Cutaneous leishmaniasis (CL) is an emerging disease in Sri Lanka, more than 400 cases having been reported since 2001. However, the morphology and taxonomic status of the Sri Lankan strain of Leishmania is not known yet. Therefore, it is important to study the morphology and to analyze the phylogenetic position to predict the risk and expansion of the disease and thereby to develop an effective control programme. Morphology of the amastigote of the Sri Lankan isolate was checked by light microscopy and electron microscopic observation. Presence of amastigotes within macrophages was confirmed in skin biopsy samples. The promastigote had the characteristic appearance of a kinetoplastid cell in cultures. The kinetoplast minicircle DNA has been used for diagnosis of Leishmania for a long time and also for phylogenetic studies on trypanosomatid flagellates. The kinetoplast minicircle was amplified using PCR and subsequently sequenced from samples obtained from Sri Lankan patients with cutaneous lesions. Mitochondrial cytochrome b gene has been recently shown to be useful for identification and phylogenetic analysis of the genus Leishmania. The nucleotide sequence of the cytochrome b gene of Sri Lankan Leishmania was determined using the semi-nested PCR and 620 bp of this gene obtained. Phylogenetic analysis using these sequences unambiguously indicated that Sri Lankan isolate of Leishmania belongs to L. donovani complex. However, the Sri Lankan isolate forms a distinct lineage within the complex and probably represents a new branch.

The beta-glucans derived from yeast cell walls have been reported for having many immunomodulatory activities in vivo and in vitro. In this study, Aureobasidium-derived soluble branched (1,3-1,6) beta-glucan (Sophy beta-glucan) was checked for natural killer (NK) activity and for the production of IFN-gamma and IL-4 in Leishmania amazonensis infection. The main experiment was performed with a group of female C57BL/6 and BALB/c mice, orally supplemented with 5% of Sophy beta-glucan and infected with promastogotes of L. amazonensis (1 x 10(7)) into the footpad. Increase in the footpad thickness with time was observed in BALB/c mice in spite of the oral Sophy beta-glucan supplement, but it was less in C57BL/6 mice. The difference in overall mean footpad thickness between 'infection only' versus 'infection + glucan' groups was statistically significant (P < 0.001). High NK activity in C57BL/6 than BALB/c mice was observed in 'glucan only' group compared to the control group and also in 'infection + glucan' group compared to 'infection only' group. The difference in the NK activity among these groups was significant (P < 0.05). The IFN-gamma level increased at weeks 7 and 8 post-infection in C57BL/6 mice and was significantly high in 'infection + glucan' group compared to the 'infection only' group (P < 0.05). IL-4 levels did not increase up to detectable levels throughout the study. The results led a conclusion that Sophy beta-glucan enhances NK activity and cellular immunity in L. amazonensis-infected mice.
Administration, Oral ; Animals ; Ascomycota/*chemistry ; Cytotoxicity Tests, Immunologic ; Female ; Foot/pathology ; Glucans/administration & dosage/*isolation & purification/pharmacology/*therapeutic use ; Immunologic Factors/administration & dosage/*isolation & purification/pharmacology/*therapeutic use ; Interferon-gamma/biosynthesis ; Interleukin-4/biosynthesis ; Killer Cells, Natural/drug effects/*immunology ; Leishmania mexicana/*immunology ; Leishmaniasis, Cutaneous/*drug therapy/immunology/pathology ; Mice ; Mice, Inbred BALB C ; Mice, Inbred C57BL ; Severity of Illness Index ; Time Factors

Introduction: Intravascular large B-cell lymphoma (IVLBCL) is a rare disease entity of non-Hodgkin lymphoma. Patients with IVLBCL frequently have neurological symptoms associated with cerebrovascular infarction or central nervous system involvement of malignant lymphoma. Case: A 67-year-old man consulted the Department of Hematology at our hospital because of fever of unknown origin, anemia and increased serum lactate dehydrogenase. Although IVLBCL was strongly suspected, no lymphoma cells were found by multiple bone marrow aspirations and skin biopsies. Two months later, he developed hyperactive delirium, which was difficult to manage using antipsychotic agents. Brain MRI revealed multiple hyper-intense infarct-like lesions on diffusion-weighted images. After assessment of bone marrow aspiration and skin biopsies, he was administered an enough dose of prednisolone to manage malignant lymphoma. Hyperactive delirium rapidly improved. Discussion: In patients with IVLBCL, corticosteroids may be useful to manage hyperactive delirium due to cerebrovascular infarction or central nervous system involvement of IVLBCL.