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1/12. Co-infection by Leishmania amazonensis and L. infantum/L. chagasi in a case of diffuse cutaneous leishmaniasis in bolivia.

    We present the first report of a co-infection by Leishmania amazonensis and L. infantum/L. chagasi isolated in 1993 from a patient with diffuse cutaneous leishmaniasis (DCL), living in the sub-Andean region of bolivia. This is the third reported case of DCL in bolivia, but the first one with isoenzymatic identification of the aetiological agents involved and the first one giving evidence for a mixed infection by 2 Leishmania parasites in the same lesion. ( info)

2/12. Diffuse cutaneous leishmaniasis with atypical aspects.

    A 16-year-old man had long-standing diffuse cutaneous leishmaniasis with the following characteristics: diffuse infiltrated lesions rich in amastigotes, absence of mucosal involvement, and lack of parasite-specific cell-mediated immune response. In situ identification of leishmania mexicana amazonensis was achieved by the use of monoclonal antibodies. Clinically, as an atypical finding there was deep and extensive ulceration in the lower limbs. Histologically, an atypical characteristic was the presence of a high number of eosinophils in the infiltrate predominantly in the ulcerated lesion. Ultrastructurally, parasitized and lysed eosinophils with dispersion of their granules were seen in the vicinity of parasitized or lysed macrophages. ( info)

3/12. Disseminated cutaneous leishmaniasis after visceral disease in a patient with AIDS.

    leishmaniasis is emerging as a common and serious opportunistic disease for patients with HIV infection. Almost all cases of HIV-Leishmania coinfection have been described in Mediterranean countries and they occur with various clinical presentations, ranging from typical visceral forms to asymptomatic or atypical cases, including cutaneous and mucocutaneous leishmaniasis. Pentavalent antimony compounds have been the mainstays of antileishmanial therapy for half a century and new lipid formulations of amphotericin b seem reliable, but the most effective treatment remains unknown. We describe a patient who was HIV infected and an intravenous drug user, with an unusual disseminated cutaneous leishmaniasis, after an initial visceral disease and after a 13-month maintenance treatment with liposomal amphotericin. The severe concurrent immunosuppression probably played an essential role in leading to this atypical cutaneous form, characterized by diffuse, nonulcerated, nonscabby maculopapular lesions. ( info)

4/12. Therapy of Venezuelan patients with severe mucocutaneous or early lesions of diffuse cutaneous leishmaniasis with a vaccine containing pasteurized Leishmania promastigotes and bacillus Calmette-Guerin: preliminary report.

    Severe mucocutaneous (MCL) and diffuse (DCL) forms of American cutaneous leishmaniasis (ACL) are infrequent in venezuela. Chemotherapy produces only transitory remission in DCL, and occasional treatment failures are observed in MCL. We have evaluated therapy with an experimental vaccine in patients with severe leishmaniasis. Four patients with MCL and 3 with early DCL were treated with monthly intradermal injections of a vaccine containing promastigotes of Leishmania (Viannia) braziliensis killed by pasteurization and viable bacillus Calmette- Guerin. Clinical and immunological responses were evaluated. Integrity of protein constituents in extracts of pasteurized promastigotes was evaluated by gel electrophoresis. Complete remission of lesions occurred after 5-9 injections in patients with MCL or 7-10 injections in patients with early DCL. DCL patients developed positive skin reactions, average size 18.7 mm. All have been free of active lesions for at least 10 months. Adverse effects of the vaccine were limited to local reactivity to BCG at the injection sites and fever in 2 patients. Extracts of pasteurized and fresh promastigotes did not reveal differences in the integrity of protein components detectable by gel electrophoresis. immunotherapy with this modified vaccine offers an effective, safe option for the treatment of patients who do not respond to immunotherapy with vaccine containing autoclaved parasites or to chemotherapy. ( info)

5/12. Disseminated cutaneous leishmaniasis.

    Disseminated cutaneous leishmaniasis DCL is a condition rarely seen in the middle east. We report a case of disseminated cutaneous leishmaniasis in a 60-years-old lady. The patient first presented 1996 with an initial lesion, which started on the butterfly area of the face and spread, probably due to immunosuppression, to involve the whole face. The lesions consisted of nodules, which did not ulcerate. The histology showed abundance of macrophages filled with amastigotes L-D bodies. The patient was started on oral zinc sulphate 10 mg/kg in 3 divided doses daily. The condition showed gradual improvement. Repeated biopsies showed upgrading of the histopathological picture. After 6-months of treatment there was complete clearance of the condition. The patient was followed up for 6-years with no recurrence. However, she presented with a new lesion on the butterfly area again in February 2003. The biopsy again showed abundance of macrophages filled with amastigotes L-D bodies. A 4-months course of zinc sulphate 10 mg/kg in 3 divided doses daily resulted in complete clearance of the lesions. zinc sulphate might represent a new treatment for this condition that has no adequate treatment until now. ( info)

6/12. Successful treatment with miltefosine of disseminated cutaneous leishmaniasis in a severely immunocompromised patient infected with hiv-1.

    We describe here a case of disseminated cutaneous leishmaniasis due to leishmania major in a severely immunocompromised patient from Burkino Faso, africa, who is infected with human immunodeficiency virus-1. The skin lesions failed to respond to full treatment courses of amphotericin b, sodium stibogluconate, and liposomal amphotericin b but were successfully treated with miltefosine, an alkylphosphocholine analogue. ( info)

7/12. Spontaneous regional healing of extensive skin lesions in diffuse cutaneous leishmaniasis (DCL).

    The authors report a case of diffuse cutaneous leishmaniasis, with longstanding evolution and presenting with diffuse infiltrated lesions rich in amastigotes in the absence of mucosal involvement. In situ characterization with monoclonal antibodies revealed Leishmania amazonensis. Large regional lesions have presented spontaneous healing without specific therapy. Considering that DCL presents with a defect in the cellular immune response, this fact demonstrate that this patient may develop a regional cellular immune response enough to destroy the parasites and to produce clearing of some lesions. ( info)

8/12. diabetes mellitus associated with pentamidine isethionate in diffuse cutaneous leishmaniasis.

    The authors report a case of a male patient from Bacabal, MA with diffuse cutaneous leishmaniasis (DCL), for at least nine years, with 168 lesions on his body. These were tumour-like nodules with some ulceration. He used pentavalent antimonial (glucantime) and an association of gamma interferon plus glucantime with improvement of the lesions but relapsed later. Recently, pentamidine isethionate (pentacarinat) was given a dosage of 4mg/kg/weight/day on alternate days for 20 applications. After 3 months a similar course of 10 application was given 2 times. Later he developed diabetic signs with weight loss of 10kg, polydypsia, polyuria and xerostomia. The lower limbs lesions showed signs of activity. blood glucose levels normalised and remain like this at moment. attention is drawn to the fact that pentamidine isethionate should be used as a therapy option with care, obeying rigorous laboratory controls including a glucose tolerance test. ( info)

9/12. leishmania major in an Egyptian patient manifested as diffuse cutaneous leishmaniasis.

    Diffuse cutaneous leishmaniasis (DCL) is an unusual form of cutaneous leishmaniasis mainly caused by infection with Leishmania aethiopica in the Old World. In this paper, diffuse cutaneous leishmaniasis was reported for the first time, in an Egyptian patient from Sinai Peninsula resulting from infection with L. major zymodeme LOND-1 as proved by enzymatic characterization, using seven enzymes. ( info)

10/12. Impaired production of cytokines in a case of human leishmaniasis.

    A patient presented with the unique clinical picture of diffuse cutaneous and mucosal leishmaniasis caused by leishmania tropica. Elevated serum levels of several cytokines including interleukin (IL) 2, interferon gamma (IFN-gamma), and tumor necrosis factor alpha were found. All cytokine levels returned to normal during therapy. No IL-10 or IL-4 levels were detectable. In whole blood cultures, induction of IFN-gamma by lipopolysaccharide (LPS) was completely negative, even after therapy. concanavalin a (Con A)-induced release of IFN-gamma, like Con A-induced release of the other cytokines, was only initially impaired but returned to normal during therapy. Induction of the other cytokines by LPS was never impaired. The low expression of human leukocyte antigen DR on monocytes increased during IFN-gamma therapy but dropped when IFN-gamma treatment was ceased. We conclude that in this patient one or more of the routes of IFN-gamma production was impaired, thus resulting in insufficient IFN-gamma production in the infected lesions (although IFN-gamma was systemically present). ( info)
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