Cases reported "Leishmaniasis, Cutaneous"

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1/7. interferon-gamma treatment induces granulomatous tissue reaction in a case of localized cutaneous leishmaniasis.

    Leishmania spp. suppress macrophage activity as part of their interaction with the immune system. interferon-gamma (IFNgamma), a cytokine that participates in the activation of macrophages and the killing of intercellular parasites, induces healing of leishmaniasis. We investigated a sequence of local and systemic inflammatory cell parameters after IFNgamma therapy in a patient with chronic, localized, cutaneous leishmaniasis caused by leishmania donovani. histology, immunohistochemistry, polymerase chain reaction (PCR) for L. donovani, and analysis of T-cell receptor gene fragments from skin lesions as well as peripheral blood phenotyping were performed before, during, and after IFNgamma therapy. During therapy, epithelioid cell granulomas developed with a high number of lesional human leukocyte antigen (HLA) DR macrophages, and HLA-DR expression on monocytes increased to high counts, indicating macrophage activation. Simultaneously, T-cell receptor-beta gene-specific PCR showed a peak at 243 base pairs, indicating clonal expansion of Leishmania-reactive T lymphocytes. After therapy, PCR detected minimal residual leishmanial dna in healing lesions, suggesting the destruction of the parasites. In conclusion, IFNgamma therapy compensates for the parasite-dependent major histocompatibility complex class II downregulation and induces healing of chronic cutaneous leishmaniasis.
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2/7. Bilateral cutaneous leishmaniasis of upper eyelids: a case report.

    An 11-year-old girl presented with a 6-month history of bilateral upper eyelid erythema, induration, and blepharitis resistant to conventional antibiotic therapy. The lesions gradually progressed to symmetrical ulcerative nodules within 3 months. Cutaneous smear and biopsy revealed numerous amastigotes in macrophage cells. Therapy with systemic pentavalent antimonial resulted in successful healing of lesions. We conclude that cutaneous leishmaniasis must be kept in mind in the differential diagnosis of bilateral chronic eyelid swelling in endemic regions of the world.
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3/7. Unusually extensive disease caused by leishmania major parasites.

    Simple cutaneous leishmaniasis (CL), which is endemic in several areas of israel, is usually caused by leishmania major. CL, which is caused by replication of parasites within dermal macrophages, is self-limited and almost always confined to the skin. We recently encountered two cases of CL in which skin defenses were breached and lesions appeared in subcutaneous locations. In one case, abnormal cell-mediated immune function was detected. The purpose of this article is to present these data and to comment on the immunological aspects of leishmaniasis.
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ranking = 0.25
keywords = macrophage
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4/7. Visceral and cutaneous leishmaniasis comparative ultrastructure of host-parasite interactions.

    The comparative ultrastructure of host-parasite interactions is described for the first time in patients with visceral (VL) and cutaneous (CL) leishmaniasis. In patients with VL, the parasite invades the bone marrow (BM) macrophages (Mcs) and neutrophils, while in patients with CL, the parasite invades the dermal fibroblasts in addition to Mcs. The skin Mcs seem to have more lethal effects on the parasite than the BM Mcs; this is possibly due to the presence of numerous melanosomes with acid phosphatase activity in the Mcs digestive vacuole. In patients with high level of VL parasitaemia, the parasite may induce the BM reticulocytes to phagocytose both the parasite and mature erythrocytes, i.e. lost recognition. In patients with low level of VLparasitaemia, the parasite may induce the BM Mcs to be haemophagocytic, i.e. temporarily mimick malignant histiocytosis until the course of treatment. In early stages of CL infection, the cellular infiltrate consists of the monocyte-macrophage system, plasma cells, lymphocytes and fibroblasts; while in the late stages, two types of epithelioid cells (ECs) are added to the infiltrate and are involved in the formation of tuberculous granulomas. Type I ECs thought to produce a granuloma factor, while type II ECs possibly precedes healing by fibrosis. However, the severity of host-parasite interactions seems to depend mainly on species of the parasite, the degree of parasitaemia, the type of infected tissue(s), and the variation of host tissue reaction against the parasite from one patient to another.
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ranking = 0.5
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5/7. Successful treatment of cutaneous leishmaniasis using systemic interferon-gamma.

    BACKGROUND: interferon-gamma (IFN-gamma) is one decisive cytokine of T-helper type 1 (Th1) cells in experimental leishmaniasis. It activates macrophages to kill intracellular parasites and leads to a decline of less mature macrophages in the infiltrate. Application of IFN-gamma heals the disease in susceptible mice and has recently been shown to be of benefit in human disease when given locally or in combination with antileishmanial drugs. OBJECTIVE: We investigated the clinical and histological effects of systemic application of IFN-gamma in a case of human cutaneous leishmaniasis in which an ulcerating lesion endangered the left upper eyelid of a 4-year-old boy. RESULTS: IFN-gamma (100 mu g/m2 of body surface per day) was given subcutaneously for a period of 28 days. The well-tolerated treatment resulted in rapid and complete healing of the lesion without functional impairment. Histological examination disclosed the formation of dermal granulomas. Immunohistochemical characterization of the myelomonocytic cells in the lesion before and after treatment revealed a marked decrease of less-mature macrophages in the infiltrate. This phenomenon equals observations in healing lesions during naturally occurring resistance in murine leishmaniasis. CONCLUSION: Systemic monotherapy with IFN-gamma can be an effective treatment for complicated cases of human cutaneous leishmaniasis without the side effects sometimes observed with systemic pentavalent antimony. Its effects on the myelomonocytic infiltrate are similar to the ones observed during the physiological immune response in natural resistance.
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ranking = 0.75
keywords = macrophage
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6/7. Topical glyceryl trinitrate: a possible treatment for cutaneous leishmaniasis.

    The treatment of cutaneous leishmaniasis (CL) is difficult in both the old and new worlds. However, nitric oxide (NO) is involved in host cell mediated immune responses against intracellular parasites such as leishmania major, and both in vitro and in vivo immunological studies indicate that Leishmania parasite killing by macrophages is mediated by this substance. Glyceryl trinitrate (GTN) is an exogenous NO donor; we have successfully treated a young man with cutaneous leishmaniasis with topical GTN. We believe this to be the first reported use of GTN in the treatment of human CL.
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ranking = 0.25
keywords = macrophage
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7/7. A case of Post-kala-azar dermal leishmaniasis.

    Only a few cases of Post-kala-azar dermal leishmaniasis have been reported in japan, especially recently. We describe a case of a 32-year-old woman who developed rose-colored nodules on her forearms two years after Kala-azar. A skin biopsy specimen from a nodule revealed not only granulomatous changes but also many amastigotes of leishmania donovani in macrophages. Rose-colored nodules were also distributed on her face and neck. Treatment with antimony compound was very effective.
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ranking = 0.25
keywords = macrophage
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