RESUMEN
Cutaneous leishmaniasis (CL) is endemic in the Bikaner region situated in the Thar Desert of Rajasthan, India. This study describes clinicoepidemiological data of pediatric CL in pre-school children (0-5 years of age) from this region during 2001-2012. In total, 151 patients with 217 lesions were reported during the study period. The mean age of the study group was 3.29 ± 1.43 years (0.25-5 years), with many (41.7%) cases being in the age group of 2-4 years. Face was the most common site involved, and morphologically, the lesions were either plaque type or papulonodular. Smear for parasitologic examination was positive in 84 (70%) of 120 cases, and histopathologic examination confirmed CL in 10 (55.55%) of 18 cases. Parasite species identification conducted for 13 randomly selected patients by polymerase chain reaction identified Leishmania tropica as the causative species. Intralesional sodium stibogluconate was the most commonly used treatment and found to be well-tolerated. Other therapies that were effective included oral rifampicin, oral dapsone, radiofrequency heat therapy (RFHT), and combinations of the three therapies.
Asunto(s)
Leishmaniasis Cutánea/tratamiento farmacológico , Leishmaniasis Cutánea/epidemiología , Administración Oral , Gluconato de Sodio Antimonio/uso terapéutico , Preescolar , Dapsona/uso terapéutico , Femenino , Humanos , Incidencia , India/epidemiología , Lactante , Inyecciones Intralesiones , Leishmaniasis Cutánea/radioterapia , Masculino , Reacción en Cadena de la Polimerasa , Tratamiento de Radiofrecuencia Pulsada/métodos , Estudios Retrospectivos , Rifampin/uso terapéuticoRESUMEN
BACKGROUND: Leishmaniases are divided into cutaneous (CL) and visceral leishmaniasis (VL). In the Old World, CL is caused by Leishmania (L.) major, L. tropica and L. aethiopica. L. tropica can also visceralize and cause VL. In India, the large epidemics of VL are caused by L. donovani and cases of CL are caused by L. major and L. tropica. However, strains of L. tropica have also been isolated from Indian cases of VL.This study was done to see if Indian strains of L. tropica isolated from human cases of CL are genetically identical to or different from Indian strains of L. tropica isolated from human cases of VL and to see if any genetic differences found correlated with clinical outcome presenting as either CL or VL. METHODS: Multilocus microsatellite typing (MLMT), employing 12 independent genetic markers specific to L. tropica, was used to characterize and identify eight strains of L. tropica isolated from human cases of CL examined in clinics in Bikaner City, Rajasthan State, north-west India. Their microsatellite profiles were compared to those of 156 previously typed strains of L. tropica from various geographical locations that were isolated from human cases of CL and VL, hyraxes and sand fly vectors. RESULTS: Bayesian, distance-based and factorial correspondence analyses revealed two confirmed populations: India/Asia and Israel/Palestine that subdivided, respectively, into two and three subpopulations. A third population, Africa/Galilee, as proposed by Bayesian analysis was not supported by the other applied methods. The strains of L. tropica from Bikaner isolated from human cases of CL fell into one of the subpopulations in the population India/Asia together with strains from other Asian foci. Indian strains isolated from human cases of VL fell into the same sub-population but were not genetically identical to the Bikaner strains of L. tropica. CONCLUSIONS: It seems that the genetic diversity encountered between the two groups of Indian strains is mainly owing to their geographical origins rather than their different times of isolation. Also, the genetic differences seen between the dermatotropic and viscerotropic strains might be connected with the difference in pathogenicity.
Asunto(s)
Leishmania tropica/genética , Leishmaniasis Cutánea/parasitología , Leishmaniasis Visceral/parasitología , Repeticiones de Microsatélite/genética , Tipificación de Secuencias Multilocus , Animales , India/epidemiología , Leishmania tropica/aislamiento & purificación , Leishmaniasis Cutánea/epidemiología , Leishmaniasis Visceral/epidemiología , FilogeniaRESUMEN
Cutaneous leishmaniasis is endemic to the Thar Desert of Rajasthan, Bikaner, India. The present study describes clinico-epidemiologcial data of all cases of cutaneous leishmaniasis CL in this region during 2001-2011. A total of 1,379 patients with 2,730 lesions were reported during the study period. Ages of patients ranged from 3 months to 86 years, and there was a predominance of infections in males. Most patients were from urban areas and lower middle socioeconomic groups. Lesions were dry, ulcerated nodules or plaques of different sizes commonly over face and upper limb. Skin smears were positive for parasites in 958 (69.5%) patients, and the remaining 45.8% (193 of 421) patients were positive by skin biopsy. Histopathologic analysis of the skin showed mixed granulomas consisting of macrophages, lymphocytes, epitheloid, and plasma cells. Species identification was conducted for 45 randomly selected patients by polymerase chain reaction, the infective species was Leishmania tropica. Most patients were treated with intra-lesional injections of sodium stibogluconate.
Asunto(s)
Leishmaniasis Cutánea/epidemiología , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , India/epidemiología , Lactante , Leishmaniasis Cutánea/tratamiento farmacológico , Leishmaniasis Cutánea/patología , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Factores Sexuales , Piel/patología , Factores Socioeconómicos , Adulto JovenRESUMEN
Current treatments for warts induce significant local tissue damage and do not prevent recurrence. We evaluated the efficacy of localised radiofrequency heat (RFH) therapy in inducing the long-term resolution of common and palmo-plantar warts in a placebo-controlled randomised single blind trial. Our data show that RFH therapy is a safe, cosmetically acceptable and long-term effective treatment for warts.
Asunto(s)
Técnicas de Ablación , Diatermia , Verrugas/cirugía , Adolescente , Adulto , Femenino , Estudios de Seguimiento , Dermatosis del Pie/cirugía , Dermatosis de la Mano/cirugía , Humanos , Masculino , Método Simple Ciego , Adulto JovenRESUMEN
Canine cutaneous leishmaniasis (CCL) is a significant veterinary problem. Infected dogs also serve as parasite reservoirs and contribute to human transmission of cutaneous leishmaniasis (CL). Current treatments for CCL are cumbersome and toxic because they are prolonged and involve multiple injections of antimonials. Radio-frequency induced heat (RFH) therapy has been found to be highly effective against CL in humans. Here, we examined the efficacy of topical RFH therapy in the treatment of CL in two pet dogs. We found that RFH therapy induced complete clinical cure and lesion healing within 45 days and both dogs have remained disease free for the last 16 months. This report is the first to demonstrate that a single topical application of RFH therapy is safe and effective in inducing long-term cure of CCL.
Asunto(s)
Enfermedades de los Perros/parasitología , Enfermedades de los Perros/terapia , Hipertermia Inducida/veterinaria , Leishmania/aislamiento & purificación , Leishmaniasis Cutánea/veterinaria , Zoonosis/parasitología , Animales , Perros , Femenino , Hipertermia Inducida/métodos , Leishmaniasis Cutánea/parasitología , Leishmaniasis Cutánea/terapia , Ondas de RadioAsunto(s)
Hipertermia Inducida , Leishmania/fisiología , Leishmaniasis Cutánea/terapia , Gluconato de Sodio Antimonio/administración & dosificación , Gluconato de Sodio Antimonio/efectos adversos , Gluconato de Sodio Antimonio/uso terapéutico , Humanos , Hipertermia Inducida/métodos , Leishmaniasis Cutánea/patología , Paromomicina/administración & dosificación , Paromomicina/uso terapéutico , Ondas de Radio , Resultado del TratamientoRESUMEN
Cutaneous leishmaniasis (CL) is a vector borne disease caused by various species of Leishmania parasite. CL is endemic in the Thar desert of Rajasthan state and Himachal Pradesh in India. Immune suppression caused by human immunodeficiency virus (HIV) infection is associated with atypical clinical presentation of CL which responds poorly to the standard treatment and causes frequent relapses. We are reporting three cases of localized and disseminated CL due to Leishmania tropica which failed to respond to conventional intralesional/intramuscular sodium stibogluconate (SSG) injections. Initially, we did not think of HIV infection because CL is endemic in this region. When patients did not respond to SSG injections, we performed enzyme-linked immunosorbent assay (ELISA) tests for HIV and they turned out to be HIV positive. Our report showed that CL is emerging as an opportunistic infection associated with HIV/AIDS and may be the first manifestation in HIV positive patients in an endemic area.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Infecciones por VIH/complicaciones , Infecciones por VIH/diagnóstico , Leishmaniasis Cutánea/complicaciones , Leishmaniasis Cutánea/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Adulto , Gluconato de Sodio Antimonio/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Humanos , Leishmaniasis Cutánea/tratamiento farmacológico , MasculinoRESUMEN
BACKGROUND/AIM: Intralesional bleomycin gained increasing popularity in the recent past for treatment of warts particularly in palmo-plantar and periungual regions as other modalities are not very effective. Hence we evaluated the role of intralesional bleomycin in periungual and palmo-plantar warts to know its efficacy in Indian patients. SETTINGS AND DESIGN: This was a placebo-controlled study. MATERIALS AND METHODS: Fifty patients of multiple palmo-plantar and periungual warts were included in this study and categorized in groups A and B of 25 each. Alternate patients were included in groups A and B and treated respectively with intralesional bleomycin (1 mg/mL solution) and normal saline as placebo, fortnightly for maximum up to two injections. Patients were followed up weekly for 1 month, fortnightly up to 12 weeks, and then quarterly for 1 year. If warts persisted after 12 weeks of starting treatment, it was considered a failure. Statistical analysis was done by the chi-square test using M-stat software. RESULTS: Group A and B patients were having 85 warts and 72 warts, respectively. The cure rate in group A and B patients was 96.47% (82/85 warts) and 11.11% (8/72 warts), respectively, after one or two injections within 12 weeks. The difference in the cure rate between two groups was statistically highly significant (<0.0001). In group A patients, a haemorrhagic eschar was formed which gradually healed in 8-12 weeks without atrophy or pigmentation; this phenomenon was not seen in group B. Only moderate pain was observed by most of the patients during injection in both groups. CONCLUSION: The intralesional injection of bleomycin is highly effective, safe, and non-toxic in periungual and palmo-plantar warts.
RESUMEN
We have established Leishmania tropica as the causative agent of cutaneous leishmaniasis (CL) in the region of India where the disease is endemic. The association between localized and circulating levels of immune-determinants in CL patients was evaluated. Reverse transcription-polymerase chain reaction analysis revealed up-regulation of interferon-gamma (IFN-gamma), interleukin (IL)-1beta, IL-8, tumour necrosis factor-alpha (TNF-alpha), IL-10 and IL-4 in dermal lesions at the pretreatment stage (n = 31) compared with healthy controls (P < 0.001) and a significant down-regulation after treatment (n = 14, P < 0.05). The results indicated that an unfavourable clinical outcome in CL was not related to an inadequate T helper 1 (Th1) cell response, but rather to impairment in multiple immune functions. Comparative assessment of treatment regimes with rifampicin (RFM) or sodium antimony gluconate (SAG) revealed tissue cytokine levels to be significantly reduced after treatment with RFM (P < 0.005), while no significant decrease was evident in the levels of IFN-gamma, TNF-alpha and IL-10 (P > 0.05) as a result of treatment with SAG. Increased transcripts of monocyte chemoattractant protein-1 (MCP-1) (P < 0.001) and inducible nitric oxide synthase (iNOS) (P < 0.05) were evident before treatment in tissue lesions and remained high after treatment. Immunohistochemistry demonstrated strong expression of myeloperoxidase (MPO) and IL-8, and moderate expression of iNOS in dermal lesions. The expression levels of IL-8, MCP-1 and nitric oxide (NO) were high in patient sera before treatment, as determined using cytokine bead array and enzyme-linked immunosorbent assay (ELISA). At the post-treatment stage, the serum IL-8 levels had decreased; however, the levels of MCP-1 and NO remained high. These data suggest that IL-8 is an effector immune-determinant in the progression of CL, whereas NO facilitates the parasite killing by macrophages via MCP-1-mediated stimulation.