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

Leishmania tropica and L. major are etiologic agents of human cutaneous leishmaniasis. Delayed type hypersensitivity (DTH) is an immunologic response that has been frequently used as a correlate for protection against or sensitization to leishmania antigen. In BALB/c mice, L. tropica infection results in non-ulcerating disease, whereas L. major infection results in destructive lesions. In order to clarify the immunologic mechanisms of these 2 different outcomes, we compared the ability of these 2 leishmania species in induction of DTH response in this murine model. BALB/c mice were infected with L. major or L. tropica, and disease evolution and DTH responses were determined. The results show that the primary L. major infection can exacerbate the secondary L. major infection and is associated with DTH response. Higher doses of the primary L. major infection result in more disease exacerbation of the secondary L. major infection as well as higher DTH response. L. tropica infection induces lower DTH responses than L. major. We have previously reported that the primary L. tropica infection induces partial protection against the secondary L. major infection in BALB/c mice. Induction of lower DTH response by L. tropica suggests that the protection induced against L. major by prior L. tropica infection may be due to suppression of DTH response.
Animals ; Disease Models, Animal ; Ear/pathology ; Female ; Foot/pathology ; *Hypersensitivity, Delayed ; Leishmania major/*immunology ; Leishmania tropica/*immunology ; Leishmaniasis, Cutaneous/*immunology/*parasitology/pathology ; Mice ; Mice, Inbred BALB C

Various Leishmania species were engineered with green fluorescent protein (GFP) using episomal vectors that encoded an antibiotic resistance gene, such as aminoglycoside geneticin sulphate (G418). Most reports of GFP-Leishmania have used the flagellated extracellular promastigote, the stage of parasite detected in the midgut of the sandfly vector; fewer studies have been performed with amastigotes, the stage of parasite detected in mammals. In this study, comparisons were made regarding the efficiency for in vitro G418 selection of GFP-Leishmania amazonensis promastigotes and amastigotes and the use of in vivo G418 selection. The GFP-promastigotes retained episomal plasmid for a prolonged period and G418 treatment was necessary and efficient for in vitro selection. In contrast, GFP-amastigotes showed low retention of the episomal plasmid in the absence of G418 selection and low sensitivity to antibiotics in vitro. The use of protocols for G418 selection using infected BALB/c mice also indicated low sensitivity to antibiotics against amastigotes in cutaneous lesions.
Amebicides/*pharmacology ; Animals ; Flow Cytometry ; Gentamicins/*pharmacology ; Green Fluorescent Proteins/*chemistry ; Host-Parasite Interactions ; Leishmania mexicana/drug effects/genetics/*growth & development ; Leishmaniasis, Cutaneous/*parasitology ; Luminescent Agents/*chemistry ; Macrophages, Peritoneal/parasitology ; Mice ; Mice, Inbred BALB C ; Organisms, Genetically Modified ; Spectrometry, Fluorescence

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

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

Leishmaniasis is a worldwide uncontrolled parasitic disease due to the lack of effective drug and vaccine. To speed up effective drug development, we need powerful methods to rapidly assess drug effectiveness against the intracellular form of Leishmania in high throughput assays. Reporter gene technology has proven to be an excellent tool for drug screening in vitro. The effects of reporter proteins on parasite infectivity should be identified both in vitro and in vivo. In this research, we initially compared the infectivity rate of recombinant Leishmania major expressing stably enhanced green fluorescent protein (EGFP) alone or EGFP-luciferase (EGFP-LUC) with the wild-type strain. Next, we evaluated the sensitivity of these parasites to amphotericin B (AmB) as a standard drug in 2 parasitic phases, promastigote and amastigote. This comparison was made by MTT and nitric oxide (NO) assay and by quantifying the specific signals derived from reporter genes like EGFP intensity and luciferase activity. To study the amastigote form, both B10R and THP-1 macrophage cell lines were infected in the stationary phase and were exposed to AmB at different time points. Our results clearly revealed that the 3 parasite lines had similar in vitro infectivity rates with comparable parasite-induced levels of NO following interferon-gamma/lipopolysaccharide induction. Based on our results we proposed the more reporter gene, the faster and more sensitive evaluation of the drug efficiency.
Amphotericin B/*pharmacology ; Animals ; Antiprotozoal Agents/*pharmacology ; Drug Evaluation, Preclinical/instrumentation/*methods ; Female ; Gene Expression ; Genes, Reporter ; Green Fluorescent Proteins/genetics/*metabolism ; Humans ; Leishmania major/*drug effects/genetics/growth & development/physiology ; Leishmaniasis, Cutaneous/*parasitology ; Luciferases/genetics/*metabolism ; Mice

The mainstay therapy against leishmaniasis is still pentavalent antimonial drugs; however, the rate of antimony resistance is increasing in endemic regions such as Iran. Understanding the molecular basis of resistance to antimonials could be helpful to improve treatment strategies. This study aimed to recognize genes involved in antimony resistance of Leishmania tropica field isolates. Sensitive and resistant L. tropica parasites were isolated from anthroponotic cutaneous leishmaniasis patients and drug susceptibility of parasites to meglumine antimoniate (Glucantime(R)) was confirmed using in vitro assay. Then, complementary DNA-amplified fragment length polymorphism (cDNA-AFLP) and real-time reverse transcriptase-PCR (RT-PCR) approaches were utilized on mRNAs from resistant and sensitive L. tropica isolates. We identified 2 known genes, ubiquitin implicated in protein degradation and amino acid permease (AAP3) involved in arginine uptake. Also, we identified 1 gene encoding hypothetical protein. Real-time RT-PCR revealed a significant upregulation of ubiquitin (2.54-fold), and AAP3 (2.86-fold) (P<0.05) in a resistant isolate compared to a sensitive one. Our results suggest that overexpression of ubiquitin and AAP3 could potentially implicated in natural antimony resistance.
Amino Acid Transport Systems/*genetics/metabolism ; Antimony/*pharmacology ; Antipruritics/*pharmacology ; *Drug Resistance ; Humans ; Leishmania tropica/drug effects/enzymology/*genetics/isolation & purification ; Leishmaniasis, Cutaneous/*parasitology ; Protozoan Proteins/*genetics/metabolism ; Ubiquitin/*genetics/metabolism

The aim of this study was to assess the cytotoxic effects of various concentrations of miltefosine on Leishmania major (MRHO/IR/75/ER) and L. tropica (MHOM/IR/02/Mash10) promastigotes and to observe the programmed cell death features. The colorimetric MTT assay was used to find L. major and L. tropica viability and the obtained results were expressed as 50% inhibitory concentration (IC50). Also, 50% effective doses (ED50) for L. major and L. tropica amastigotes were also determined. Annexin-V FLUOS staining was performed to study the cell death properties of miltefosine using FACS analysis. Qualitative analysis of the total genomic DNA fragmentation was performed by agarose gel electrophoresis. Furthermore, to observe changes in cell morphology, promastigotes were examined using light microscopy. In both strains of L. major and L. tropica, miltefosine induced dose-dependent death with features of apoptosis, including cell shrinkage, DNA laddering, and externalization of phosphatidylserine. The IC50 was achieved at 22 microM and 11 microM for L. major and L. tropica after 48 hr of incubation, respectively. ED50 of L. major and L. tropica amastigotes were 5.7 microM and 4.2 microM, respectively. Our results indicate that miltefosine induces apoptosis of the causative agent of cutaneous leishmaniasis in a dose-dependent manner. Interestingly, L. major did not display any apoptotic changes when it was exposed to miltefosine in concentrations sufficient to kill L. tropica.
Animals ; Apoptosis/*drug effects ; Cell Cycle/drug effects ; Cell Line ; DNA Fragmentation/drug effects ; Humans ; Leishmania major/cytology/*drug effects ; Leishmania tropica/cytology/*drug effects ; Leishmaniasis, Cutaneous/parasitology ; Mice ; Phosphorylcholine/*analogs & derivatives/pharmacology

This study investigated whether trinitroglycerine (TNG) as nitric oxide (NO) releasing agent had anti-leishmanial effects and mediated pathology in BALB/c mice infected with Leishmania major. Cutaneous leishmaniasis (CL), a zoonotic infection caused by leishmania protozoa is still one of the health problems in the world and in Iran. NO is involved in host immune responses against intracellular L. major, and leishmania killing by macrophages is mediated by this substance. Moreover, application of CL treatment with NO-donors has been recently indicated. In our study, TNG was used for its ability to increase NO and to modify CL infection in mice, in order to evaluate NO effects on lesion size and formation, parasite proliferation inside macrophages, amastigote visceralization in target organs, and NO induction in plasma and organ suspensions. Data obtained in this study indicated that TNG increased plasma and liver-NO, reduced lesion sizes, removed amastigotes from lesions, livers, spleens, and lymph nodes, declined proliferation of amastigotes, hepatomegaly, and increased survival rate. However, TNG reduced spleen-NO and had no significant effects on spelenomegaly. The results show that TNG therapy reduced leishmaniasis and pathology in association with raised NO levels. TNG had some antiparasitic activity by reduction of positive smears from lesions, livers, spleens, and lymph nodes, which could emphasize the role of TNG to inhibit visceralization of L. major in target organs.
Animal Structures/parasitology ; Animals ; Antiprotozoal Agents/chemistry/*therapeutic use ; Female ; Leishmania major/*drug effects/immunology ; Leishmaniasis, Cutaneous ; Macrophages/parasitology ; Mice ; Mice, Inbred BALB C ; Nitric Oxide/blood/metabolism/*pharmacology ; Nitroglycerin/*analogs & derivatives/*therapeutic use ; Severity of Illness Index ; Skin/pathology ; Survival Analysis