most ofthe sample was composed of men (71%), adults (73%), with household income of 1-5 minimumwages (79%), and incomplete basic education (48.5%). The predominant ATL form was cutaneous(72%), and 39% presented comorbidities, the most frequent was hypertension (30.8%). The most prevalent clinical and nutritional events were: recent reduction in food intake (23.9%); nasal obstruction (22.1%); oral ulcer (14.7%), anorexia + dysphagia (13.2% each) and odynophagia(10.3%). The healing time was 145.50 ± 87.84 days for skin lesions, and 172.89 ± 123 days formucous membrane lesions. Low weight in 10%, and hypoalbuminemia in 12% of the patients havebeen observed...

Thermotherapy. An alternative for the treatment of American cutaneous leishmaniasis.

BACKGROUND: Pentavalent antimonials (Sb5) and miltefosine are the first-line drugs for treating cutaneous leishmaniasis in Colombia; however, toxicity and treatment duration negatively impact compliance and cost, justifying an active search for better therapeutic options. We compared the efficacy and safety of thermotherapy and meglumine antimoniate for the treatment of cutaneous leishmaniasis in Colombia. METHOD: An open randomized Phase III clinical trial was performed in five military health centres. located in northwestern, central and southern Colombia. Volunteers with parasitological positive diagnosis (Giemsa-stained smears) of cutaneous leishmaniasis were included. A single thermotherapy session involving the application of 50°C at the center and active edge of each lesion. Meglumine antimoniate was administered intramuscularly at a dose of 20 mg Sb5/kg weight/day for 20 days. RESULTS: Both groups were comparable. The efficacy of thermotherapy was 64% (86/134 patients) by protocol and 58% (86/149) by intention-to-treat. For the meglumine antimoniate group, efficacy by protocol was 85% (103/121 patients) and 72% (103/143) by intention-to-treat, The efficacy between the treatments was statistically significant (p 0.01 and < 0.001) for analysis by intention to treat and by protocol, respectively. There was no difference between the therapeutic response with either treatment regardless of the Leishmania species responsible for infection. The side effects of meglumine antimoniate included myalgia, arthralgia, headache and fever. Regarding thermotherapy, the only side effect was pain at the lesion area four days after the initiation of treatment. CONCLUSION: Although the efficacy rate of meglumine antimoniate was greater than that of thermotherapy for the treatment of cutaneous leishmaniasis, the side effects were also greater. Those factors, added to the increased costs, the treatment adherence problems and the progressive lack of therapeutic response, make us consider thermotherapy as a first line treatment for cutaneous leishmaniasis.

Treatment of leishmaniasis in the Oyapock basin (French Guiana): A K.A.P. survey and analysis of the evolution of phytotherapy knowledge amongst Wayãpi Indians.

ETHNOPHARMACOLOGICAL RELEVANCE: Cutaneous leishmaniasis is a neglected disease with a high incidence in French Guiana, mainly in the middle and upper Oyapock basin, where Amerindian and some Brazilian people live. The main goals of this work were (i) to assess the knowledge about leishmaniasis in the different populations of the middle and upper Oyapock basin, (ii) to study the therapeutic strategies adopted by people affected by leishmaniasis and (iii) to document the use of phytotherapeutic remedies for leishmaniasis. Knowledge, attitudes and practices (K.A.P.) related to this disease and its treatments have been studied according to cultural group and geographical settlement. Within the Wayãpi group, the evolution of the knowledge of phytoremedies over the last 20 years has been characterised by literature-based comparisons. MATERIALS AND METHODS: A total of 144 questionnaires were administered in all the villages of the upper Oyapock and Camopi basins. Correspondence analyses were used for multivariate analysis. Plant species were identified at the Cayenne Herbarium (CAY). RESULTS: The biomedical concept of leishmaniasis correlates well with the Teko and Wayãpi concepts of kalasapa and kalasapau. Although the vector of this disease was not correctly identified, the most commonly cited aetiology (74.5%) was vector-borne, and related epidemiological schemes correlate well with the one encountered in French Guiana. Theoretically and practically, health centres were the most commonly used resource for diagnostic in instances of leishmaniasis infection (65.9%), independently of the patient's cultural group, along with the use of pharmaceutical drugs (85.3%). Pharmaceuticals were commonly utilised despite the frequent (51.5%) use of phytotherapeutic remedies, alone or in combination with drugs. The most cited medicinal plant species for the treatment of leishmaniasis included Eleutherine bulbosa (Mill.) Urb. (Iridaceae, cited 14 times), Euterpe oleracea Mart. (Arecaceae, 9), Cecropia obtusa Trecul (Cecropiaceae, 8), Jatropha curcas L. (Euphorbiaceae, 7), Ceiba pentandra (L.) Gaertn. (Bombacaceae, 6) and Carica papaya L. (Caricaceae, 6). Multiple correspondence analyses demonstrated that the species used in leishmaniasis remedies are more prone to vary by the user's place of residence than by their cultural origin, which indicates that exchange of knowledge about leishmaniasis remedies has occurred across different cultural groups. Literature-based comparisons between the remedies for leishmaniasis used by the Wayãpi during the 1980s showed a striking evolution, both in terms of diversity of species and number of plants used. The large number of species shared with other Guianese groups argues for intercultural exchange and may explain the majority (57.1%) of the newly used species highlighted in our study. CONCLUSIONS: Leishmaniasis is a well-known disease in the studied area. Phytotherapeutic treatments are still in use, although they are not the main source of remedies, and should undergo pharmacological studies to evaluate their potential therapeutic value.

Evaluation of intralesional 0.2% ciprofloxacin as a treatment for cutaneous leishmaniasis.

Although cutaneous leishmaniasis lesions usually heal spontaneously they cause unsightly scarring. This study evaluated a possible new therapy in 38 patients, with 70 lesions, randomly assigned to intralesional injection of ciprofloxacin (0.2%) or intralesional sodium chloride hypertonic solution (7%). After excluding patients who defaulted on treatment, lesions assigned to sodium chloride treatment (n = 21) were completely healed (with or without scarring) in 76.2% of cases, and, when a scar remained, the scar size was reduced 66.0% compared with the original lesion. Lesions assigned to ciprofloxacin (n = 27) showed an 81.5% healing rate with an average scar size reduction of 68.6%. Intralesional 0.2% ciprofloxacin was as effective as hypertonic saline in the treatment of cutaneous leishmaniasis infection.

The efficacy of thermotherapy to treat cutaneous leishmaniasis in Colombia: a comparative observational study in an operational setting.

An open label, comparative study to compare the efficacy of thermotherapy to meglumine antimoniate in treating cutaneous leishmaniasis patients in an operational context was carried out in Chaparral, Colombia. After enrollment patients were followed-up for up to 100 days. Per protocol and intention-to-treat cure rates for 47 patients treated using thermotherapy (one-time 50 degrees C applications for 30s) were 100 and 19%, respectively. Per protocol and intention-to-treat cure rates for meglumine antimoniate (20 mg/kg body weight administered intramuscularly for 21 d) were 78 and 23%, respectively.

A Leishmania (L.) amazonensis ATP diphosphohydrolase isoform and potato apyrase share epitopes: antigenicity and correlation with disease progression.

A Leishmania (Leishmania) amazonensis ATP diphosphohydrolase isoform was partially purified from plasma membrane of promastigotes by preparative non-denaturing polyacrylamide gel electrophoresis. SDS-PAGE followed by Western blots developed with polyclonal anti-potato apyrase antibodies identified diffuse bands of about 58-63 kDa, possibly glycosylated forms of this protein. By ELISA technique, a significantly higher total IgG antibody level against potato apyrase was found in serum from promastigote-infected mice, as compared to the uninfected mice, confirming both the existence of shared epitopes between the parasite and vegetable proteins, and the parasite ATP diphosphohydrolase antigenicity. By Western blotting, serum from amastigote-infected BALB/c mice recognizes both potato apyrase and this antigenic ATP diphosphohydrolase isoform isolated from promastigotes, suggesting that it is also expressed in the amastigote stage. The infection monitored along a 90-day period in amastigote-infected mice showed reactivity of IgG2a antibody in early steps of infection, while the disappearance of the IgG2a response and elevation of IgG1 antibody serum levels against that shared epitopes were associated with the progression of experimental leishmaniasis. This is the first observation of the antigenicity of a L. (L.) amazonensis ATP diphosphohydrolase isoform, and of the ability of cross-immunoreactivity with potato apyrase to differentiate serologically stages of leishmaniasis in infected mice.

Cutaneous leishmaniasis: therapeutic strategies and future directions.

Cutaneous leishmaniasis is a major tropical infection caused by vector-borne protozoa of the Leishmania species. Disease presentation, clinical course, prognosis and response to therapy is species- and geographic region-dependent. A wide variety of treatment modalities exist for the diverse spectrum of clinical disease. Traditional antileishmanial systemic agents such as antimonials, pentamidine and amphotericin are limited by toxic side effects, parenteral route of administration and emerging drug resistance. Newer agents such as oral miltefosine have shown efficacy and tolerability. However, use of systemic pharmacotherapies remains limited by their relative high cost in developing countries and despite advances in basic scientific research, there has been little progress in new drug development for what remains a neglected disease afflicting 12 million of the world's poorest population. This article examines the merits of existing and emerging therapies and reasons for variation in therapy response.

Cutaneous leishmaniasis.

Cutaneous leishmaniasis is a widespread tropical infection caused by numerous different species of Leishmania protozoa that are transmitted by sandflies. Its clinical presentations are extremely diverse and dependent on a variety of parasite and host factors that are poorly understood. Diagnosis should aim to identify the exact species involved, but this requires laboratory investigations that are not widely available. No single ideal treatment has been identified, and those available are limited by variable success rates and toxicity. Clinical guidelines are needed to make better use of the investigations and treatments that do exist. Prevention is currently limited to bite prevention measures.