Leishmaniasis cutaneous

Patomomycin This oral aminoglycoside was first shown to be effective as a topical treatment for cutaneous leishmaniasis, and later as a parenteral drug against visceral leishmaniasis. Phase III clinical trials were completed in 2005 in India, 15 years after the potential of this component for treating viscer al leishmaniasis was discovered. It is currently not registered for this use. 

Fig. 9.15. A 56-year-old patient with wrinkles and atrophic scar due to old cutaneous leishmaniasis before (a) and 3 -months after (b) deep chemical peel...

Diseases which will probably be subject to control by insecticides but have not yet been adequately tested include sandfly fever, dengue, urban yellow fever, bartonellosis, cutaneous leishmaniasis, Chagas disease, filariasis, trench fever, and louse-born relapsing fever. Some of the virus encephalitides. sleeping sickness, and visceral leishmaniasis may also be susceptible of control. 

Scott, P. (1991) IFN-y modulates the early development of Thl and Th2 responses in a murine model of cutaneous leishmaniasis. Journal of Immunology 147, 3149-3155. 

Titus, R.G., Sherry, B., and Cerami, A., Tumor necrosis factor plays a protective role in experimental murine cutaneous leishmaniasis, J. Exp. Med., 170, 2097, 1989. 

Al-Abdely HM, et al. Efficacies of KY62 against Leishmania amazonensis and Leishmania donovani in experimental murine cutaneous leishmaniasis and visceral leishmaniasis. Antimicrob Agents Chemother 1998 42 2542. 

The flagellate leishmania is transmitted to humans by the bite of the female sandfly of the genus Phlebotomus. Three principal diseases result from infection with Leishmania spp. L. donovani causes visceral leishmaniasis (kala-azar) L. tropica and L. major produce cutaneous leishmaniasis, and L. braziliensis causes South American mucocutaneous leishmaniasis. In visceral leishmaniasis, the protozoan parasitizes the reticuloendothelial cells, and this results in an enlargement of the lymph nodes, liver, and spleen the spleen can become massive. Cutaneous leishmaniasis remains localized to the site of inoculation, where it forms a raised disfiguring ulcerative lesion. South American leishmaniasis is variable in its presentation. It is characterized by ulceration of the mucous membranes of the nose, mouth, and pharynx some disfiguring skin involvement also is possible. 

No pentavalent antimonial is licensed for use, but sodium stibogluconate is available from the Parasitic Disease Drug Service of the Centers for Disease Control (CDC) for treatment of leishmaniasis. While the pentavalent antimony compounds can be given intravenously or intramuscularly, local infiltration of the lesion in cutaneous leishmaniasis is highly effective. Because of the lower toxicity of liposomal amphotericin B, this drug is considered a first-line choice for vis-cerotropic leishmaniasis rather than the antimonials. 

It is pentavalent antimonial. It inhibits -SH dependent enzymes and block glycolytic fatty acid oxidation pathways. It is rapidly absorbed after IM injection and excreted unchanged in urine. Used in cutaneous and visceral leishmaniasis. It is given parenterally (20 mg/kg/day IM/IV) for three weeks in cutaneous leishmaniasis and for four weeks in visceral and mucocutaneous disease. 

G. Other applications Actimmune may have application in the treatment of a variety of cancers (e.g., malignant melanoma, ovarian cancer), AIDS, rheumatoid arthritis, hepatitis B, and cutaneous leishmaniasis, atopic dermatitis, and keloidal scarring. There is preliminary evidence that Actimmune may benefit patients with pulmonary fibrosis. 

Pentamidine is an alternative to sodium stibogluconate in the treatment of visceral leishmaniasis, with similar efficacy, although resistance has been reported. The drug has been successful in some cases that have failed therapy with antimonials. The dosage is 2-4 mg/kg intramuscularly daily or every other day for up to 15 doses, and a second course may be necessary. Pentamidine has also shown success against cutaneous leishmaniasis, but it is not routinely used for this purpose. 

This important antifungal drug (see Chapter 48) is an alternative therapy for visceral leishmaniasis, especially in parts of India with high-level resistance to sodium stibogluconate. Liposomal amphotericin has shown excellent efficacy at a dosage of 3 mg/kg/d intravenously on days 1-5, 14, and 21. Nonliposomal amphotericin (1 mg/kg intravenously every other day for 30 days) is much less expensive, also efficacious, and widely used in India. Amphotericin is also used for cutaneous leishmaniasis in some areas. The use of amphotericin, and especially liposomal preparations, is limited in developing countries by difficulty of administration, cost, and toxicity. 

Soto J et al Efficacy of miltefosine for Bolivian cutaneous leishmaniasis. Am J Trop Med Hyg 2008 78 210. [PMID 18256415]... 

Tuon FF et al Treatment of New World cutaneous leishmaniasis—a systematic review with a meta-analysis. Int J Dermatol 2008 47 109. [PMID 18211479]... 

Antimony(III) sodium gluconate Sodium antimony(lll) dimercaptosuccmate (Stibocaptate) Ethylstibamme " Antimony(V) sodium gluconate Less toxic than tartrates 172 (mouse intravenous) Schistosomiasis Schistosomiasis Kala Azar Espudia Cutaneous leishmaniasis... 

Hamilton, J.G., Ward, R.D., Dougherty, M. J., Maignon, R., Ponce, C., Ponce, E., Noyes, H. and Zeledon, R. (1996). Comparison of the sex-pheromone components of Lutzomyia longipalpis (Diptera Psychodidae) from areas of visceral and atypical cutaneous leishmaniasis in Honduras and Cost Rica. Ann. Prop. Med. Parasitol., 90, 533-541. 

Allopurinol and meglumine antimoniate (Glucantime) have been evaluated in a randomized controlled trial in 150 patients with cutaneous leishmaniasis (2). They received oral allopurinol (15 mg/kg/day) for 3 weeks or intramuscular meglumine antimoniate (30 mg/kg/day, corresponding to 8 mg/kg/day of pentavalent antimony, for 2 weeks), or combined therapy. There were a few adverse effects in those who used allopurinol nausea, heartburn (n = 3), and mild increases in transaminases (n = 2). These symptoms subsided on drug withdrawal. 

Esfandiarpour I, Alavi A. Evaluating the efficacy of allopurinol and meglumine antimoniate (Glucantime) in the treatment of cutaneous leishmaniasis. Int J Dermatol 2002 41(8) 521. ... 

Momeni AZ, Reiszadae MR, Aminjavaheri M. Treatment of cutaneous leishmaniasis with a combination of allopurinol and low-dose meglumine antimoniate. Int J Dermatol 2002 41(7) 441-3. 

A randomized, double-bhnd, placebo-controlled study of sodium stibogluconate for 10 and 20 days has been conducted in 38 US military personnel with cutaneous leishmaniasis 19 received sodium stibogluconate for 10... 

Peripheral sensory neuropathy has been described after the use of sodium stibogluconate for cutaneous leishmaniasis (SEDA-21, 300). 

Thrombocytopenia has been reported in a patient with Leishmania donovani infection and AIDS after stibogluconate therapy for 7 days (SEDA-13, 838). There have been two further reports, one involving a patient with cutaneous leishmaniasis (occurring after 19 days of treatment), the second a man with kala-azar (who became thombocytopenic 11 days after starting therapy) in kala-azar a low platelet count is common and the count normally rises with treatment (SEDA-18, 294). 

The treatment of cutaneous leishmaniasis has been reviewed, including the use of pentavalent antimonials... 

Saldanha AC, Romero GA, Merchan-Hamann E, Magalhaes AV, Macedo V de O. Estudo comparativo entre estibogluconato de sodio BP 88R e antimoniato de meglumina no tratamento da leishmaniose cutanea I. Eficacia e seguranca. [A comparative study between sodium stibogluconate BP 88R and meglumine antimoniate in the treatment of cutaneous leishmaniasis. I. The efficacy and safety.] Rev Soc Bras Med Trop 1999 32(4) 383-7. 

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