RESUMEN
Treatment of persistent leishmaniasis with oral agents has received increasing attention, although the optimal agent for use in all settings has not been determined. This report describes a patient with persistent cutaneous infection due to Leishmania mexicana mexicana who apparently responded to therapy with allopurinol after treatment with a course of ketoconazole failed. In vitro testing of pre- and posttreatment isolates from the wound did not demonstrate the development of resistance to ketoconazole. To our knowledge, this is the first report that independently confirms the recently reported efficacy of allopurinol for treatment of leishmaniasis.
Asunto(s)
Alopurinol/uso terapéutico , Cetoconazol/uso terapéutico , Leishmania mexicana/efectos de los fármacos , Leishmaniasis Cutánea/tratamiento farmacológico , Adulto , Alopurinol/farmacología , Animales , Belice , Resistencia a Medicamentos , Agricultura Forestal , Humanos , Cetoconazol/farmacología , Masculino , Enfermedades Profesionales/tratamiento farmacológico , Enfermedades Profesionales/parasitología , Estados Unidos/etnologíaRESUMEN
Some epidemiologic features of the painful crisis in homozygous sickle cell disease were examined in a retrospective study of 995 painful crises. Previously reported associations with cold weather and pregnancy were confirmed. There was a striking increase in painful crises in male patients between the ages of 15 and 25 years, whereas female patients showed little age-related change. The frequency of painful crises correlated positively with hemoglobin levels and reticulocyte counts in both sexes and negatively with mean corpuscular volume in female patients. There was a striking increase in painful crises in male patients with hemoglobin levels above 8.5 g/dL (greater than 85 g/L). High hemoglobin levels appear to be an important risk factor for painful crises.
Asunto(s)
Anemia de Células Falciformes/genética , Homocigoto , Dolor/etiología , Enfermedad Aguda , Adolescente , Adulto , Factores de Edad , Anemia de Células Falciformes/epidemiología , Frío , Recuento de Eritrocitos , Índices de Eritrocitos , Femenino , Hemoglobina Falciforme/análisis , Humanos , Jamaica , Masculino , Embarazo , Complicaciones Hematológicas del Embarazo/sangre , Reticulocitos , Estudios Retrospectivos , Riesgo , Factores SexualesRESUMEN
A randomized, controlled, trial of a topical antibiotic preparation (neomycin, bacitracin, and polymyxin B) was performed in 30 patients with homozygous sickle cell (SS) disease and chronic leg ulceration. Over a period of 8 weeks, the reduction in ulcer size was significantly (P less than 0.05) greater in the treatment group than in the control group. The results suggest that these topical antibiotics may contribute to the therapy of chronic leg ulceration associated with sickle cell disease.