Female ; Humans ; Leishmaniasis, Cutaneous ; diagnosis ; drug therapy ; pathology ; Male ; Middle Aged

Leishmaniasis is a parasitic disease caused by Leishmania species and is classified into three forms; cutaneous, mucocutaneous, and visceral. The eyelid is a rare site involved by leishmaniasis and only makes up 2.5% of cases with cutaneous leishmaniasis (CL). Although CL can affect both upper and lower lids on either their outer or inner aspects, the lateral canthus is most often affected. The most common aspect of lid leishmaniasis is chalazion-like lesions but ulcerous, phagedenic, cancer-like forms, and unilateral chronic granulomatous blepharitis may be observed. When the lid is involved, the disease is usually self-limiting; healing usually takes up to one year, hence early diagnosis and treatment are important. The diagnosis is based on a high index of suspicion regarding the endemicity of the disease in the region. Response to treatment in lid CL cases is quite satisfactory. In this article, we report nine cases of lid leishmaniasis with satisfactory responses to intralesional meglumine antimoniate.
Adolescent ; Adult ; Child ; Eyelid Diseases/*parasitology ; Eyelids/*parasitology ; Female ; Humans ; Infant ; Injections, Intralesional ; Leishmaniasis, Cutaneous/*drug therapy ; Male ; Meglumine/*administration & dosage ; Organometallic Compounds/*administration & dosage ; Treatment Outcome

Tamoxifen is an antagonist of the estrogen receptor and currently used for the treatment of breast cancer. The current treatment of cutaneous leishmaniasis with pentavalent antimony compounds is not satisfactory. Therefore, in this study, due to its antileishmanial activity, effects of tamoxifen on the growth of promastigotes and amastigotes of Leishmania major Iranian strain were evaluated in vitro. Promastigotes and amastigotes were treated with different concentrations (1, 5, 10, 20, and 50 µg/ml) and time periods (24, 48, and 72 hr) of tamoxifen. After tamoxifen treatment, MTT assay (3-[4,5-dimethylthiazol-2-yl]-2,5 biphenyl tetrazolium bromide assay) was used to determine the percentage of live parasites and Graph Pad Prism software to calculate IC50. Flow cytometry was applied to investigate the induction of tamoxifen-induced apoptosis in promastigotes. The half maximal inhibitory concentration (IC50) of tamoxifen on promastigotes was 2.6 µg/ml after 24 hr treatment. Flow cytometry analysis showed that tamoxifen induced early and late apoptosis in Leishmania promastigotes. While after 48 hr in control group the apoptosis was 2.0%, the 50 µg/L concentration of tamoxifen increased it to 59.7%. Based on the in vitro antileishmanial effect, tamoxifen might be used for leishmaniasis treatment; however, further researches on in vivo effects of tamoxifen in animal models are needed.
Animals ; Antiprotozoal Agents/pharmacology/therapeutic use ; Apoptosis/*drug effects ; Cells, Cultured ; Inhibitory Concentration 50 ; Leishmania major/*drug effects ; Leishmaniasis, Cutaneous/drug therapy ; Macrophages/parasitology ; Mice ; Tamoxifen/*pharmacology/therapeutic use

Cutaneous leishmaniasis (CL), due to Leishmania major, is endemic in different parts of Iran and has long been recognized in most provinces of Iran. This study was conducted to determine the prevalence of childhood leishmaniasis in 3 areas at the southeast of Kashan. A descriptive study was carried out on all children referred to central laboratories during a 3-year period. Initial information including age, sex, sites of ulcer on the body, number of lesions, address, and the place of the disease was obtained. The study gathered 117 children, and the results showed a prevalence of 7.2% in patients with lesions among the population and 4.2% of people displayed lesion and scar. The ages of subjects were from 6 to 15 years (average 9.75 years). The boy: girl ratio was 1.2. All of our patients lived in an endemic area. The face was affected in 47.0% of cases. The encountered forms of leishmaniasis are as follows: papulonodular 27.4%, ulcer 60.7%, sporotrichoid 6%, impetiginous 2.5%, and erysipeloid 3.4%. Treatment with intramuscular meglumine antimoniate 20-30 mg/kg/day was done for 93 patients. Meglumine antimoniate treatment was tolerated with no side effects. All leishmaniasis lesions healed within an average period of 2-14 months. Hyperpigmented scars were formed in 25.6% of the patients, atrophic scars in 4.3%, and hypopigmented scars were in 3.4%, respectively. The findings of this study indicate increased prevalence of CL in the villages at the area of Kashan and Aran-Bidgol. The clinical finding patterns belonged to different endemic strains of L. major in Isfahan, which indicates the possible transmission of infection from Isfahan to this area.
Prevalence ; Organometallic Compounds/therapeutic use ; Meglumine/therapeutic use ; Male ; Leishmaniasis, Cutaneous/drug therapy/epidemiology/parasitology/physiopathology ; *Leishmania major/drug effects/pathogenicity ; Iran ; Humans ; Female ; *Endemic Diseases ; Child ; Antiprotozoal Agents/therapeutic use ; Animals ; Adolescent

Lupoid leishmaniasis is a unique form of cutaneous leishmaniasis characterized by unusual clinical features and a chronic relapsing course, mostly caused by infection with Leishmania tropica. In this clinical form, 1-2 yr after healing of the acute lesion, new papules and nodules appear at the margin of the remaining scar. Herein, we describe a case of this clinical form that was resistant to 2 courses of treatments: systemic glucantime and then a combination therapy with allopurinol and systemic glucantime. However, marked improvement was seen after a combination therapy with topical trichloroacetic acid solution (50%) and systemic glucantime, and there were no signs of recurrence after 1 yr of follow-up.
Administration, Topical ; Adult ; Antiprotozoal Agents/administration & dosage/*therapeutic use ; Humans ; Leishmaniasis, Cutaneous/*drug therapy/pathology ; Male ; Meglumine/*therapeutic use ; Organometallic Compounds/*therapeutic use ; Trichloroacetic Acid/administration & dosage/*therapeutic use

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

INTRODUCTIONAntimonial compounds are regarded as the treatment of choice for cutaneous leishmaniasis (CL). Systemic administration of these drugs has some side effects including cardio toxicity and electrocardiogram (EKG) changes. The objective of our study was to evaluate EKG changes in the patients with CL treated with systemic glucantime.

MATERIALS AND METHODSOne hundred and thirty-one patients were enrolled in this prospective study. All of the selected patients had confirmed CL and were candidates for treatment with systemic glucantime. The patients were treated with systemic glucantime and EKG was performed before, during (weekly) and 1 month after cessation of the treatment. All of the collected data were analysed using SPSS software.

RESULTSThe most common change was prolonged QT interval that was seen in 19% of the patients. ST depression occurred in 6.1% of the patients. Minimal ST elevation occurred in 3% and inverted T was observed in 7.4% of the patients. Single premature atrial contraction (PAC) and single premature ventricular contraction (PVC) occurred in 0.7% and 2.29% of patients, respectively. Bradycardia was observed in 10.6% and left bundle branch block in 0.7% of the patients. All of these changes reversed after stopping the treatment except 1 case with left bundle branch block that lasted for 1 month after the treatment.

CONCLUSIONSOur results showed that treatment with glucantime can induce many ECG changes as QT prolongation have significant risk. We suggest that ECG monitoring should be performed in high-risk patients undergoing glucantime treatment with special attention to ECG changes mostly prolonged QT interval.

Administration, Oral ; Adult ; Animals ; Antimony ; Antiprotozoal Agents ; administration & dosage ; adverse effects ; Atrial Premature Complexes ; chemically induced ; physiopathology ; Bradycardia ; chemically induced ; physiopathology ; Bundle-Branch Block ; chemically induced ; physiopathology ; Dose-Response Relationship, Drug ; Electrocardiography ; drug effects ; Female ; Follow-Up Studies ; Humans ; Leishmaniasis, Cutaneous ; complications ; drug therapy ; physiopathology ; Male ; Meglumine ; administration & dosage ; adverse effects ; Organometallic Compounds ; administration & dosage ; adverse effects ; Prognosis ; Prospective Studies ; Ventricular Premature Complexes ; chemically induced ; physiopathology