Mucocutaneous forms

Leishmaniasis affects some 12 million humans aimuaHy ia an area where 350 million are at risk. It is a complex of at least two protozoan diseases, consisting primarily of cutaneous and visceral forms. A mucocutaneous form is considered by some to be another distinct variety. Clinical manifestations of the disease range from an asymptomatic infection to an infection ia which there is considerable destmction of cutaneous tissue and mucous membranes. Leishmaniasis can often be fatal, especially ia the visceral form. The seriousness of the disease depends on the state of the immunological system of the... 

Antimony compounds have been used to treat leishmaniasis ever since tartar emetic (antimony potassium tartrate) was discovered early in the 20th century to have efficacy against the mucocutaneous form of the disease. The cutaneous form has been treated with tartar emetic formulated in an ointment. Many side effects have been seen with this trivalent antimonial, some of which can be ascribed to the difficulty of obtaining pure antimony for its manufacture. These side effects include toxicity to the heart, Hver, and kidneys. Other promising trivalent antimonials have been abandoned in favor of pentavalent antimonials with lower toxicity. 

Amphotericin B (15) is an antifimgal macioHde antibiotic produced by Streptomjces nodosus that has been used as an alternative, albeit more toxic, dmg to the antimonials. It acts as a leishmanicide against the visceral and mucocutaneous forms of the disease. To overcome its potentially severe nephrotoxicity, the dmg must be adrninistered over an extended period of time. 

Leishmaniasis. The causative agents are flagellated protozoa that are transmitted by sand flies to humans. The parasites are taken up into phagocytes, where they remain in phagolysosomes and multiply until the cell dies and the parasites can infect new cells. Symptoms A visceral form, known as kala-azar, and cutaneous or mucocutaneous forms exist (A). An estimated 12 million humans are affected. Therapy is dif cult pen-tavalent antimonial compounds, such as stibogluconate, must be given for extended periods. Adverse effects are pronounced. 

In the adult, both the cutaneous and mucocutaneous forms of leishmaniasis [Leishmania braziliensis and L. mexicana) are treated with stibogluconate. An alternative drug for the visceral form is amphotericin B. 

The disease can range from cutaneous ulcers to the mucocutaneous form affecting the nose, oral cavity, and pharynx. The highest incidence usually is seen in the summer months, especially in subjects working near forested areas. Visceral leishmaniasis may be ac-... 

Melarsoprol Drug of choice in African sleeping sickness (late, CNS stage of trypanosonraas) also used in mucocutaneous forms of the disease... 

In 1912, however, (201) it was discovered that espundia (American mucocutaneous leishmaniasis) can be cured by tartar emetic. It was soon learned that kala-a2ar (visceral leishmaniasis) and oriental sore (a cutaneous form of the disease occurring in the Middle East) also respond to antimonial therapy, especially when compounds of pentavalent antimony are employed. Treatment of leishmaniasis with the latter type of antimonials is safe and effective in over 90% of the cases (202). In 1918, it was demonstrated that tartar emetic is of value in the treatment of schistosomiasis (203). Pentavalent antimonials proved to be less effective. The introduction of antimony compounds for the treatment of parasitic diseases is undoubtedly one of the important milestones in the history of therapeutics (see Antiparasitic agents). 

Certain species of the D bra liensis complex may cause mucocutaneous leishmaniasis, a form seen most frequently in northern and central South America. The patient first develops skin infections which later metastasize to produce highly disfiguring mucocutaneous lesions of the oronasopharynx. 

The answer is d. (Hardman, pp 1183-1184.) Mucocutaneous infections, most commonly Candida albicans, involve the moist skin and mucous membranes. Agents used topically include amphotericin B, nystatin, miconazole, and clotrimazole. Ketoconazole and fluconazole are administered orally in pill form for treatment of chronic infections... 

Foscarnet is approved for the treatment of acyclovir-resistant mucocutaneous HSV infections in immunocompromised individuals. A clinical study indicated that it is more effective than vidarabine. Foscarnet has also been used for the treatment of acyclovir-resistant VZV and nonretinitis forms of CMV infection, although its efficacy is not so well established. 

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. 

Skin reactions are the most frequent of aU adverse effects of gold they develop in about 25% of patients, sometimes in association with other forms of gold intolerance. Up to 30% of patients taking auranofin develop mucocutaneous adverse effects and 18-24% develop a rash or pruritus, meriting withdrawal in some 4% of cases (SEDA-10, 208). 

The potential therapeutic effect of berbamine (10, 25, and 50 pg/ml)(and thirteen other bisbenzylisoquinoline alkaloids) against the protozoan disease leishmaniasis was studied by biological assays on in vitro culture forms of three strains of Leishmania L. brasiliensis brasiliensis (cutaneous and mucocutaneous leishmaniasis), L. mexicana amazonensis (cutaneous), and L. donovani (visceral leishmaniasis). Berbamine was found to inhibit the growth of all three types to differing degrees, but was not as active as daphnandrine, gyrocarpine, or obaberine [194]. 

The main clinical symptoms of cutaneous leishmaniasis are related to dermal problems like skin lesions and ulcerations. The mucocutaneous leishmaniasis is the severe and destructive form of cutaneous leishmaniasis that may occasionally cause destruction or disfiguration of tissues of nasal septum, lips and larynx. 

This disease is caused by a protozoan belonging to the genus Leish-mania. The three variations of the disease are visceral leishmaniasis (kala-azm, black fever, or Assam fever), cutaneous leishmaniasis, and mucocutaneous leishmaniasis. " The visceral form is caused predominantly by L. donovani, whereas the other two forms are caused... 

Fungal infections have emerged as a major cause of death among cancer patients and transplant recipients. In addition, patients with acquired immune-deficiency syndrome (AIDS) experience substantially more frequent and severe forms of cryptococcosis, histoplasmosis, coccidioidomycosis, and mucocutaneous (esophageal, oral, and vulvovaginal) candidiasis. 

Dibucaine (No. 11) is probably the most toxic anesthetic presently in use, as it is 15 times more toxic than procaine. It is also about 15 times more potent thus it is usable at low doses. Parenteral use is limited to the spinal route effects are long lasting (see Table 13-6). This property makes it particularly appealing for topical use (skin) and mucocutaneous areas (e.g., rectal) in the form of creams and ointments. 

Leishmania, parasitic protozoa transmitted by flesh-eating flies, cause various diseases ranging from cutaneous or mucocutaneous lesions to splenic and hepatic enlargement with fever. Soilium stibogluconate (pentavalent antimony), the primary drug in all forms of the disease, appears to kill the parasite by inhibition of glycolysis or effects on nucleic acid metabolism. Alternative agents include pentamidine (for visceral leishmaniasis), metronidazole (for cutaneous lesions), and amphotericin B (for mucocutaneous leishmaniasis). 

Leishmaniasis, a vector borne disease caused by obligate intracellular macrophage protozoa, is characterized by complexity and diversity. The disease can present itself in four difierent forms in humans cutaneous, diffuse cutaneous, mucocutaneous, and visceral. 

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