1/105. Cutaneous leishmaniasis. Ultrastructural study of 3 cases. Ultrastructure study of specimens taken from 3 patients with cutaneous leishmaniasis showed parasites within macrophages. None were found in extracellular locations. Within the macrophages cytoplasm, parasites were located either lying free in the cytoplasm or inside intracytoplasmic vacuoles. parasites in various stages of degeneration were found both lying free in the cytoplasm or within vacuoles. The parasite-macrophage relationship and the mechanism by which the host reacts toward the parasite are discussed. ( info) |
| Over a 2-year period two cases of dermal leishmaniasis of special interest were recognized in texas. The first occurred in 1972 in a 74-year-old woman who had residences in Dilworth and Gahzales, Gonzales County, and the other was in a 56-year-old man from Kenedy, Karnes County, in 1974. Both cases were biopsy- and culture-positive, and the second patient exhibited anti-Leishmania antibodies by indirect immunofluorescent antibody and direct agglutination tests. Epidemiologic investigation revealed no association between the two cases and suggested that both patients had acquired their infections locally in southern texas. Moreover, serologic evidence of Leishmania infection was uncovered in a neighbor of the second case and in 3 dogs living nearby. Potential sylvatic reservoirs and arthropod vectors of the disease are resident in the area. Epidemiologic data suggest that dermal leishmaniasis is endemic in south-central texas. ( info) |
3/105. polymerase chain reaction as a diagnostic tool for detecting Leishmania. polymerase chain reaction (PCR) has been used to identify a Leishmania parasite in a cutaneous ulcer from a 27-year-old patient infected during travel in peru. The available classical diagnostic methods could not confirm the diagnosis in a sufficiently short time. Therefore, two sets of oligonucleotides were designed and with both of them fragments of the expected size were obtained. The sequence of the fragment derived from kinetoplast dna corresponds to the Leishmania Viannia complex. polymerase chain reaction has advantages over classical diagnostic methods, which makes it an important technique in those hospitals and clinical laboratories in europe which lack standard diagnostic tests for Leishmania. ( info) |
4/105. Successful treatment of visceral leishmaniasis in Finnish-type congenital nephrotic syndrome. Visceral leishmaniasis is a parasitic disease endemic in the Mediterranean Basin, including malta. Finnish-type congenital nephrotic syndrome is an autosomal recessive condition that presents in the first 3 months of life with heavy proteinuria, hypoalbuminemia with secondary edema, and hyperlipidemia. We present an infant with congenital nephrotic syndrome who had had unilateral nephrectomy and who also developed visceral leishmaniasis. He was successfully cleared of the infection by the administration of sodium stibogluconate, with no deterioration of renal function or other complications. ( info) |
5/105. Bronchopulmonary and mediastinal leishmaniasis: an unusual clinical presentation of leishmania donovani infection. We describe a case of unusual leishmaniasis in a Sudanese man with a history of progressively enlarging granulomatous mediastinal lymphadenopathy, worsening hemoptysis, and an intense mucosal granulomatous inflammatory response in the large bronchi. leishmania donovani dna was detected in bronchial biopsies by polymerase chain reaction. This is a novel description of human leishmanial infection in an immunocompetent patient involving this anatomical site. The patient's condition improved clinically, spirometrically, and radiologically after a course of treatment with amphotericin b. The cell-mediated immune response was analyzed before, during, and after successful antileishmanial chemotherapy. ( info) |
| This is a case report of a 29 year old male with pneumocystis pneumonia and tuberculosis, and who was initially suspected of having hiv infection, based on risk factor analyses, but was subsequently shown to be hiv negative. The patient arrived at the hospital with fever, cough, weight loss, loss of appetite, pallor, and arthralgia. In addition, he was jaundiced and had cervical lymphadenopathy and mild heptosplenomegaly. He had interstitial infiltrates of the lung, sputum smears positive for mycobacterium tuberculosis and pneumocystis carinii, and stool tests were positive for strongyloides stercoralis and schistosoma mansoni. He was diagnosed as having AIDS, and was treated for tuberculosis, pneumocystosis, and strongyloidiasis with a good response. The patient did not receive anti-retroviral therapy, pending outcome of the hiv tests. A month later, he was re-examined and found to have worsening hepatosplenomegaly, pancytopenia, fever, and continued weight loss. At this time, it was determined that his hiv ELISA antibody tests were negative. A bone marrow aspirate was done and revealed amastigotes of leishmania, and a bone marrow culture was positive for Leishmania species. He was treated with pentavalent antimony, 20 mg daily for 20 days, with complete remission of symptoms and weight gain. This case demonstrates that immunosuppression from leishmaniasis and tuberculosis may lead to pneumocystosis, and be misdiagnosed as hiv infection. The occurrence of opportunistic infections in severely ill patients without hiv must always be considered and alternate causes of immunosuppression sought. ( info) |
7/105. Successful treatment of ocular leishmaniasis. PURPOSE: To report successful treatment of a case of ocular leishmaniasis with combined stibogluconate and allupurinol. METHOD: A 32-year-old physician developed a non-tender reddish chalazion like lesion in his right lower lid, associated with conjunctivitis and nodular episcleritis. biopsy of the lesion in his eyelid and conjunctiva disclosed a dense inflammatory response including histiocytes containing typical leishmania organisms. RESULT: Therapy with stibogluconate, both intralesional and intramuscular, was initiated with some improvement. However recurrence of the lesion occurred. Systemic retreatment with combined stibogluconate and allupurinol led to complete healing of the lesion. CONCLUSION: Ocular leishmaniasis is a rare and potentially blinding disorder. Combined stibogluconate and allupurinol may be an effective therapy in such cases. ( info) |
| A man acquired cutaneous leishmaniasis in afghanistan. The disease involved two sites and remained active for seven months. Treatment with metronidazole was followed by resolution of the skin lesions in one month. ( info) |
9/105. Identification of Leishmania chagasi from skin in Leishmania/hiv co-infection: a case report. A case of hiv/Leishmania co-infection presenting both visceral and cutaneous manifestations is reported. Leishmania infection was confirmed by conventional methods (parasitological approach and serology) and by PCR. Leishmania chagasi isolated from the skin lesion was characterized by enzyme electrophoresis and by restriction fragment length polymorphism of the internal transcribed spacer of the ribosomal gene. ( info) |
| Ten cases of skin infection due to mycobacterium marinum are reported from israel. Most of the infections were contracted in natural bathing pools at Ein Feshka on the shores of the Dead Sea, south of Jericho. The lesions closely resembled those of cutaneous leishmaniasis prevalent in this region. The condition does not seem to have been detected previously in the middle east. ( info) |