Leishmaniasis cutánea inducida por anti-factor de necrosis tumoral en paciente con artritis psoriásica y uveítis / Anti-tumour necrosis factor-induced cutaneous leishmaniasis in patient with psoriatic arthritis and uveítis

No disponible

Leishmaniasis cutánea en un paciente con colitis ulcerosa en tratamiento con infliximab / Cutaneous leishmaniasis in a patient with ulcerative colitis under treatment with infliximab

No disponible

Visceral leishmaniasis with cutaneous symptoms in a patient treated with infliximab followed by fatal consequences.

Leishmaniasis is an infectious disease caused by parasitic flagellates of the genus Leishmania. The authors present a case of 44-year-old man with Crohn's disease treated successfully with infliximab. This case report shows rare visceral leishmaniasis with cutaneous symptoms in an immunocompromised patient. Skin manifestations may occur before or after the visceral infection and they are often diverse.

[Infectious complications in patients treated with anti-TNF-alpha: two cases of leishmaniasis]. / Complications infectieuses liées au traitement par anti-TNFα : à propos de deux cas de leishmaniose.

UNLABELLED: We report the cases of two patients treated with anti-TNF-alpha for uveitis. The first patient developed visceral leishmaniasis and the second cutaneous leishmaniasis. FIRST CASE: an 8-year-old girl was treated with corticosteroids and intravenous infliximab for juvenile idiopathic arthritis with bilateral anterior uveitis. After 12 months of treatment, she presented with fever, hepatosplenomegaly and thrombocytopenia. Visceral leishmaniasis was diagnosed, and she was treated successfully with parenteral liposomal Amphotericin-B (Ambisome(®)). Upon resolution, we re-instituted her treatment with infliximab. Second case: a 48-year-old man consulted us for severe panuveitis of the left eye with a serous retinal detachment. He was diagnosed with seronegative ankylosing spondylitis. His uveitis and arthritis were treated successfully with infliximab for 20 months, after which two cutaneous lesions appeared. The diagnosis of cutaneous leishmaniasis without visceral involvement was based on the presence of Leishmania in the skin scraping of a lesion. Intravenous infusions of infliximab were discontinued, and local treatment consisting of intralesional injections of meglumine antimonate salts (Glucantime(®)) was initiated, leading to rapid improvement. Anti-TNFα drugs are used frequently now. They appear promising in terms of efficacy, but one must carefully monitor patients for possible side effects, including infection.

Activity, toxicity and analysis of resistance of essential oil from Chenopodium ambrosioides after intraperitoneal, oral and intralesional administration in BALB/c mice infected with Leishmania amazonensis: a preliminary study.

The World Health Organization has classified the leishmaniasis as a major tropical disease. Current therapy is toxic, expensive and cause several adverse effects. The majority of people in endemic areas of leishmaniasis depend of natural and traditional medicine. This study was developed to examine the activity of the essential oil from Chenopodium ambrosioides in BALB/c mice infected with Leishmania amazonensis. The infected animals received two cycle of treatment by different routes (intraperitoneal, oral or intralesional route). The intraperitoneal administration of the essential oil at dose of 30 mg/Kg prevented lesion development and decrease the parasite burden. Oral administration retarded the infection in the experimental model compared with untreated mice, although it was less effective that the intraperitoneal route. The administration by intralesional route did not show activity. Intraperitoneal and oral treatment at 30 mg/Kg with the essential oil had better antileishmanial effect that treatment with the reference drug, amphotericin B at 1 mg/Kg. Preliminarily, we examined the toxicity and the resistance after treatment. Signs of toxicity were evident only in the animals treated by intraperitoneal route. No resistance was detected in L. amazonensis isolates obtained from treated mice. These data clearly demonstrated that this natural product could be an alternative for the development of a new drug against cutaneous leishmaniasis based in the ethnomedical information.

Eficacia y toxicidad de los antimoniales pentavalentes (Glucantime® y Pentostam®) en un modelo animal de leishmaniasis cutánea americana: aplicación de la luminometría / Efficacy and toxicity of pentavalent antimonials (Glucantime® and Pentostam®) in an American cutaneous leishmaniasis animal model: luminometry application

Los antimoniales pentavalentes Glucantime® y Pentostam® son los medicamentos de primera línea usados en el tratamiento anti- Leishmania; sin embargo, no hay estudios in vivo que comparen su eficacia y toxicidad controlando variables del hospedero. Los estudios bioquímicos en Leishmania detectaron diferencias entre los dos medicamentos en la inhibición de la topoisomerasa I, que podrían reflejarse en diferencias en su efectividad. Para evaluar la eficacia clínica se infectaron hámsteres en la pata trasera derecha con 106 promastigotes de Leishmania panamensis silvestre y transfectada con el gen de la luciferasa. Para evaluar la eficacia parasitológica se estandarizó la cuantificación de parásitos en los tejidos por luminometría. Tres semanas después de la inoculación, los animales se trataron intramuscularmente con Glucantime® o Pentostam® (30, 60 o 120 mg de SbV/kg por día por 20 días). La toxicidad se evaluó en hámsteres tratados intramuscularmente con 120, 160 o 240 mg de SbV/kg por día por 20 días de Glucantime® o Pentostam®. La resolución de las lesiones en los animales inoculados con ambas cepas fue similar con ambos medicamentos. La carga parasitaria disminuyó de forma equivalente con ambos medicamentos en todas las dosis, y resultó en diferencias significativas con respecto a los controles ( p<0,01). Los niveles séricos de creatinina, aspartato aminotransferasa, alanino aminotransferasa y amilasa no evidenciaron alteraciones hepáticas o renales. Los animales tratados con dosis iguales o mayores de 120 mg de SbV/kg por día por 20 días de Pentostam® presentaron alteraciones inflamatorias micro y macroscópicas en el sitio de la inyección que no se observaron en los tratados con Glucantime®. Estos resultados confirman observaciones clínicas sobre la eficacia similar de ambos productos e indican una toxicidad local mayor del Pentostam®