Harmonized clinical trial methodologies for localized cutaneous leishmaniasis and potential for extensive network with capacities for clinical evaluation.

INTRODUCTION: Progress with the treatment of cutaneous leishmaniasis (CL) has been hampered by inconsistent methodologies used to assess treatment effects. A sizable number of trials conducted over the years has generated only weak evidence backing current treatment recommendations, as shown by systematic reviews on old-world and new-world CL (OWCL and NWCL). MATERIALS AND METHODS: Using a previously published guidance paper on CL treatment trial methodology as the reference, consensus was sought on key parameters including core eligibility and outcome measures, among OWCL (7 countries, 10 trial sites) and NWCL (7 countries, 11 trial sites) during two separate meetings. RESULTS: Findings and level of consensus within and between OWCL and NWCL sites are presented and discussed. In addition, CL trial site characteristics and capacities are summarized. CONCLUSIONS: The consensus reached allows standardization of future clinical research across OWCL and NWCL sites. We encourage CL researchers to adopt and adapt as required the proposed parameters and outcomes in their future trials and provide feedback on their experience. The expertise afforded between the two sets of clinical sites provides the basis for a powerful consortium with potential for extensive, standardized assessment of interventions for CL and faster approval of candidate treatments.

Cutaneous and meningeal sporotrichosis in a HIV patient.

A male patient with HIV and past history of tuberculosis and suspected neurotoxoplasmosis was admitted to the hospital with vomiting and small nodules through all his body. Few of the nodules were found forming chains of enlarged lymphatic vessels, especially on lesions located on the limbs. Some of the nodules were ulcerated with a serosanguineous discharge. Collected samples from ulcerated and the nodular lesions showed the presence of Sporothrix schenckii in culture. Although all hemocultures were negative, a spinal fluid collected from this patient and cultures from the cutaneous lesions were both positive for S. schenckii. The patient showed improvement after treatment with Amphotericin B. Sadly, he later died of complications not related to the S. schenckii infection. This case of disseminated sporotrichosis is a remainder that in patients with immunological disorders exotic forms of this fungal clinical entity could be expected.

Cutaneous and meningeal sporotrichosis in a HIV patient

Un paciente con VIH e historia de tuberculosis con sospecha de unaneurotoxoplasmosis, fue admitido en el hospital con vómitos y con pequeñosnódulos en todo el cuerpo. Algunos de los nódulos fueron observadosformando cadenas de vasos linfáticos agrandados, especialmente en lasextremidades. Muestras colectadas de las lesiones ulceradas y nodularesfueron positivas en cultivo para Sporothrix schenckii. Aunque todos loshemocultivos fueron negativos, muestras tomadas de líquido cefalorraquideoy de las lesiones cutáneas fueron positivas para S. schenckii. El pacienterespondió al tratamiento con anfotericina B. Sin embargo, murió más tarde porcomplicaciones no relacionadas con la infección. Este caso de esporotricosisdiseminada es un llamada de atención para recodar que en pacientes condesordenes immunológicos pueden producirse formas exóticas de laenfermedad(AU)

A male patient with HIV and past history of tuberculosis and suspectedneurotoxoplasmosis was admitted to the hospital with vomiting and smallnodules through all his body. Few of the nodules were found forming chainsof enlarged lynphatic vessels, especially on lesions located on the limbs.Some of the nodules were ulcerated with a serosanguineos discharge.Collected samples from ulcerated and the nodular lesions showed thepresence of Sporothrix schenckii in culture. Although all hemocultures werenegative, a spinal fluid collected from this patient and cultures from thecutaneous lesions were both positive for S. schenckii. The patient showedimprovement after treatment with Amphotericin B. Sadly, he later died ofcomplications not related to the S. schenckii infection. This case ofdisseminated sporotrichosis is a remainder that in patients with immunologicaldisorders exotic forms of this fungal clinical entity could be expected(AU)