A randomized, placebo-controlled trial in Tunisia treating cutaneous leishmaniasis with paromomycin ointment.

A randomized, placebo-controlled, double-blind trial was carried out in 1992 in central Tunisia to assess the tolerability and efficacy of paromomycin ointment against zoonotic cutaneous leishmaniasis caused by Leishmania major. One hundred fifteen patients, 2--60 years of age, with a single lesion of parasitologically confirmed cutaneous leishmaniasis, were included in the trial. The ointment was applied twice a day from day 1 through day 14. Clinical and parasitologic evaluations of lesions were done at days 0, 15, 45, and 105. Fifty-seven patients were allocated the treatment and 58 the placebo. Based on local toxicity and laboratory evaluation, there was no difference in tolerability between the two groups. Parasitologic evaluation at day 15 showed that 74.5% of the treated group had negative smears compared with 56.4% among controls (P = 0.06). This difference was no longer apparent at days 45 and 105. Clinical evaluation at days 15, 45, and 105 did not indicate any difference between the two groups. The clinical evaluation at day 15 was a good predictor of the final prognosis of the lesion in the two groups when analyzed separately, suggesting no clinical relapse in either group. These findings suggest that paromomycin ointment should not be used in the present formulation as a treatment for zoonotic cutaneous leishmaniasis in Tunisia.

[Spontaneous course of lesions of Leishmania major cutaneous leishmaniasis in Tunisia]. / Evolution spontanée des lésions de leishmaniose cutanée a Leishmania major en Tunisie.

INTRODUCTION: The evolution of zoonotic cutaneous leishmaniasis (ZCL) caused by L. major, was usually described with crosssectional studies of patients under anti-leishmanial drugs. This work aimed to describe the clinical and parasitological status by a follow-up study of patients with ZCL and treated with a placebo. MATERIAL AND METHODS: In 1992, 58 patients with unique lesion of ZCL confirmed parasitologically and treated with vaseline twice a day for 15 days were followed in days 0, 15, 45 and 105. During every visit we have performed a clinical description of the lesion, a direct smear and a culture on NNN medium. RESULTS: 81 p. 100 of the lesions were ulcerated in day 0. A rapid clinical healing was noticed in 6.9 p. 100 of patients and the lesion remained active in 25.9 p. 100 of cases until day 105. Direct smears became negative among 56.4 p. 71 p. 100 and 92.3 p. 100 in days 15, 45 and 105 respectively. DISCUSSION: The ulcer was the most frequent sign during the diagnosis. The rapid conversion of positive parasitological tests suggest that the diagnosis of ZCL in endemic zones should be based mainly on clinical criteria.

[Kaposi's sarcoma and hypereosinophilic syndrome]. / Sarcome de Kaposi et syndrome hyperéosinophilique.

The authors report the case of a 73-year-old patient with severe Kaposi's sarcoma associated with an idiopathic hypereosinophilic syndrome. This association has not been reported until today and incites us to report this case.