allopurinol and Leishmaniasis--Cutaneous

Topics: Allopurinol; Amphotericin B; Antimony Sodium Gluconate; Humans; Incidence; Ketoconazole; Leishmaniasis, Cutaneous; Leishmaniasis, Visceral

Topics: Allopurinol; Animals; Antimony; Hot Temperature; Humans; Imidazoles; Leishmania braziliensis; Leishmania guyanensis; Leishmania major; Leishmania mexicana; Leishmania tropica; Leishmaniasis, Cutaneous; Leishmaniasis, Mucocutaneous; Pentamidine

Leishmaniasis are parasitic diseases in extension. They appear in new foci, because of important displacements of populations, and they affect immunocompromised patients (under chemotherapy, transplanted, or HIV infected). Study of 33 cases of leishmaniasis, 22 visceral and 11 cutaneous, at the Hôpital du Kremlin-Bicêtre, France, showed predominant contamination in Maghreb and in the south of France. In the case of Kala-Azar, fever (18 cases) and hepatosplenomegaly (19 cases) are frequent, and the serodiagnosis and the search of parasites by myelogram are always positive. In HIV-infected individuals, clinical signs are similar, but the serodiagnosis is less reliable. Evolution is bad in transplanted patients who must remain under immunosuppressive drugs. In the case of cutaneous leishmaniasis, diagnosis is based on local sample, while the serodiagnosis remains negative. Treatment is sometimes long, necessitating repeated treatments.

Topics: Allopurinol; Animals; Child, Preschool; Disease Reservoirs; Female; Global Health; Humans; Leishmaniasis, Cutaneous; Leishmaniasis, Visceral; Male; Meglumine; Pentamidine; Protozoan Vaccines

Old World cutaneous leishmaniasis (OWCL) is an endemic and major health problem in Iran. The optimal treatment of OWCL is unknown, and current treatments are not ideally effective and have many adverse effects. To compare the efficacy and tolerability of combined oral azithromycin and allopurinol with intramuscular Glucantime in the treatment of OWCL, we conducted a prospective randomized clinical trial. A total of 86 patients with OWCL were assigned and divided randomly into two groups; they received a combination of azithromycin capsule 10 mg/kg/d and allopurinol tablet 10 mg/kg/d for two months or IM injection of Glucantime 20 mg/kg of antimony daily for 20 days. All patients were followed for two months after termination of treatment. Although immediately at the end of the treatment period, complete response was seen in 27.8% of patients on combination therapy vs. 0% in the Glucantime group. The combination of azithromycin and allopurinol had a better outcome; two months after the end of the treatment period, complete, partial, and no responses were seen in 38.9%, 22.2%, and 38.9% in combination therapy and 40%, 31.4%, and 28.6% in the Glucantime group. There was no significant difference between the response rate in both groups after two months (P = 0.5). No severe adverse effect occurred. This study demonstrated that the efficacy of combined oral azithromycin and allopurinol at the above doses and duration was similar to that of IM Glucantime in the treatment of OWCL.

Topics: Administration, Oral; Adult; Allopurinol; Anti-Bacterial Agents; Antimetabolites; Antiprotozoal Agents; Azithromycin; Drug Therapy, Combination; Female; Humans; Injections, Intramuscular; Iran; Leishmaniasis, Cutaneous; Male; Meglumine; Meglumine Antimoniate; Middle Aged; Organometallic Compounds; Treatment Outcome

The aim of this trial was to evaluate the effectiveness and safety of miltefosine-allopurinol combination therapy vs. the current reference combination therapy, meglumine antimoniate-allopurinol, for canine leishmaniosis. Dogs included in the study exhibited clinical signs of the disease, were positive by PCR and serologically positive by immunofluorescent antibody test for leishmaniosis, and negative for ehrlichiosis. Dogs were divided into two groups: Group 1 was treated with 2 mg/kg of miltefosine orally once daily for 28 days and 10 mg/kg of allopurinol orally twice daily for 7 months; Group 2 was treated with 50 mg/kg of meglumine antimoniate sub-cutaneously twice daily for 28 days and allopurinol (same dose as Group 1) for 7 months. Dogs were examined according to the following schedule: pre-inclusion, Day 0 (D0), D14, D28, D84, D140 and D196. At each visit, blood, urine and bone marrow samples were collected. Parameters monitored included haematology, biochemistry, protein electrophoresis, serology, urinary protein/creatinine ratio and RTQ-PCR performed on bone marrow aspirates. A significant reduction in total clinical score and parasite load was observed in both groups over the 7-month study period (P < 0.0001), with no significant difference between groups (P = 0.3). The safety of miltefosine-allopurinol combination therapy was confirmed by lack of effect on renal and hepatic parameters and adverse reactions. Miltefosine, in combination with allopurinol, offers a safe, convenient and effective alternative treatment option for canine leishmaniosis compared to the reference therapy.

Topics: Allopurinol; Animals; Dog Diseases; Dogs; Drug Therapy, Combination; Female; Leishmaniasis, Cutaneous; Male; Meglumine; Meglumine Antimoniate; Organometallic Compounds; Phosphorylcholine

Canine leishmaniasis (CL) is a systemic parasitic disease with a wide variability of response to specific therapy: the majority of patients apparently improve with treatment, some of them respond but later relapse, and few of them do not respond at all. It has been demonstrated that the immune response plays a key role in the development and outcome of Leishmania infection in the dog and in the response to the treatment, although this response is not well understood. Some authors have suggested that ill dogs show a reduction in the percentage of circulating CD4+ lymphocytes and in the CD4+/CD8+ ratio, both of which normalize after treatment and clinical recovery. The present paper discusses the variation of the different lymphocyte subpopulations (CD3, CD4, CD8, CD21) of peripheral blood mononuclear cells (PBMC) in 28 dogs diagnosed with CL and submitted to conventional treatment with meglumine antimoniate (Glucantime) for 1 month and with allopurinol (Zyloric) for 1 year, in order to evaluate the usefulness of these parameters as indicators of the immunological condition of the ill animals and of the prognosis of their evolution during the treatment. It is concluded that circulating lymphocyte subpopulations are similar in dogs with leishmaniasis and in healthy dogs and that there is no correlation between the clinical status or response to therapy and the values of the counts of the different lymphocyte subpopulations. Therefore, the percentage of different lymphocyte subpopulations cannot be used as a parameter to predict the evolution of an individual patient in a clinical context.

Topics: Allopurinol; Animals; Antiprotozoal Agents; Dog Diseases; Dogs; Female; Leishmaniasis, Cutaneous; Lymphocyte Subsets; Male; Meglumine; Meglumine Antimoniate; Organometallic Compounds; Time Factors

The objective of this study was to compare the efficacy of a combination of allopurinol (AL) and low-dose meglumine antimoniate (MA) with standard-dose MA in cutaneous leishmaniasis caused by Leishmania major. An open, controlled study was performed. Seventy-two patients were randomly selected from volunteers with cutaneous leishmaniasis living in a hyperendemic area. Exclusion criteria included pregnancy, nursing vs. gestation, age less than 5 years, and duration of disease of more than 4 months. Each patient received MA (60 mg/kg/day) or AL (20 mg/kg/day) plus low-dose MA (30 mg/kg/day) for 20 days, and was followed up for 30 days after cessation of treatment. The study was completed as planned in 66 patients. Complete healing occurred in 74.2% of patients in the MA group and in 80.6% of patients in the MA + AL group. No difference was found between the two groups with respect to side-effects. The combination of AL and MA increases the anti-leishmanial effects of antimoniate. In this study, it was confirmed that low-dose MA plus AL is as effective as high-dose MA in the treatment of cutaneous leishmaniasis caused by L. major.

Topics: Adolescent; Adult; Allopurinol; Antimetabolites; Antiprotozoal Agents; Child; Child, Preschool; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Humans; Leishmaniasis, Cutaneous; Male; Meglumine; Meglumine Antimoniate; Middle Aged; Organometallic Compounds; Treatment Outcome

Cutaneous leishmaniasis is a common disease in Iran, particularly in Kerman province. It usually occurs via the bite of an infected sandfly.. One hundred and fifty patients suffering from cutaneous leishmaniasis were included in this study in Kerman. The patients were randomly divided into three groups. They were matched with regard to age, sex, duration of the disease, and type, number, and site of the lesions. For each group, one of the following therapeutic methods was applied: (i) oral allopurinol (15 mg/kg/day) for 3 weeks; (ii) intramuscular injection of Glucantime (30 mg/kg/day), corresponding to 8 mg/kg/day of pentavalent antimony, for 2 weeks; (iii) combined therapy. The lesions were re-examined at the end of treatment and 2 and 4 weeks later. The response to treatment was graded as excellent (reduction in the size of the lesion by at least 80% or complete clearance), good (reduction in the size of the lesion by 50%), and poor (minimal or no change in the lesion).. The overall results indicated that 18% of patients showed excellent response, 6% good response, and 76% poor response in the first group. In the second group, 24% of patients showed excellent response, 6% good response, and 70% poor response. In the third group, 46% of patients showed excellent response, 8% good response, and 46% poor response.. The results obtained by the three therapeutic methods indicated that combined therapy with allopurinol plus Glucantime was much more effective than that obtained by each of the two drugs when used alone (P < 0.05).

Topics: Administration, Oral; Adolescent; Allopurinol; Antiprotozoal Agents; Drug Therapy, Combination; Female; Humans; Injections, Intramuscular; Iran; Leishmaniasis, Cutaneous; Male; Meglumine; Meglumine Antimoniate; Organometallic Compounds; Treatment Outcome

In 16 dogs, the diagnosis of canine leishmaniasis could be detected by direct microscopic identification, by determination of the antibody titre or by PCR method (peripheral blood/bone marrow). On the basis of the clinical and laboratory diagnostic results 9 cases of the cutaneous type and 7 dogs of the combined cutaneous-visceral type (+ mono- or polyarthritis, hepatopathy and/or renal insufficiency as well as occular manifestation) have been classified. Therapy was: GLUCANTIME in 6 dogs, allopurinol in 3 dogs as single agent, combination-therapy GLUCANTIME and allopurinol in 7 dogs. During GLUCANTIME-treatment the following adverse reactions could be observed: general weakness, reduced food intake up to anorexia, vomiting and diarrhoea. Laboratory parameters showed sporadically leucopenia or pancreatitis. Adverse reactions during allopurinol therapy were: vomitus/diarrhoea or urine concrements. One dog with GLUCANTIME therapy, 2 dogs with allopurinol as well as 2 dogs with combination therapy are clinically symptom-free at the moment (peripheral blood and bone marrow: PCR negative). The remaining 11 patients showed a good to very good improvement of the clinical symptoms. However, since the peripheral blood respectively the bone marrow continue to be PCR positive, relapses have to be expected in these dogs.

Topics: Allopurinol; Animals; Antiprotozoal Agents; Dog Diseases; Dogs; Female; Follow-Up Studies; Leishmania infantum; Leishmaniasis, Cutaneous; Leishmaniasis, Visceral; Male; Meglumine; Meglumine Antimoniate; Organometallic Compounds; Treatment Outcome

Hundreds of thousands of cases of cutaneous leishmaniasis occur each year worldwide. Available therapies are parenteral, moderately toxic, and costly.. To determine the efficacy of and tolerance for oral allopurinol as monotherapy for cutaneous leishmaniasis.. Randomized, controlled trial.. Outpatient clinics in 11 regions of Colombia in which cutaneous leishmaniasis is endemic.. 187 otherwise healthy adults with cutaneous leishmaniasis. Eighty-four percent of patients were infected with or were from regions with Leishmania panamensis; 16% were infected or were from regions with L. braziliensis.. Patients were randomly assigned to one of three treatment groups. The first group received allopurinol, three 100-mg tablets four times daily (20 mg/kg of body weight per day) for 28 days. The second group received three placebo tablets four times daily for 28 days. The third group received Glucantime, 20 mg of intramuscular antimony/kg per day for 20 days.. Complete cure was defined as complete clinical reepithelialization of all lesions at 3 months and no relapse during 12 months of follow-up.. Of 182 patients whose data could be analyzed, 157 (86%) were evaluated. In the allopurinol group, 18 of 55 (33% [95% CI, 21% to 47%]) patients were cured; in the placebo group, 17 of 46 patients (37% [CI, 23% to 52%]) were cured (difference, 4% [CI, -14% to 22%]; P = 0.68); and in the Glucantime group, 52 of 56 patients (93% [CI, 83% to 98%]) were cured (P < 0.001 compared with the allopurinol and placebo groups combined). In most cases, therapy was considered to have failed because the lesion did not reepithelialize by 1.5 months after the end of therapy. Three cases of relapse (two in the allopurinol group and one in the placebo group) at the nasal mucosa (mucosal leishmaniasis) had occurred by the end of 12 months of follow-up.. Allopurinol monotherapy has no effect on Colombian cutaneous disease primarily caused by L. panamensis and therefore is unlikely to be effective against cutaneous leishmaniasis in other endemic regions.

Topics: Adult; Allopurinol; Antimetabolites; Antimony; Antiprotozoal Agents; Female; Follow-Up Studies; Humans; Leishmaniasis, Cutaneous; Male; Meglumine; Meglumine Antimoniate; Organometallic Compounds; Treatment Failure

We conducted a randomized, controlled study in southern Colombia to determine if the addition of allopurinol to stibogluconate was superior to stibogluconate alone in the treatment of cutaneous leishmaniasis. Lesions that healed after a 3-month course of therapy and remained so during a 1-year period of follow-up were considered cured. The cure rate for patients treated with stibogluconate was 39%; the addition of allopurinol increased this rate to 71% (P = .005). For the treatment of cutaneous leishmaniasis, the combination of allopurinol and stibogluconate is significantly more effective than is stibogluconate alone. These results support those of other clinical studies in which allopurinol and stibogluconate were shown to be superior to stibogluconate alone. The aggregate data support the use of allopurinol as an inexpensive, orally administered agent that can be used as an adjunct to stibogluconate or, perhaps, other oral agents in the treatment of cutaneous leishmaniasis.

Topics: Adolescent; Adult; Aged; Allopurinol; Antimony Sodium Gluconate; Antiprotozoal Agents; Drug Therapy, Combination; Female; Humans; Leishmaniasis, Cutaneous; Male; Middle Aged

Topics: Adolescent; Adult; Allopurinol; Antimetabolites, Antineoplastic; Brazil; Child; Evaluation Studies as Topic; Follow-Up Studies; Humans; Leishmaniasis, Cutaneous; Meglumine; Middle Aged; Mucous Membrane; Treatment Outcome; Ulcer; Uric Acid

Cutaneous leishmaniasis is endemic in Iran. One of the clinical pictures of this disease is leishmaniasis recidivans (LR). Most of the drugs used for cutaneous leishmaniasis are ineffective in LR.. Twenty-five patients (13 women and 12 men), who had LR and whose disease had been proved by previous direct smears, were accepted for the study. The duration of disease in all patients was more than 2 years and they had previously been treated for their cutaneous leishmaniasis by different methods. All patients were treated with a combination of allopurinol (AL) (20 mg/kg/day for 30 days) and meglumine antimoniate (MA) (70 mg/kg/day for 15 days). Laboratory tests including hemograms, liver function, and kidney function tests, were done both at baseline and at the end of therapy.. Twenty-four out of 25 patients (96%) responded well to treatment and after 1 year follow-up no relapse had occurred. The drugs were well tolerated by the patients producing no side effects nor any significant changes in laboratory values.. A combination of AL and antimoniate is an effective method for the treatment of LR and for patients with cutaneous leishmaniasis who are resistant to the usual treatments.

Topics: Adolescent; Adult; Aged; Allopurinol; Antiprotozoal Agents; Child; Child, Preschool; Drug Therapy, Combination; Female; Humans; Leishmaniasis, Cutaneous; Male; Meglumine; Meglumine Antimoniate; Middle Aged; Organometallic Compounds; Recurrence; Treatment Outcome

Topics: Allopurinol; Humans; Leishmaniasis, Cutaneous; Meglumine; Meglumine Antimoniate; Organometallic Compounds

Pentavalent antimony, the generally accepted treatment for leishmaniasis, is given parenterally, and it is expensive and not readily available in developing countries. An inexpensive, orally administered compound would be a substantial advance in treatment. Previous studies in vitro have shown synergism between allopurinol and pentavalent antimony in tissue-culture systems. We designed this clinical study to determine whether synergism could be demonstrated in patients.. We performed a randomized, controlled study of the efficacy of allopurinol plus meglumine antimoniate (Glucantime), as compared with meglumine antimoniate alone, in patients with cutaneous leishmaniasis, who were recruited from a village in southeastern Colombia. In addition, those who declined injections were treated with allopurinol alone, and those who declined any treatment were considered controls. All the patients were followed for one year after the completion of treatment. Lesions that healed completely at three months and remained healed during follow-up were considered to be cured.. The cure rate for patients treated with meglumine antimoniate was 36 percent; the addition of allopurinol increased the rate to 74 percent (P less than 0.001). Treatment with allopurinol alone yielded a cure rate of 80 percent (P less than 0.001). There were no cures among the untreated patients. There was no significant difference between the cure rate with allopurinol plus meglumine antimoniate and that with allopurinol alone. No major toxic effects were observed.. For the treatment of American cutaneous leishmaniasis, the combination of allopurinol and meglumine antimoniate is significantly more effective than meglumine antimoniate alone, probably because of the efficacy of allopurinol alone, which appears to be as good as the combination.

Topics: Adolescent; Adult; Allopurinol; Antimony; Antiprotozoal Agents; Child, Preschool; Developing Countries; Drug Synergism; Drug Therapy, Combination; Female; Humans; Leishmaniasis, Cutaneous; Male; Meglumine; Meglumine Antimoniate; Organometallic Compounds

Cutaneous leishmaniasis (CL) is a serious tropical disease and a neglected health challenge in Iran. Although limited data are available regarding anthroponotic CL, cases resistant to meglumine antimoniate (Glucantime) are increasingly being reported. Via an open-label noncontrolled case series, allopurinol (10 mg/kg/day) plus itraconazole (3-4 mg/kg/day) were orally administered for 1 month to 27 patients (56 lesions) with anthroponotic CL, most of whom were resistant to Glucantime. A mean lesion size of 3.5 ± 1.9 cm at baseline was reduced to 0.6 ± 1.0 after 1 month of treatment. Excellent treatment response was observed in 85.7% of lesions after 1 month. Recurrence only occurred in one patient in the 3-month follow-up session. This study presents preliminary evidence that oral allopurinol plus itraconazole could be an effective treatment in patients with anthroponotic CL.

Topics: Allopurinol; Antiprotozoal Agents; Humans; Iran; Itraconazole; Leishmaniasis, Cutaneous; Meglumine; Meglumine Antimoniate; Organometallic Compounds; Treatment Outcome

In the present study, we reported the natural infection by Leishmania sp. in a domestic cat, in which the amastigote forms of the parasite were observed within a lesion on its ear-tip. Fragment of the lesion was obtained and cultured in NNN medium, and PCR-RFLP analysis of the isolated sample was performed, which revealed that the profile was compatible with Leishmania (L.) amazonensis. This is the first proven case of a cat infected by L. (L.) amazonensis reported in Belém city, Pará state, northern Brazil.

Topics: Allopurinol; Animals; Azithromycin; Brazil; Cat Diseases; Cats; Diagnosis, Differential; Female; Leishmania mexicana; Leishmaniasis, Cutaneous; Skin Diseases; Trypanocidal Agents

A nine year aged male presented with facial lesions and the problem of responding to conventional treatment of leishmaniasis. Multiple injections of antimony and several topical ointments had been administered in hospital but fresh lesions erupted with potential to disfigure. Smears examined from nodular lesions confirmed presence of Leishmania amastigotes and parenteral pentostam was commenced for over eight weeks. A partial clinical outcome was achieved judged by extent of re-epithelialisation. Combined therapy of pentostam and oral allopurinol at a dose of 7mg/kg/day was started and finalised at 120 days. All facial lesions receded and 100% re-epithelialisation of the lesions established.

Topics: Administration, Oral; Allopurinol; Antimony Sodium Gluconate; Antiprotozoal Agents; Child; Drug Therapy, Combination; Humans; Kenya; Leishmaniasis, Cutaneous; Male

Leishmaniasis recidivans (LR) is a rare phenomenon in the world with high morbidity in children.. Overall 22 838 school children were examined during 1994-2006. Diagnosis was performed by combination of methods as clinical appearance, direct smears, cultures, polymerase chain reaction (PCR) and histology.. Ninety-eight cases were diagnosed as LR with duration of lesions varying from 2 to 8 years and diameter of lesions 1-5 cm, yellowish-brown appearance with papules around or in the scar. Most of the lesions (95%) were on the face. No amastigote was found in direct smears. Identification of nine random isolates by PCR confirmed all species to be L. tropica. Tissue sections showed typical granulomatous reactions with various inflammatory cells but no visible amastigote was seen.. The presence of LR as an important cause of morbidity has future implications for treatment regimens and immunoprophylaxis.

Topics: Adolescent; Allopurinol; Child; Face; Female; Humans; Iran; Leishmania tropica; Leishmaniasis, Cutaneous; Male; Meglumine; Meglumine Antimoniate; Organometallic Compounds; Prevalence

Cutaneous leishmaniasis (CL) is an endemic disease in Iran, particularly in Kerman Province. Leishmaniasis recidivans (LR) is one of the characteristics of this disease with a chronic course. Most patients with LR are resistant to the usual treatments.. Thirty-two patients (18 females and 14 males), suffering from LR, whose disease had been demonstrated by previous direct smears or skin biopsies, were included in this study in Kerman. The duration of disease in all patients was more than 1.5 years, and they had all previously received various drugs for their disease. All patients were treated with a combination of oral allopurinol (20 mg/kg for 30 days) and intramuscular injection of meglumine antimoniate (50 mg/kg for 15 days) and were followed up for 2 years. Skin biopsies were obtained from the skin lesions of nine cases at the beginning (baseline), during, and end of therapy. All patients were checked for complete blood count (CBC) and liver and kidney function tests on the first and last day of treatment.. All patients, except two (87.5%), responded well to treatment within 30 days. No significant side-effects were observed. The disease of two patients (Cases 24 and 28) recurred 6 and 13 months after treatment, respectively. Histologic examination of nine cases during and at the end of therapy showed a progression to atrophied granulomata, more lymphocytic than histiocytic infiltration, and, finally, fibrosis replacing the granulomata.. From the results of this study, a combination of allopurinol plus meglumine antimoniate may be considered as a highly effective treatment for LR.

Topics: Adolescent; Adult; Allopurinol; Animals; Antimetabolites; Antiprotozoal Agents; Child; Child, Preschool; Drug Therapy, Combination; Face; Female; Humans; Leishmaniasis, Cutaneous; Male; Meglumine; Meglumine Antimoniate; Middle Aged; Organometallic Compounds; Recurrence; Treatment Outcome

Topics: Albumins; Allopurinol; Animals; Antibodies, Protozoan; Antiprotozoal Agents; Biopsy, Fine-Needle; Biopsy, Needle; DNA, Protozoan; Dog Diseases; Dogs; Female; Fluorescent Antibody Technique, Indirect; Globulins; Leishmania; Leishmaniasis, Cutaneous; Lymph Nodes; Male; Polymerase Chain Reaction

A study has been performed to investigate the usefulness of the polymerase chain reaction (PCR) for both the diagnosis and the follow-up after treatment of canine leishmaniosis (CaL). Blood samples (PBL) and/or bone marrow aspirates (BM) could be examined in a total of 18 confirmed cases of primary CaL. PBL was PCR-positive in 87%, whereas the BM was found to be positive in all cases (n=14) tested. PBL and BM from a total of 13 patients were submitted to PCR examinations after meglumine antimoniate (Glucantime) treatment. Only one dog showed a negative PCR after 2 treatment cycles (days 1-2: 50 mg/kg bw; days 3-10: 100 mg/kg bw). Examination of the PBL and BM after 15 months remained further PCR negative. All other dogs, from which four were pretreated with allopurinol up to 5 weeks, continued to be positive (92%) at least in the BM. Ten dogs could be monitored by means of the PCR after allopurinol treatment (2 x 10 mg/kg/bw/day/) either as a monodrug therapy in seven or as a successive combination with Glucantime in three cases. Two out of three dogs which showed good clinical improvement after daily administration for five weeks were likewise PCR negative in both the PBL and the BM. The four other dogs remained positive after the single therapy with allopurinol up to 5 weeks. A further three dogs were treated with allopurinol for 5 weeks, 6 and 20 month, respectively, after being clinically cured with Glucantime. Two of them were PCR negative in the PBL and BM after 5 weeks and 20 month, respectively. The results presented suggest that longterm treatment with allopurinol has some therapeutic benefit in CaL especially when administered following treatment with the pentavalent antimonial Glucantime.

Topics: Allopurinol; Animals; Antiprotozoal Agents; Dog Diseases; Dogs; Follow-Up Studies; Humans; Leishmania; Leishmaniasis, Cutaneous; Leishmaniasis, Visceral; Meglumine; Meglumine Antimoniate; Organometallic Compounds; Polymerase Chain Reaction; Sensitivity and Specificity; Species Specificity

Topics: Adolescent; Allopurinol; Antimetabolites; Antiprotozoal Agents; Child; Female; Follow-Up Studies; Humans; Hypopigmentation; Leishmaniasis, Cutaneous; Leishmaniasis, Visceral; Male; Remission Induction

Twenty male patients with zoonotic cutaneous leishmaniasis were included in this study. Each patient received 1200 mg of allopurinol/day in divided doses for a duration of one month. 80% of patients had an excellent response (cure), however, sometimes leaving mild pigmented or faintly coloured skin i.e. a more or less acceptable scar, but with no recurrence for one year follow-up. The drug was well tolerated. However, it showed headache in 20%, myalgia in 10% and transient increase of liver enzymes in 20%. All these side effects disappeared at the end of treatment. The parasites have particular enzymatic reactions that have relevance for chemotherapy. Certain purine analogous are metabolised by the parasites to nucleotides and aminated to the analogous of adinine nucleotides. These halt protein synthesis and cause break down of RNA. Allopurinol is recommended in treatment of cutaneous leishmaniasis, as it is effective, cheap, orally administered, available and with less side effects.

Topics: Adult; Allopurinol; Antimetabolites; Humans; Leishmaniasis, Cutaneous; Male; Treatment Outcome; Zoonoses

Topics: Allopurinol; Child, Preschool; Female; Humans; Leishmaniasis, Cutaneous

Topics: Adult; Allopurinol; Elbow; Humans; Leishmaniasis, Cutaneous; Male

Treatment of persistent leishmaniasis with oral agents has received increasing attention, although the optimal agent for use in all settings has not been determined. This report describes a patient with persistent cutaneous infection due to Leishmania mexicana mexicana who apparently responded to therapy with allopurinol after treatment with a course of ketoconazole failed. In vitro testing of pre- and posttreatment isolates from the wound did not demonstrate the development of resistance to ketoconazole. To our knowledge, this is the first report that independently confirms the recently reported efficacy of allopurinol for treatment of leishmaniasis.

Topics: Adult; Allopurinol; Animals; Belize; Drug Resistance; Forestry; Humans; Ketoconazole; Leishmania mexicana; Leishmaniasis, Cutaneous; Male; Occupational Diseases; United States