Cases reported "Recurrence"

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1/25. Revival of tetracyclines--in the treatment of visceral leishmaniasis?

    A 37-year-old immigrant from kosovo who had been in switzerland for 2 years developed fever, cough, weight loss and malaise. serology (complement binding reaction) was positive for leptospirosis. The symptoms resolved very rapidly under vibramycin 2 x 100 mg/day for 3 weeks. However, a flare-up occurred after cessation of medication. Reexposure to tetracyclines improved the symptoms though they did not subside completely. bone marrow analysis demonstrated intracellular leishmania (amastigotes). Analysis of frozen serum preserved since the first hospitalisation and samples from the second admission were positive for leishmania (indirect fluorescence antibody test) and confirmed the diagnosis of visceral leishmaniasis. Reevaluation of the serology for leptospirosis was negative using the specific microagglutination method. Treatment with antimony for 28 days resolved all symptoms. The parasites of visceral leishmaniasis grow intracellularly and eradication may be impossible in patients with an impaired cellular immune response. Flare-ups thus recur in 60-100% of patients with organ transplants or AIDS, despite regular treatment. Our finding raises the question whether relapses are suppressed in immunocompromised patients by tetracyclines, drugs known to be well tolerated even under long-term exposure. Randomised studies are required in this setting.
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keywords = leishmaniasis
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2/25. Relapse of cutaneous leishmaniasis in a patient with an infected subcutaneous rheumatoid nodule.

    Cutaneous leishmaniasis is a protozoal infection generally considered to be limited to the skin. In israel, the disease is common in geographically defined areas and is caused predominantly by leishmania major. Sporotrichoid subcutaneous spread has been reported but is uncommon. We describe a patient with rheumatoid arthritis, treated with methotrexate and prednisone, in whom numerous rheumatoid nodules concomitant with cutaneous leishmaniasis were found, mimicking sporotrichoid spread of the disease. In a rheumatoid nodule that was examined by electron microscopy, Leishmania parasites were found at intracellular and extracellular locations. This observation supports the hypothesis that cutaneous leishmaniasis parasites persist after clinical cure of the disease and may re-emerge as a result of immunosuppression.
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ranking = 1.1666666666667
keywords = leishmaniasis
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3/25. Reactivation of cutaneous leishmaniasis after surgery.

    Cutaneous leishmaniasis (CL) is caused by a parasite from the genus Leishmania. infection is transmitted to humans from the bite of sandflies. We describe an 85-year-old man who developed CL on his face after recent cutaneous surgery in that site. The case is also unusual because the most likely source of exposure to the infection occurred over 50 years previously. polymerase chain reaction, slit-skin smear, serology and the leishmanin test were not helpful in diagnosis, which was confirmed by histopathological demonstration of the parasite.
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keywords = leishmaniasis
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4/25. Visceral leishmaniasis in human immunodeficiency virus (hiv)-infected and non-hiv-infected patients. A comparative study.

    Visceral leishmaniasis is an endemic infection in Mediterranean countries, where it has become a frequent complication of acquired immunodeficiency syndrome (AIDS). The incidence of visceral leishmaniasis is increasing in spain due to human immunodeficiency virus (hiv)-related cases, but some aspects of its epidemiology, clinical features, and management remain unknown. In addition, no comparative clinical studies about the disease in hiv-infected and non-hiv-infected patients have been reported. During a 24-year period, 120 cases of visceral leishmaniasis were diagnosed at our institution and 80 (66%) were associated with hiv infection. The mean age at diagnosis was higher in hiv-infected that in non-hiv-infected patients (33.2 versus 23.2 yr; p = 0.002), but the male/female ratio was similar in both groups. The main risk factor for hiv infection was intravenous drug abuse (78.7%). The clinical presentation of leishmaniasis was similar in both groups, but hiv-infected patients had a lower frequency of splenomegaly than hiv-negative individuals (80.8% versus 97.4%; p = 0.02). hiv-infected patients had a greater frequency and degree of leukopenia, lymphocytopenia, and thrombocytopenia. Most of them were profoundly immunosuppressed (mean CD4 lymphocyte count, 90 cells/mm3) at the time of diagnosis of leishmaniasis, and 53.7% had AIDS. The sensitivity of serologic studies for Leishmania was significantly lower in hiv-infected than in non-hiv-infected patients (50% versus 80%; p < 0.001), but the diagnostic yield of bone marrow aspirate (67.1% versus 79.4%) and bone marrow culture (62.9% versus 66.6%) was similar in both groups. After initial treatment, the response rate was significantly lower in hiv-infected than in non-hiv-infected individuals (54.8% versus 89.7%; p = 0.001). The relapse rate was 46.2% and 7.5%, respectively (p < 0.001). Secondary prophylaxis with antimonial compounds or amphotericin b seems to be useful in preventing relapses in hiv-infected patients. The mortality rate was higher (53.7% versus 7.5%; p < 0.001) and the median survival time shorter (25 versus > 160 mo; p < 0.001) in AIDS patients than in hiv-negative individuals. Although leishmaniasis could contribute to death in a significant number of hiv-infected patients, it was the main cause of death in only a few of them. The CD4 lymphocyte count and the use of highly active antiretroviral therapy and secondary prophylaxis for leishmaniasis were the most significant prognostic factors for survival in AIDS patients. Visceral leishmaniasis behaves as an opportunistic infection in hiv-infected individuals and should be considered as an AIDS-defining disease.
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keywords = leishmaniasis
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5/25. Visceral leishmaniasis in an AIDS patient on successful antiretroviral therapy: failure of parasite eradication despite increase in CD4 T-cell count but low CD8 T-cell count.

    An unusual cutaneous relapse of visceral leishmaniasis (initially mistaken for eruptive histiocytomas) was seen in an AIDS patient despite good virological and CD4 T-cell responses to highly active antiretroviral therapy. splenectomy and the patient's low CD8 T-cell count are discussed as possible causes of failed disease control.
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ranking = 0.83333333333333
keywords = leishmaniasis
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6/25. leishmaniasis recidivans recurrence after 43 years: a clinical and immunologic report after successful treatment.

    We describe a patient with very late recurring leishmaniasis recidivans from whom lesional biopsy samples were obtained during and after topical steroid treatment that demonstrated the ability of the host to contain the parasite in the absence of therapy. Combination therapy with intralesional sodium stibogluconate and oral itraconazole was successful and immunologic data suggest that both CD4( ) and CD8( ) T cell subsets had roles in this disease process.
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ranking = 0.16666666666667
keywords = leishmaniasis
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7/25. 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.
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keywords = leishmaniasis
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8/25. Topical treatment of persistent cutaneous leishmaniasis with ethanolic lipid amphotericin b.

    A 1.5-year-old infant was referred because of spreading skin lesions diagnosed earlier as cutaneous leishmaniasis that did not respond to repeated courses with paromomycin-containing ointment. After consideration of the alternative therapeutic options, the infant was treated with a topical colloidal solution of amphotericin b for 3 weeks, This mode of therapy resulted in resolution of the skin lesions. No local or systemic side effects were observed. There were no signs of recurrence 3 months after cessation of the treatment.
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ranking = 0.83333333333333
keywords = leishmaniasis
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9/25. Visceral leishmaniasis. Persistence of parasites in lymph nodes after clinical cure.

    Visceral leishmaniasis (VL) is generally associated with severe immunodeficiency (AIDS; renal, liver, and heart transplantations; haemopoietic malignancies). More rarely it can be related to an immunotolerence status such as pregnancy. Various observations report the development of leishmaniasis several months or even years after exposure to the parasite. Relapses occur rarely in patients not known to be immunocompromised, but are common after incomplete treatment. They are frequent in patients with Leishmania/hiv co-infection. Asymptomatic phases and relapses suggest that parasite can exist in the tissues for a long time before and/or after clinical onset of the disease.The mechanisms of onset of clinical leishmaniasis following exposure and infestation are highly relevant to understanding the pathology of the disease. The survival of Leishmania parasite between infection and disease or after cure is a very important issue for clinicians and epidemiologists. We describe two cases of VL occurring in a patient with lymphoma and in a pregnant woman. In both cases, parasites remained present in the lymph nodes after clinical cure.
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ranking = 1.1666666666667
keywords = leishmaniasis
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10/25. 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.
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keywords = leishmaniasis
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