amphotericin-b and Leishmaniasis--Mucocutaneous

Leishmaniasis is a protozoal infection transmitted by a sandfly vector. In Germany, leishmaniasis of the mucous membranes is a rare condition and usually due to extension of local skin disease into the mucosal tissue via direct extension, bloodstream or lymphatics. We report a case of endonasal leishmaniasis in a female German resident who presented in a university hospital with nasal obstruction. Histology of the left nasal septum biopsy was suggestive of leishmaniasis. The molecular detection of DNA was positive for leishmania infantum. The patient was successfully treated as a case of mucocutaneous leishmaniasis receiving liposomal amphotericin follow up visits showed significant improvement with no recurrence.

Topics: Aged; Amphotericin B; Antiprotozoal Agents; Female; Follow-Up Studies; Humans; Leishmania infantum; Leishmaniasis, Mucocutaneous; Nasal Obstruction; Nose Diseases

Old World cutaneous and mucosal leishmaniasis is a potentially serious disease. Systemic treatment approaches with pentavalent antimonials, liposomal amphotericin B, fluconazole and miltefosine are increasingly used despite the absence of supportive evidence - to date, no prospective clinical trials have been conducted for systemic treatment of these diseases. We performed a literature search to delineate the contemporary evidence for the use of liposomal amphotericin B, and found that although cure rates of 17/20 (85%) were achieved in immune competent patients with Old World cutaneous leishmaniasis and cure rates of 10/13 (77%) for Old World mucosal leishmaniasis due to L. infantum, the available data is highly limited with high variation in total treatment dosages. The presented findings reflect a lack of consensus on the optimal treatment dosage and on the schedule of application.

Topics: Amphotericin B; Antiprotozoal Agents; Humans; Leishmaniasis, Mucocutaneous; Treatment Outcome

Leishmaniasis is a parasitic infection endemic to more than 90 countries worldwide. As travel to endemic areas increases, dermatologists need to keep this entity in the differential for any chronic skin lesion in persons who may have had a possible exposure for any duration. It can be difficult to diagnose because manifestations are varied and sometimes subclinical. This article discusses the current state of epidemiology, pathogenesis, clinical presentation, diagnosis, and treatment options. A special focus is placed on cutaneous manifestations and their treatment.

Topics: Amphotericin B; Antimony Sodium Gluconate; Antiprotozoal Agents; Deoxycholic Acid; Drug Combinations; Humans; Incidence; Leishmania braziliensis; Leishmania donovani; Leishmania mexicana; Leishmania tropica; Leishmaniasis, Diffuse Cutaneous; Leishmaniasis, Mucocutaneous; Leishmaniasis, Visceral; Phosphorylcholine; Polymerase Chain Reaction; Travel

The diagnosis of leishmaniasis can be challenging because it mimics both infectious and malignant conditions. A misdiagnosis may lead to an unfavorable outcome. Using culture, histologic, and/or polymerase chain reaction study results, a diagnosis of leishmaniasis can be established and treatment initiated. Appropriate management requires an accurate diagnosis, which often includes identification of the specific etiologic species. Different endemic areas have varying sensitivities to the same medication, even within individual species. Species identification may be of practical value, because infections with select species have a substantial risk of visceral involvement. In addition, HIV and otherwise immunocompromised patients with leishmaniasis have a propensity for diffuse cutaneous leishmaniasis. For most New World Leishmania species, parenteral antimonial drugs remain the first line of therapy, while Old World species are easily treated with physical modalities. Historically, live organism vaccination has been used and is effective in preventing leishmaniasis, but results in an inoculation scar and an incubation period that may last for years. A more effective method of vaccination would be welcome.

Topics: Amphotericin B; Animals; Antiprotozoal Agents; Biopsy, Needle; Drug Therapy, Combination; Endemic Diseases; Female; Humans; Immunocompromised Host; Immunohistochemistry; Incidence; Leishmania; Leishmaniasis, Cutaneous; Leishmaniasis, Mucocutaneous; Male; Prognosis; Risk Assessment; Treatment Outcome; Tropical Climate

Leishmaniasis causes significant morbidity and mortality and thus constitutes a serious public health problem. Even though it has long been endemic in developing countries, in recent years the economic globalization and the increased volume of international travel have extended its prevalence in developed countries. In addition, native populations may be exposed to the infection through blood transfusion and the use of blood products produced from infected asymptomatic individuals. Mucosal leishmaniasis (ML) is a chronic form of this infection, which attacks the mucosa. In most cases this form of leishmaniasis results from the metastatic spread of Leishmania (Viannia) braziliensis from cutaneous lesions. It is a healthcare issue because of its wide demographic distribution, its association with significant morbidity levels, and because of the pressing concern that tourists who travel to endemic areas might present the disease even years later. The treatment currently available for ML is based on drugs such as pentavalent antimony-containing compounds, amphotericin B deoxycholate and pentamidine and often guarantees a satisfactory clinical response. Nevertheless, it also frequently provokes serious side effects. This review offers a critical analysis of the drugs now available for the treatment of ML as also of the future prospects for the treatment of the disease.

Topics: Amphotericin B; Animals; Antimony; Antiprotozoal Agents; Deoxycholic Acid; Developed Countries; Developing Countries; Drug Combinations; Endemic Diseases; Humans; Leishmania braziliensis; Leishmaniasis, Mucocutaneous; Pentamidine; Travel

Mucosal leishmaniasis (ML) is an important endemic disease and public-health problem in underdeveloped countries because of its significant morbidity and mortality. Increases in ecological tourism have extended this problem to developed countries. This form of leishmaniasis, caused by reactivation after primary cutaneous lesion, has a natural history of progressive destruction of the nasal septa and soft and hard palates, causing facial disfiguration and leading to respiratory disturbances. Treatment of ML, based on several therapies, depends on use of toxic compounds, and few drugs have emerged over the past 40 years. Drug resistance has increased, and the cure rate is no better than 70% in the largest studies. Despite these data, there has been no systematic review of therapies used to treat this important tropical disease. The aim of this study is to determine the best drug management for treatment of ML in Latin America based on the best studies offered by the medical literature. The MEDLINE, LILACS, EMBASE, Web of Science, and Cochrane Library databases were searched to identify articles related to ML and therapy. The studies were independently selected by 2 authors. Articles with sufficient data for cure and treatment failures, internal and external validity information, and > 4 patients in each treatment were included. Validation of this systematic review was based on guidelines to guarantee quality; 22 articles met our inclusion criteria. Stibogluconate achieved a 51% cure rate (76/150 patients), and 88% of patients treated with meglumine were cured (121 patients). Pentamidine and amphotericin were as effective as meglumine. Use of itraconazole and other therapies (pentoxifylline, allopurinol, or interferon-gamma) was controversial, and numbers of patients in some studies were insufficient for statistical analysis. Meglumine may be the drug of choice in the treatment of ML, as it offers similar cure rates when compared with amphotericin B and pentamidine. Cost, adverse effects, local experience, and availability of drugs to treat ML are strong points to be considered before determining the best management of this disease, especially in developing countries.

Topics: Amphotericin B; Animals; Antimony Sodium Gluconate; Antiprotozoal Agents; Humans; Itraconazole; Latin America; Leishmania; Leishmaniasis, Mucocutaneous; Meglumine; Paromomycin; Pentamidine

In 1903, Leishman and Donovan separately described the protozoan now called Leishmania donovani in splenic tissue from patients in India with the life-threatening disease now called visceral leishmaniasis. Almost a century later, many features of leishmaniasis and its major syndromes (ie, visceral, cutaneous, and mucosal) have remained the same; but also much has changed. As before, epidemics of this sandfly-borne disease occur periodically in India and elsewhere; but leishmaniasis has also emerged in new regions and settings, for example, as an AIDS-associated opportunistic infection. Diagnosis still typically relies on classic microbiological methods, but molecular-based approaches are being tested. Pentavalent antimony compounds have been the mainstay of antileishmanial therapy for half a century, but lipid formulations of amphotericin B (though expensive and administered parenterally) represent a major advance for treating visceral leishmaniasis. A pressing need is for the technological advances in the understanding of the immune response to leishmania and the pathogenesis of leishmaniasis to be translated into field-applicable and affordable methods for diagnosis, treatment, and prevention of this disease.. This paper discusses the pathogenesis and clinical management of leishmaniasis. Leishmaniasis is a vector-borne disease caused by obligate intramacrophage protozoa, characterized by diversity and complexity. It is endemic in areas of the tropics, subtropics, and southern Europe, in settings ranging from rain forests in Americas to deserts in western Asia, and from rural to periurban areas. Several clinical syndromes are categorized under the term leishmaniasis: most notably visceral, cutaneous, and mucosal leishmaniasis, which result from replication of the parasite in macrophages of the mononuclear phagocyte system, dermis, and naso-oro-pharyngeal mucosa, respectively. These syndromes are caused by a total of about 21 leishmanial species, which are transmitted by about 30 species of phlebotomine sandflies. Clinical manifestation of the disease depends on the type of leishmaniasis, which could be life-threatening systemic infection (visceral), chronic skin sores (cutaneous), or dreaded metastatic complications, which causes facial disfigurement (mucosal). Clinical management is directed to prevent death from visceral leishmaniasis and morbidity from cutaneous and mucosal leishmaniasis. Also included in its management is the ongoing research on immunoregulation of leishmaniasis in the understanding of the immune response to intracellular pathogens and rationalizing vaccine development. General principles on the disease diagnosis and treatment are outlined in this paper.

Topics: Amphotericin B; Animals; Antimony; Antiprotozoal Agents; Drug Administration Schedule; Female; HIV Infections; Humans; Leishmania; Leishmaniasis; Leishmaniasis, Cutaneous; Leishmaniasis, Mucocutaneous; Leishmaniasis, Visceral; Male

The epidemiological, clinical and biological features of associated visceral leishmaniasis/human immunodeficiency virus infection are examined on the basis of a literature review of 239 published cases. The co-infection is principally located in Southern Europe, mainly in Spain, France and Italy. The study of restricted cohorts of patients showed that co-infection occurs in about 2 to 7% of AIDS patients. A part from the classical symptoms of visceral leishmaniasis, atypical or unusual symptoms (cutaneous, digestive or pulmonary) are described in about 10% of the cases. The parasite is occasionally found in blood and normal skin. Visceral leishmaniasis is frequently associated with other opportunistic diseases. Nine different zymodemes of Leishmania infantum, including two new ones, have been isolated from co-infected patients. There have also been a few cases of tegumentary leishmaniasis associated with AIDS.

Topics: Acquired Immunodeficiency Syndrome; Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antimony; Female; Humans; Leishmaniasis, Cutaneous; Leishmaniasis, Mucocutaneous; Leishmaniasis, Visceral; Male

Amphotericin B (AmB) has been the most effective systemic antifungal agent, but its use is limited by the dose-limiting toxicity of the conventional micellar dispersion formulation (Fungizone). New formulations with better and improved safety profiles are being developed and include ABELCET (formerly ABLC), but their dispositions have not been well characterized; hence, the reason for their improved profiles remains unclear. This report details the pharmacokinetics of ABELCET examined in various pharmacokinetic and efficacy studies by using whole-blood measurements of AmB concentration performed by high-pressure liquid chromatography. The data indicated that the disposition of AmB after administration of ABELCET is different from that after administration of Fungizone, with a faster clearance and a larger volume of distribution. It exhibits complex and nonlinear pharmacokinetics with wide interindividual variability, extensive distribution, and low clearance. The pharmacokinetics were unusual. Clearance and volume of distribution were increased with dose, peak and trough concentrations after multiple dosings increased less than proportionately with dose, steady state appeared to have been attained in 2 to 3 days, despite an estimated half-life of up to 5 days, and there was no evidence of significant accumulation in the blood. The data are internally consistent, even though they were gathered under different conditions and circumstances. The pharmacokinetics of ABELCET suggest that lower concentrations in blood due to higher clearance and greater distribution may be responsible for its improved toxicity profile compared to those of conventional formulations.

Topics: Amphotericin B; Antifungal Agents; Antineoplastic Agents; Area Under Curve; Chromatography, High Pressure Liquid; Drug Combinations; Drug Interactions; Half-Life; HIV Infections; Humans; Kidney Diseases; Leishmaniasis, Mucocutaneous; Mycoses; Neutropenia; Phosphatidylcholines; Phosphatidylglycerols; Reference Values

It has been suggested that salt loading protects against amphotericin B-induced nephrotoxicity. The influence of saline loading on the nephrotoxic response to amphotericin B (50 mg/dose given i.v. over 4 hr 3 X/week for 10 weeks) was assessed in two groups of ten patients each who were diagnosed with mucocutaneous leishmaniasis. Patients were randomized to receive either 1 liter of 0.9% saline or 1 liter of 5% dextrose in water, administered i.v. over one hour in a double-blinded manner, directly prior to amphotericin B administration. Renal function was monitored on a weekly basis two days after the last dose of amphotericin B. Baseline characteristics were similar in both groups except for a slightly higher serum creatinine concentration (Cr) in the saline group (0.8 +/- 0.05 vs. 0.6 +/- 0.04 mg/dl). Baseline sodium (Na) excretion was relatively high (262 +/- 23 mmol/day in the dextrose group and 224 +/- 17 mmol/day in the saline group). None of the patients sustained an increase in Cr to values greater than 1.7 mg/dl. Although mean Cr remained within normal, there was a significant difference between the two groups over the ten week period, with the dextrose group sustaining a significant increase in Cr and the saline group remaining unchanged. Serum potassium (K) levels fell in both groups necessitating oral K supplementation. The saline group required significantly greater amounts of K supplementation to maintain a normal serum K. Amphotericin B caused a rapid reduction in the acidification ability of the kidney in response to an ammonium chloride load. Under these conditions, the saline group had a poorer ability to acidify the urine.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Adult; Aged; Amphotericin B; Creatinine; Glomerular Filtration Rate; Humans; Kidney; Leishmaniasis, Mucocutaneous; Middle Aged; Potassium; Sodium Chloride

Topics: Amphotericin B; Humans; Leishmaniasis, Mucocutaneous; Lupus Erythematosus, Systemic

Topics: Amphotericin B; Animals; Antiprotozoal Agents; Communicable Diseases, Imported; Ear; Humans; Leishmania braziliensis; Leishmaniasis, Mucocutaneous; Male; Middle Aged; Phosphorylcholine; Travel

Cutaneous leishmaniasis (CL) and mucocutaneous leishmaniasis (MCL) are endemic diseases in America, especially in some countries such as Colombia. Among the therapeutic options is amphotericin B (AB). Nevertheless, its lipid-associated formulations have better safety profiles and effectiveness in other diseases, so far with no comparative studies in CL or MCL. We conducted a retrospective descriptive study describing the effectiveness and adverse effects of AB deoxycholate (ABD), AB colloidal dispersion (ABCD), and liposomal AB (LAB) as third-line treatments for CL and MCL. The effectiveness of LAB (88.5%) was greater than those of ABCD (66.6%) and ABD (80.8%). There were also fewer adverse effects in the LAB group (46.2%) than in the ABD (96.1%) and ABCD (80.9%) groups. LAB is an alternative for the treatment of CL and MCL in patients with therapeutic failure to first- and second-line drugs; findings suggest it might be less toxic and more effective than ABD and ABCD.

Topics: Amphotericin B; Antiprotozoal Agents; Colloids; Colombia; Deoxycholic Acid; Drug Combinations; Humans; Leishmaniasis, Cutaneous; Leishmaniasis, Mucocutaneous; Retrospective Studies

Leishmaniasis, considered by the World Health Organization as one of the most important tropical diseases, is endemic in the Mediterranean Basin. The aim of this study was to evaluate epidemiological and clinical characteristics of cutaneous (CL) and mucocutaneous leishmaniasis (MCL) in La Fe University Hospital, Valencia, Spain. The particular focus was on diagnosis techniques and clinical differences according to the immunological status of the patients.. An eleven-year retrospective observational study of CL and MCL episodes at the hospital was performed. Epidemiological, clinical and therapeutic variables of each case, together with the microbiological and anatomopathological diagnosis, were analyzed.. A total of 42 patients were included, 30 of them were male and 28 were immunocompetent. Most of the cases (36/42) were diagnosed in the last 5 years (2013-2017). The incidence of CL and MCL increased from 3.6/100,000 (2006-2012) to 13.58/100,000 (2013-2017). The majority of the patients (37/42) exhibited CL, in 30 cases as single lesions (30/37). Ulcerative lesions were more common in immunosuppressed patients (13/14) than in immunocompetent patients (20/28), (P = 0.2302). The length of lesion presence before diagnosis was 7.36 ± 6.72 months in immunocompetent patients and 8.79 ± 6.9 months in immunosuppressed patients (P = 0.1863). Leishmania DNA detection (92.3%) was the most sensitive diagnostic technique followed by Giemsa stain (65%) and histopathological examination (53.8%). Twelve patients (12/42) had close contact with dogs or were living near to kennels, and 10 of them did not present underlying conditions. Intralesional glucantime (21/42) and liposomal amphotericin B (7/42) were the most common treatments administered in monotherapy. All patients evolved successfully and no relapse was reported.. Some interesting clinical and epidemiological differences were found in our series between immunocompetent and immunosuppressed patients. Future studies can take these results further especially by studying patients with biological therapy. Skin biopsies combining NAAT with histological techniques are the most productive techniques for CL or MCL diagnosis.

Topics: Administration, Cutaneous; Adolescent; Adult; Aged; Amphotericin B; Child; Child, Preschool; Female; Humans; Immunocompromised Host; Leishmania; Leishmaniasis, Cutaneous; Leishmaniasis, Mucocutaneous; Male; Meglumine Antimoniate; Middle Aged; Retrospective Studies; Risk Factors; Spain; Young Adult

The six previously reported civilian cases of mucosal leishmaniasis (ML) diagnosed in the United States have all represented imported New World ML. We describe two new patients with ML diagnosed in New York City-a Syrian immigrant with a nasal mass (

Topics: Aged; Amphotericin B; Antiprotozoal Agents; Humans; Leishmania braziliensis; Leishmaniasis, Mucocutaneous; Male; Middle Aged; New York City; Phosphorylcholine

Mucocutaneous leishmaniasis (MCL) is a complication of tegumentary leishmaniasis, causing potentially life-threatening lesions in the ear, nose, and throat (ENT) region, and most commonly due to Leishmania (Viannia) braziliensis. We report a case of relapsing MCL in an Italian traveler returning from Argentina.. A 65-year-old Italian male patient with chronic kidney disease, arterial hypertension, prostatic hypertrophy, and type-2 diabetes mellitus was referred for severe relapsing MCL acquired in Argentina. ENT examination showed severe diffuse pharyngolaryngeal edema and erythema, partially obstructing the airways. A nasopharyngeal biopsy revealed a lymphoplasmacytic inflammation and presence of Leishmania amastigotes, subsequently identified as L. (V.) braziliensis by hsp70 PCR-RFLP analysis and sequencing. Despite receiving four courses of liposomal amphotericine B (L-AmB) and two courses of miltefosine over a 2-year period, the patient presented recurrence of symptoms a few months after the end of each course. After the patient was referred to us, a combined treatment was started with intravenous pentamidine 4 mg/kg on alternate days for 10 doses, followed by one dose per week for an additional seven doses, intralesional meglumine antimoniate on the nasal lesion once per week for six doses, oral azoles for three months, and aerosolized L-AmB on alternate days for three months. The treatment led to regression of mucosal lesions and respiratory symptoms. Renal function temporarily worsened, and the addition of insulin was required to maintain glycemic compensation after pentamidine discontinuation.. This case highlights the difficulties in managing a life-threatening refractory case of MCL in an Italian traveler with multiple comorbidities. Even though parenteral antimonial derivatives are traditionally considered the treatment of choice for MCL, they are relatively contraindicated in cases of chronic kidney disease.The required dose adjustment in cases of impaired renal function is unknown, therefore the use of alternative drugs is recommended. This case was resolved with combination treatment, including aerosolized L-AmB, which had never been used before for MCL.

Topics: Administration, Intravenous; Aged; Amphotericin B; Antiprotozoal Agents; Argentina; Azoles; Drug Therapy, Combination; Humans; Leishmania braziliensis; Leishmaniasis, Mucocutaneous; Male; Meglumine Antimoniate; Pentamidine; Recurrence

Leishmaniasis is endemic in the Indian subcontinent with predominance of visceral leishmaniasis (VL) due to Leishmania donovani. Cutaneous leishmaniasis (CL) is uncommon, and mucocutaneous leishmaniasis (MCL) is rarely reported in this region. Recent reports reveal a changing epidemiology and atypical manifestations. A retrospective study of 52 suspected cases with cutaneous and mucosal involvement seen from January 2008 to December 2018 in a tertiary care setting in a non-endemic state in southern India is reported. Twelve patients were confirmed to have leishmaniasis; seven had MCL, two had CL, and three had post-kala-azar dermal leishmaniasis (PKDL). All cases were male, with a median age of 41.5 years (interquartile range, 30-55.5 years), and the median duration of the disease was 6 years (interquartile range, 1-9.5 years). Patients with MCL had mucosal involvement including destructive ulcero-proliferative lesions due to delayed diagnosis; none had a history of travel to countries endemic for MCL and all were attributable to L. donovani species. On the other hand, Leishmania major which was the causative species in both CL patients was associated with travel to the Middle East. Patients with PKDL presented with multiple plaques and hypopigmented patches; one had concomitant VL and all were from endemic areas. Hitherto uncommon MCL, caused by potentially atypical variants of L. donovani, has emerged as a new manifestation of leishmaniasis in this region. A high index of suspicion based on lesions seen and history of travel combined with PCR-based diagnostics are required to confirm diagnosis for the various skin manifestations of leishmaniasis.

Topics: Adolescent; Adult; Amphotericin B; Antifungal Agents; Antimony Sodium Gluconate; Antiprotozoal Agents; Deoxycholic Acid; Drug Combinations; Humans; India; Itraconazole; Leishmania donovani; Leishmania major; Leishmaniasis, Cutaneous; Leishmaniasis, Mucocutaneous; Male; Middle Aged; Skin

Mucocutaneous leishmaniasis (MCL) is a rare infection caused by several species within the genus

Topics: Adult; Amphotericin B; Female; Granulomatous Disease, Chronic; Humans; Immunosuppressive Agents; Leishmania; Leishmaniasis, Mucocutaneous

Topics: Aged, 80 and over; Amphotericin B; Antiprotozoal Agents; Foreskin; Humans; Infusions, Intravenous; Injections, Intralesional; Leishmania; Leishmaniasis, Mucocutaneous; Male; Meglumine Antimoniate; Treatment Outcome

Immunosuppressive treatments for rheumatic diseases present special problems in areas endemic for chronic infectious diseases because of the possibility of reactivation. Leishmaniasis is a significant neglected tropical disease caused by different species of protozoan parasites within the genus

Topics: Adult; Amphotericin B; Antiprotozoal Agents; Humans; Immunosuppressive Agents; Immunotherapy; Leishmaniasis, Mucocutaneous; Male; Recurrence; Secondary Prevention; Spondylitis, Ankylosing

Liposomal amphotericin B (L-AMB) has been used for mucosal leishmaniasis (ML), but comparative studies on L-AMB and other drugs used for the treatment of ML have not been conducted. The present study aimed to evaluate the outcome of patients with ML who were treated with L-AMB.. This is a 15-year retrospective study of Brazilian patients with a confirmed diagnosis of ML. The therapeutic options for the treatment of ML consisted of L-AMB, amphotericin B lipid complex (ABLC), deoxycholate amphotericin B (d-AMB), itraconazole, antimonial pentavalent, or pentamidine. Healing, cure rate and adverse effects (AEs) associated with the drugs used to treat this condition were analyzed.. In 71 patients, a total of 105 treatments were evaluated. The outcome of the treatment with each drug was compared, and results showed that L-AMB was superior to other therapeutic regimens (P = 0.001; odds ratio [OR] = 4.84; 95% confidence interval [CI] = 1.78-13.17). d-AMB had worse AEs than other treatment regimens (P = 0.001, OR = 0.09; 95% CI = 0.09-0.43). Approximately 66% of the patients presented with AEs during ML treatment. Although L-AMB was less nephrotoxic than d-AMB, it was associated with acute kidney injury compared with other drugs (P <0.05).. L-AMB was more effective than other therapies for the treatment of ML. However, a high incidence of toxicity was associated with its use. Therapeutic choices should be reassessed, and the development of new drugs is necessary for the treatment of ML.

Topics: Acute Kidney Injury; Adult; Aged; Aged, 80 and over; Amphotericin B; Antimony; Antiprotozoal Agents; Brazil; Cohort Studies; Deoxycholic Acid; Drug Combinations; Female; Humans; Itraconazole; Leishmania braziliensis; Leishmaniasis, Mucocutaneous; Liposomes; Male; Middle Aged; Pentamidine; Retrospective Studies; Treatment Outcome

The identification of specific therapeutic targets and the development of new drugs against leishmaniasis are urgently needed, since chemotherapy currently available for its treatment has several problems including many adverse side effects. In an effort to develop new antileishmanial drugs, in the present study a series of 28 N-benzyl-1H-benzimidazol-2-amine derivatives was synthesized and evaluated in vitro against Leishmania mexicana promastigotes. Compounds 7 and 8 with the highest antileishmanial activity (micromolar) and lower cytotoxicity than miltefosine and amphotericin B were selected to evaluate their activity against L. braziliensis 9and L. donovani, species causative of mucocutaneous and visceral leishmaniasis, respectively. Compound 7 showed significantly higher activity against L. braziliensis promastigotes than compound 8 and slightly lower than miltefosine. Compounds 7 and 8 had IC

Topics: Amino Acid Sequence; Amphotericin B; Animals; Antiprotozoal Agents; Arginase; Benzimidazoles; Cell Line; Inhibitory Concentration 50; Leishmania braziliensis; Leishmania donovani; Leishmania mexicana; Leishmaniasis, Cutaneous; Leishmaniasis, Mucocutaneous; Leishmaniasis, Visceral; Macrophages; Mice; Molecular Docking Simulation; Phosphorylcholine; Sequence Alignment

Topics: Amphotericin B; Antiprotozoal Agents; Chronic Disease; Edema; Humans; Leishmaniasis, Mucocutaneous; Lip Diseases; Male; Middle Aged

This clinical case presents a patient with a raised and ulcerative lesion with erythematous edges in the mouth, on the lower lip that was unsuccessfully treated as herpes labialis. Clinical data and laboratory tests (Montenegro skin test, indirect immunofluorescence, direct parasite search and polymerase chain reaction) led to the diagnosis of American tegumentary leishmaniasis caused by Leishmania (Viannia) sp. Treatment with pentavalent antimonial (Glucantime®) for 120 days was not effective and administration of amphotericin B for 30 days resulted in wound healing. Glucantime® treatment protocol was longer than the recommended by the Brazilian Ministry of Health in the handbook of mucosal leishmaniasis. This suggests that amphotericin B should have been administered earlier, preventing the psychological and social problems faced by the patient. This study reports a rare clinical case of primary mucosal leishmaniasis on the lip that had a delayed diagnosis, highlighting the precariousness in the management of disease and showing that, despite the importance of leishmaniasis in Brazil, it is still neglected by health professionals.

Topics: Adult; Amphotericin B; Antiprotozoal Agents; Fluorescent Antibody Technique, Indirect; Humans; Leishmania; Leishmaniasis, Mucocutaneous; Lip Diseases; Male

Amphotericin B (AmB) is a recommended medication for the treatment of cutaneous and mucosal leishmaniasis in cases of therapeutic failure with first-line medications; however, little is known about the in vitro susceptibility to AmB of clinical isolates of the subgenus Viannia, which is most prevalent in South America. This work aimed to determine the in vitro susceptibility profiles to AmB of clinical isolates of the species L. (V.) panamensis, L. (V.) guyanensis and L. (V.) braziliensis. In vitro susceptibility to AmB was evaluated for 65 isolates. Macrophages derived from the U937 cell line were infected with promastigotes and exposed to different AmB concentrations. After 96 hours, the number of intracellular amastigotes was quantified by qPCR, and median effective concentration (EC50) was determined using the PROBIT model. The controls included sensitive strains and experimentally derived less sensitive strains generated in vitro, which presented EC50 values up to 7.57-fold higher than the values of the sensitive strains. The isolates were classified into groups according to their in vitro susceptibility profiles using Ward's hierarchical method. The susceptibility to AmB differed in an intraspecies-specific manner as follows: 28.21% (11/39) of L. (V.) panamensis strains, 50% (3/6) of L. (V.) guyanensis strains and 34.61% (9/26) of L. (V.) braziliensis strains were classified as less sensitive. The latter subset featured three susceptibility groups. We identified Colombian isolates with different AmB susceptibility profiles. In addition, the capacity of species of subgenus Viannia to develop lower susceptibility to AmB was demonstrated in vitro. These new findings should be considered in the pharmacovigilance of AmB in Colombia and South America.

Topics: Amphotericin B; Colombia; Humans; Leishmania; Leishmania braziliensis; Leishmania guyanensis; Leishmaniasis, Cutaneous; Leishmaniasis, Mucocutaneous; Macrophages; Pharmacovigilance; Polymerase Chain Reaction; Sample Size; South America; Species Specificity; U937 Cells

Topics: Aged; Amphotericin B; Antiprotozoal Agents; Female; Humans; Leishmaniasis, Mucocutaneous; Male; Middle Aged; Treatment Outcome

Topics: Adalimumab; Adult; Amphotericin B; Anti-Inflammatory Agents; Antibodies, Monoclonal; Antiprotozoal Agents; Brazil; Diagnosis, Differential; Granuloma; Humans; Infliximab; Leishmaniasis, Mucocutaneous; Lymphoma, T-Cell; Male; Tumor Necrosis Factor-alpha

To compare the cost-effectiveness of L-AmB with that of Sb. We developed an economic model based on retrospective data of 73 hospitalised patients in 2006-2012, from hospital and public health system perspectives.. In the economic model, 82.2% of patients who started treatment with L-AmB had completed it after 2 months, vs. 22.0% for the Sb. In the treatment of mucocutaneous leishmaniasis, L-AmB is a cost-effective alternative to Sb

Topics: Adult; Aged; Amphotericin B; Antiprotozoal Agents; Brazil; Cost-Benefit Analysis; Drug Costs; Female; Hospitalization; Humans; Leishmania braziliensis; Leishmaniasis, Mucocutaneous; Male; Middle Aged; Models, Economic

Complex cutaneous and muco-cutaneous leishmaniasis (CL and MCL) often requires systemic therapy. Liposomal amphotericin B (L-AmB) has a strong potential for a solid clinical benefit in this indication.. We conducted a retrospective analysis of data from a French centralized referral treatment program and from the "LeishMan" European consortium database. All patients with parasitologically proven CL or MCL who received at least one dose of L-AmB were included. Positive outcome was based on ulcer closure as per recent WHO workshop guidelines.. From 2008 through 2016, 43 travelers returning from 18 countries (Old World n = 28; New World n = 15) were analyzed with a median follow-up duration of 79 days [range 28-803]. Main clinical forms were: localized CL with one or multiple lesions (n = 32; 74%) and MCL (n = 8; 19%). As per published criteria 19 of 41 patients (46%) were cured 90 days after one course of L-AmB. When the following items -improvement before day 90 but no subsequent follow-up, delayed healing (>3 months) and healing after a second course of L-AmB- were included in the definition of cure, 27 of 43 patients (63%) had a positive outcome. Five patients (MCL = 1; CL = 4) experienced a relapse after a median duration of 6 months [range 3-27] post treatment and 53% of patients (23/43) experienced at least one adverse event including severe hypokalaemia and acute cardiac failure (one patient each). In multivariate analysis, tegumentary infection with L. infantum was associated with complete healing after L-AmB therapy (OR 5.8 IC 95% [1.03-32]) while infection with other species had no impact on outcome.. In conditions close to current medical practice, the therapeutic window of L-AmB was narrow in travellers with CL or MCL, with the possible exception of those infected with L. infantum. Strict follow-up is warranted when using L-AmB in patients with mild disease.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amphotericin B; Antiprotozoal Agents; Child; Child, Preschool; Female; Humans; Infant; Leishmania; Leishmaniasis, Cutaneous; Leishmaniasis, Mucocutaneous; Male; Middle Aged; Retrospective Studies; Travel; Treatment Outcome

This report describes a case of mucosal leishmaniasis caused by

Topics: Administration, Intravenous; Adult; Amphotericin B; Humans; Leishmania major; Leishmaniasis, Mucocutaneous; Male; Nasal Septum

Mucosal leishmaniasis (ML) is a disfiguring manifestation of Leishmania (Viannia) infection. We evaluated parasite load (PL) over time as a potential biomarker of treatment outcome in ML. PL was assessed with kinetoplast DNA quantitative real-time polymerase chain reaction (kDNA-qPCR) at enrollment, days 14 and 21-28 of therapy and 3, 6, 12-18, and 18-24 months after treatment of ML and correlated to demographic, clinical, and parasitologic factors. Forty-four patients were enrolled: 30 men and 14 women. Enrollment PL differed significantly by causative species (P < 0.001), and was higher in patients with severe ML (nasal and laryngeal involvement) compared with those with only isolated nasal involvement (median = 1,285 versus 51.5 parasites/μg tissue DNA; P = 0.005). Two patterns of PL emerged: pattern 1 (N = 23) was characterized by a sequential decline in PL during and after therapy until kDNA was undetectable. Pattern 2 (N = 18) was characterized by clearance of detectable kDNA during treatment, followed by an increased PL thereafter. All patients who failed treatment (N = 4) demonstrated pattern 1. Leishmania (Viannia) braziliensis was overrepresented among those with pattern 2 (P = 0.019). PL can be quantified by cytology brush qPCR during and after treatment in ML. We demonstrate that treatment failure was associated with undetectable PL, and L. (V.) braziliensis infection was overrepresented in those with rebounding PL.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amphotericin B; Antimony Sodium Gluconate; Biomarkers; Child; DNA, Kinetoplast; DNA, Protozoan; Female; Humans; Leishmaniasis, Mucocutaneous; Male; Middle Aged; Pilot Projects; Real-Time Polymerase Chain Reaction; Treatment Outcome; Young Adult

Mucosal leishmaniasis is a chronic infection that affects the upper respiratory tract and/or the oral mucosa caused by Leishmania protozoan parasites. We present two cases of oral leishmaniasis and discuss the different diagnostic strategies and treatment. In both cases, the patients were male, 60 and 94 years of age, and presented with lesions on the soft palate. In the first patient, the final diagnosis was made on the basis of histopathologic examination. In the second case, polymerase chain reaction and Montenegro skin test were necessary to confirm the diagnosis. The first patient was treated with meglumine antimoniate (Glucantime), and the lesions healed after 2 months. In the second case, the patient received treatment with liposomal amphotericin B but later died as a result of generalized infection. Mucosal leishmaniasis is a highly disfiguring disease. Early diagnosis is important to prevent a lethal outcome.

Topics: Aged, 80 and over; Amphotericin B; Antiprotozoal Agents; Brazil; Fatal Outcome; Humans; Leishmaniasis, Mucocutaneous; Male; Meglumine; Meglumine Antimoniate; Middle Aged; Mouth Mucosa; Organometallic Compounds; Polymerase Chain Reaction; Skin Tests

The clinical, microbiological, and histopathological findings of six patients with mucosal leishmaniasis are reported. Five of these patients were Spanish with no history of travel abroad, while the other was from Bolivia but had lived in Spain for more than 5 years. Two patients had no underlying disease, while the other four had several other medical conditions. Lesions were located in the nose in three patients and in the larynx in the other three. Symptoms included difficulty in swallowing, nasal obstruction, dysphonia, and polypoid lesions mimicking cancer. The diagnosis was based on the identification of parasites, or on PCR assay or culture. Five patients were treated with liposomal amphotericin B and the other with antimonial compounds.

Topics: Adult; Aged; Amphotericin B; Animals; Female; Humans; Larynx; Leishmania infantum; Leishmaniasis, Mucocutaneous; Male; Middle Aged; Neoplasms; Nose; Polymerase Chain Reaction; Spain

Midline destructive lesions have multiple possible etiologies, which can be grouped into neoplastic, infectious, or vasculitis-associated. The purpose of these case reports and literature review was to highlight the need to include mucocutaneous leishmaniasis in the diagnosis of midfacial lesions in any patient who has lived in Leishmania-endemic areas because this entity meets all of the clinical criteria to be considered a form of midline destructive lesion. We present two cases of mucocutaneous leishmaniasis that occurred in a Bolivian male immigrant and a European male traveler to Panama, in whom lesions were misdiagnosed as different midline destructive lesions with different causes (Wegener, vasculitis, and natural killer or T-cell lymphoma [NKTL]). The conclusion of our work is that all patients with midline destructive lesions should undergo histologic and molecular studies to be evaluated for mucosal leishmaniasis, particularly patients whose clinical history suggests this possibility. In cases of uvular involvement, biopsy of this region might be a possible alternative to nasal biopsy.

Topics: Adult; Aged; Amphotericin B; Antiprotozoal Agents; Combined Modality Therapy; Diagnosis, Differential; Humans; Leishmaniasis, Mucocutaneous; Male; Meglumine; Meglumine Antimoniate; Mouth Diseases; Nose Diseases; Organometallic Compounds

Primary mucosal leishmaniasis is a rare infectious disease, particularly in immunocompetent patients. We present a 50-year-old patient with a 6-week history of a painful lesion of the left buccal mucosa that mimicked cancer. The exophytic lesion looked invasive, and we took an incisional biopsy specimen to exclude cancer. The diagnosis of leishmaniasis was unexpected, and the patient was successfully treated with amphotericin B for five weeks. After five months the patient had a visceral recurrence. Chronic exophytic and ulcerated mucosal lesions that do not heal within 3-4 weeks should be regarded as the first signs of oral cancer, but primary oral leishmaniasis can easily mimic it.

Topics: Amphotericin B; Antiprotozoal Agents; Diagnosis, Differential; Follow-Up Studies; Humans; Leishmaniasis, Mucocutaneous; Male; Middle Aged; Mouth Diseases; Mouth Mucosa; Mouth Neoplasms; Recurrence

Immune reconstitution inflammatory syndrome (IRIS) is an immuno-pathologic reaction to quiescent opportunistic microbial pathogens upon restoration of underlying immune defects. Here we report a Honduran patient with HIV/AIDS who developed a facial rash worsening on antiretroviral therapy and increasing CD4 count. Culture and PCR analysis from the skin biopsy identified Leishmania panamensis, which was effectively treated with long-term liposomal amphotericin B. This is the first report of mucocutaneous leishmaniasis (MCL)-associated IRIS due to L. panamensis.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antiprotozoal Agents; Female; HIV Infections; Humans; Immune Reconstitution Inflammatory Syndrome; Leishmania; Leishmaniasis, Mucocutaneous; Polymerase Chain Reaction

The standard treatment of mucosal leishmaniasis (ML) is pentavalent antimonials, agents with serious adverse effects. Alternative agents include amphotericin B deoxycholate and liposomal amphotericin B. We performed a retrospective study including 29 patients treated with liposomal amphotericin B, most of whom had comorbidities, history of previous treatment of ML, and contraindications to the use of antimonial pentavalent or amphotericin B deoxycholate. We observed a cure rate of 93.1%. Kidney failure was the most important side effect, reported in five patients (17.2%). This study showed a good efficacy and safety profile of liposomal amphotericin B in patients with ML and contraindications to the use of other agents.

Topics: Adult; Aged; Aged, 80 and over; Amphotericin B; Antiprotozoal Agents; Brazil; Female; Humans; Leishmania; Leishmaniasis, Mucocutaneous; Male; Middle Aged; Renal Insufficiency; Retrospective Studies; Treatment Outcome

Studies assessing the efficacy of liposomal amphotericin B (LAB) in the treatment of patients with mucosal leishmaniasis (ML) are very scarce in the literature and an optimal dose regimen has not yet been defined.. We performed a retrospective and descriptive analysis from records of 16 patients with ML treated with LAB. The mean daily dose of LAB was 2.5 mg/kg/day.. Healing of the lesion was observed in 14 (88%) of the 16 patients. The mean cumulative doses, excluding the two treatment failures, were 2265 mg and 33 mg/kg.. Liposomal amphotericin B in the cumulative dose of 30 to 35 mg/kg was able to achieve 100% effectiveness.

Topics: Adult; Aged; Aged, 80 and over; Amphotericin B; Antiprotozoal Agents; Dose-Response Relationship, Drug; Female; Humans; Leishmaniasis, Mucocutaneous; Male; Middle Aged; Retrospective Studies

Topics: Amphotericin B; Antiprotozoal Agents; Humans; Infectious Disease Incubation Period; Leishmania guyanensis; Leishmaniasis, Mucocutaneous; Male; Middle Aged

Mucosal leishmaniasis (ML) is a chronic form of tegumentary leishmaniasis, which causes destructive lesions of nasal, pharyngeal, and laryngeal mucosa. We describe a case of leishmaniasis reactivation with simultaneous cutaneous and mucosal forms in a renal transplanted patient with no history of prior leishmaniasis. Reactivation after renal transplantation was not reported in Brazil. A 67-year-old woman receiving prednisone 20 mg/day, tacrolimus 1 mg/day, and mycophenolic acid 360 mg/day presented with nose edema with erythema and cutaneous lesions. Amastigotes were identified on biopsies and the polymerase chain reaction confirmed Leishmania (Viannia) braziliensis. The patient was treated with liposomal amphotericin B but died 3 weeks after as a result of bacterial septic shock. In conclusion, tegumentary leishmaniasis can reactivate with simultaneous cutaneous and mucosal forms in a renal transplanted patient during the immunosuppressant therapy.

Topics: Aged; Amphotericin B; Antiprotozoal Agents; Fatal Outcome; Female; Humans; Immunosuppressive Agents; Kidney Transplantation; Leishmania braziliensis; Leishmaniasis, Mucocutaneous; Treatment Failure

Topics: Aged, 80 and over; Amphotericin B; DNA Primers; Humans; Laryngeal Diseases; Leishmania infantum; Leishmaniasis, Mucocutaneous; Male; Polymerase Chain Reaction; Polymorphism, Restriction Fragment Length; Sequence Analysis, DNA; Tomography, X-Ray Computed; Treatment Outcome; Turkey

Mucocutaneous leishmaniasis, which mostly occurs in the New World, is mainly associated with Leishmania braziliensis and to a lesser degree L. panamensis and L. amazonensis infections. Primary mucosal leishmaniasis is very rare in Iran in spite of high prevalence of cutaneous and visceral leishmanisis. A nine-year-old boy had cutaneous leishmaniaisis for five years involving the left side of his face; he then developed swelling and ulceration of the lip and left side buccal mucosa five months before hospital admission. He had severe swelling of the lower lip and there was ulceration and bleeding of the buccal mucosa. Direct smear revealed leishman bodies and nested PCR confirmed the presence of kinetoplast DNA of L. major in the oral mucosal specimen. The patient received amphotericin B deoxycholate 1 mg/kg/day for one month. The lip and face inflammatory reaction disappeared to nearly normal after one month of therapy. The patient was discharged with ketoconazole (5mg/kg/day) for six weeks. To our knowledge, this is the first report of mucocutaneous leishmaniasis caused by L. major in Iran.

Topics: Amphotericin B; Antiprotozoal Agents; Child; DNA, Kinetoplast; DNA, Protozoan; Humans; Iran; Leishmania major; Leishmaniasis, Mucocutaneous; Male; Molecular Diagnostic Techniques; Mouth Mucosa; Polymerase Chain Reaction; Treatment Outcome

Topics: Adult; Aged; Amphotericin B; Antiprotozoal Agents; Female; Humans; Leishmaniasis, Mucocutaneous; Male; Middle Aged; Mouth Mucosa; Treatment Outcome

The evolution and therapeutic outcome of American tegumentary leishmaniasis (ATL) depend upon many factors, including the balance between Th1 and Th2 cytokines to control parasite multiplication and lesion extension. Other cytokines known for their role in inflammatory processes such as interleukin IL-17 or IL-18 as well as factors controlling keratinocyte differentiation and the inflammatory process in the skin, like the Notch system, could also be involved in the disease outcome. Notch receptors are a group of transmembrane proteins that regulate cell fate decisions during development and adulthood in many tissues, including keratinocyte differentiation and T-cell lineage commitment, depending on their activation by specific groups of ligands (Delta-like or Jagged).. To compare the in situ expression of Notch system proteins (receptors, ligands and transcriptional factors) and cytokines possibly involved in the disease outcome (IL-17, IL-18, IL-23 and transforming growth factor-β) in ATL cutaneous and mucosal lesions, according to the response to therapy with N-methyl glucamine.. Cutaneous and mucosal biopsies obtained from patients prior to therapy with N-methyl glucamine were analysed by immunohistochemistry and real-time polymerase chain reaction.. Notch receptors and Delta-like ligands were found increased in patients with ATL, particularly those with poor response to therapy or with mucosal lesions.. The increase of Notch receptors and Delta-like ligands in patients with a poor response to treatment suggests that these patients would require a more aggressive therapeutic approach or at least a more thorough and rigorous follow-up.

Topics: Adult; Amphotericin B; Antiprotozoal Agents; Female; GATA3 Transcription Factor; Humans; Immunohistochemistry; Intercellular Signaling Peptides and Proteins; Interleukins; Leishmaniasis, Mucocutaneous; Male; Receptors, Notch; RNA, Messenger; T-Box Domain Proteins; Treatment Outcome

Mucosal leishmaniasis is a well-known clinical manifestation of infections caused by species belonging to the Leishmania (Viannia) subgenus in Central and South America but not of Leishmania species endemic in the so-called Old World. We report on three cases of mucosal leishmaniasis caused by Leishmania (Leishmania) infantum contracted in southern Europe. Two patients were immunocompromised; one patient had no underlying condition. Lesions were located in the oral mucosa, oesophagus and nose. All lesions relapsed under standard treatment with liposomal amphotericin B. A cure was achieved after secondary and extended treatment with liposomal amphotericin B or miltefosine. Mucosal leishmaniasis contracted in southern Europe has to be considered in the differential diagnosis of lesions in the naso-buccal-oesophageal mucosa and may occur in previously healthy persons.

Topics: Adult; Aged; Amphotericin B; Antiprotozoal Agents; Esophagus; Europe; Female; Humans; Leishmania infantum; Leishmaniasis, Mucocutaneous; Male; Middle Aged; Mouth Mucosa; Nasal Mucosa; Phosphorylcholine; Treatment Outcome

Cutaneous leishmaniasis (CL) is rarely seen in the United States, and the social and geographic context of the infection can be a key to its diagnosis and management. Four Somali and one Ethiopian, in U.S. Border Patrol custody, came to the United States by the same human trafficking route: Djibouti to Dubai to Moscow to Havana to Quito; and then by ground by Columbia/Panama to the United States-Mexico border where they were detained. Although traveling at different times, all five patients simultaneously presented to our institution with chronic ulcerative skin lesions at different sites and stages of evolution. Culture of biopsy specimens grew Leishmania panamensis. Soon thereafter, three individuals from East Africa traveling the identical route presented with L. panamensis CL to physicians in Tacoma, WA. We document here the association of a human trafficking route and new world CL. Clinicians and public health officials should be aware of this emerging infectious disease risk.

Topics: Adult; Africa, Eastern; Amphotericin B; Cluster Analysis; Disease Outbreaks; Humans; Leishmania; Leishmaniasis, Mucocutaneous; Male; Panama; Skin Ulcer; Social Problems; Travel; United States; Young Adult

Liposomal amphotericin B has been used as an alternative treatment of mucosal leishmaniasis, but the optimal dose is not established. We retrospectively reviewed the clinical outcome of eight patients with mucosal leishmaniasis treated with liposomal amphotericin B. The mean total dose was 35 mg/kg (range 24-50 mg/kg), which resulted in the healing of all the lesions in all patients and no recurrences were observed during the follow-up period (mean 25 months; range 7-40 months).

Topics: Adult; Aged; Amphotericin B; Dose-Response Relationship, Drug; Humans; Leishmaniasis, Mucocutaneous; Male; Middle Aged; Retrospective Studies

A 43-year-old Brazilian female presented in 2001 with nasal stuffiness and sinusitis. A biopsy was consistent with limited Wegener's granulomatosis although antineutrophil cytoplasmic antibodies were negative. Her nasal inflammation progressed despite trials of prednisone, methotrexate, and azathioprine. A septal perforation developed and a repeat biopsy showed granulomatous inflammation. In 2006 the patient was referred to Division of Rheumatology, University of California, Los Angeles. The nose was grossly erythematous and a magnetic resonance imaging revealed nasal destruction and sinusitis. Palatine biopsies showed chronic inflammation. Cyclophosphamide at 150 mg/d resulted in markedly improved mucocutaneous lesions. The patient developed a leg and arm rash in 2007. A skin biopsy was positive for Leishmania braziliensis. The cyclophosphamide was discontinued and amphotericin B was initiated with transient benefit. Remission was achieved with pentavalent antimony. Despite multiple nasopharyngeal biopsies, for a 6-year span, mucocutaneous leishmaniasis masqueraded as Wegener's granulomatosis. Cyclophosphamide not only resulted in clinical improvement, due to reduced inflammatory response, but also allowed widespread cutaneous dissemination.

Topics: Adult; Amphotericin B; Antiprotozoal Agents; Brazil; California; Diagnosis, Differential; Female; Granulomatosis with Polyangiitis; Humans; Infusions, Intravenous; Leishmaniasis, Mucocutaneous; Meglumine; Meglumine Antimoniate; Organometallic Compounds; Referral and Consultation

Topics: Aged; Amphotericin B; Animals; Antiprotozoal Agents; Epistaxis; Humans; Laryngeal Diseases; Leishmania braziliensis; Leishmaniasis, Mucocutaneous; Male; Mucous Membrane; Nasopharyngeal Diseases; Nose Diseases

Topics: Amphotericin B; Humans; Leishmaniasis, Mucocutaneous; Male; Middle Aged

A 69 year old man living in Spain contracted mucocutaneous leishmaniasis involving the nose. The infecting organism was Leishmania infantum, which only rarely causes the New World form of the disease. The source of infection was probably a neighbour's dog. The patient began treatment with liposomal amphotericin B but died of pneumonia two months later.

Topics: Amphotericin B; Animals; Antiprotozoal Agents; Dog Diseases; Dogs; Humans; Leishmania infantum; Leishmaniasis, Mucocutaneous; Male; Nose Diseases; Spain; Zoonoses

Topics: Adult; Amphotericin B; Antifungal Agents; HIV Infections; Humans; Leishmaniasis, Mucocutaneous; Male

Topics: Amphotericin B; Animals; Antiprotozoal Agents; Humans; Immunocompromised Host; Itraconazole; Kidney Transplantation; Leishmania donovani; Leishmaniasis, Mucocutaneous; Liposomes; Male; Middle Aged; Tongue; Tongue Diseases; Treatment Outcome

Topics: Amphotericin B; Antimony; Antimony Sodium Gluconate; Gluconates; Humans; Leishmaniasis, Mucocutaneous; Male

The treatment of two patients with severe mucosal leishmaniasis due to Leishmania braziliensis braziliensis is described. Both patients had received much prior antimonial therapy and one had relapsed after a total dose of 2.5 g of Amphotericin B. Both patients responded to prolonged continuous Pentostam therapy at a daily dose of 20 mg Sbv/kg/day for 62 days in one case and for 85 days in the other. Pentavalent antimonials can be curative in such protracted courses in selected patients unresponsive to standard chemotherapy.

Topics: Adult; Amphotericin B; Antimony; Antimony Sodium Gluconate; Child; Gluconates; Humans; Leishmaniasis, Mucocutaneous; Male; Meglumine; Meglumine Antimoniate; Organometallic Compounds

Topics: Adult; Amphotericin B; Ancylostomiasis; Humans; Infusions, Parenteral; Leishmaniasis; Leishmaniasis, Mucocutaneous; Malaria; Male; Middle Aged; Plasmodium falciparum

The case histories of five patients initially resistant to Glucantime therapy are presented. In addition comments are made on each patient since they demonstrated unusual clinical features. The practical difficulties in assessing true resistance to Glucantime are briefly discussed.

Topics: Amphotericin B; Antigens; Antimony; Brazil; Female; Fluorescent Antibody Technique; Humans; Leishmania; Leishmaniasis, Mucocutaneous; Meglumine; Meglumine Antimoniate; Middle Aged; Organometallic Compounds; Sorbitol

The American skin and mucous membrane leishmaniasis or mucocutaneous leishmaniasis is induced through phlebotomus bites and occurs in South and Central America. Untreated severe multilating ulcerations of the face with involvement of oral, nasal, and pharyngeal mucous membranes may occur. Therapy consists of intramuscular administration of three- or pentavalent antimon preparations. In failure-patients amphotericin B is used instead.

Topics: Amphotericin B; Antimony; Diagnosis, Differential; Humans; Leishmaniasis, Mucocutaneous

Topics: Adult; Amphotericin B; Antimony; Diagnosis, Differential; Gingivitis, Necrotizing Ulcerative; Humans; Leishmaniasis, Mucocutaneous; Male; Paracoccidioidomycosis

With the setting up of a rural-medical post in the region of Pachitea-Pichis river, affluent of the Alto Ucayali, in the year 1973, the authors made the diagnosis of 120 cases of pigmentary Leishmaniasis (1,2 % of the total population). 55 % of this series corresponded to pure cutaneous forms and 65 were of the muco-cutaneous type, 21 of the latter being mutilating. Sixty per cent were young males working as wood labourers or farmers. The treatment with Repodral (Etilofen) was useful only in the initial froms. Brezilian Pemhigus foliaceous which is considered endemic in the same geographical area responded wery well to treatment with prednisolone.

Topics: Administration, Topical; Adolescent; Adult; Aged; Amphotericin B; Anti-Inflammatory Agents; Child; Child, Preschool; Dermatitis, Occupational; Humans; Infant; Leishmaniasis, Mucocutaneous; Male; Middle Aged; Pemphigus; Peru; Prednisolone; Skin Ulcer; Wood

Twelve patients with South American mococutaneous leishmaniasis who attended the Hospital Amazonico in Peru between February and September 1974 were treated with amphotericin B. The lesions responded rapidly to treatment. A relatively low total dose of amphotericin B induced healing of active lesions. No serious adverse effects of treatment were encountered.

Topics: Adolescent; Adult; Amphotericin B; Child; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Humans; Injections, Intravenous; Leishmaniasis, Mucocutaneous; Male; Middle Aged; Proteinuria

A case of mococutaneous leishmaniasis in a patient referred to Memorial Sloan-Kettering Cancer Center, New York, with a presumptive diagnosis of lethal mid-line granuloma is described. The patient had lived in Bolivia and had been treated with antimony during and after which his mucosal lesions progressed. These lesions completely healed with 971 mg of amphotericin B. Mucocutaneous leishmaniasis is endemic in many areas of Central and South America and may occur in patients in the United States who have lived in or traveled to these areas. Organisms may be difficult to identify, and multiple biopsies and cultures may be necessary. The use of amphotericin B for the treatment of leishmaniasis is reviewed. It is an effective alternative to antimony therapy, and in some cases resistant to antimony, it may be the drug of choice.

Topics: Adult; Amino Sugars; Amphotericin B; Antimony; Bolivia; Diagnosis, Differential; Granuloma, Lethal Midline; Humans; Leishmaniasis, Mucocutaneous; Male; New York City; Travel

Topics: Adult; Age Factors; Amphotericin B; Antimony; Drug Resistance; Humans; Leishmaniasis, Mucocutaneous; Male; Nasal Mucosa; Peru; Prognosis; Sculpture

Topics: Adolescent; Adult; Amphotericin B; Benzenesulfonates; Child; Child, Preschool; Female; Humans; Infant; Leishmaniasis, Mucocutaneous; Male; Middle Aged; Peru

Topics: Adolescent; Adult; Amphotericin B; Child; Female; Humans; Leishmania; Leishmaniasis, Mucocutaneous; Male; Middle Aged; Mucous Membrane

Topics: Amphotericin B; Antimony; Female; Germany, West; Humans; Leishmania; Leishmaniasis, Mucocutaneous; Male; Metronidazole; Protozoan Infections; Pyrimethamine; Skin Diseases, Infectious; Streptomycin; Toxoplasmosis; Trichomonas; Trichomonas Infections; Trichomonas vaginalis; Trichomonas Vaginitis

Topics: Amphotericin B; Anti-Infective Agents; Antimony; Child; Humans; Leishmaniasis, Mucocutaneous

Topics: Amidines; Amphotericin B; Anemia; Animals; Antimony; Blood Protein Electrophoresis; Child, Preschool; Chloroquine; Complement Fixation Tests; Diagnosis, Differential; Dogs; Haplorhini; Hepatomegaly; Humans; Leishmaniasis, Mucocutaneous; Leishmaniasis, Visceral; Leukopenia; Liver Function Tests; Metronidazole; Rodentia; Skin Tests; Splenomegaly

Topics: Adolescent; Adult; Amphotericin B; Blastomycosis; Drug Resistance, Microbial; Female; Humans; Leishmaniasis, Mucocutaneous; Male; Otorhinolaryngologic Diseases

Topics: Adolescent; Adult; Amphotericin B; Blastomycosis; Female; Humans; Leishmaniasis, Mucocutaneous; Male; Otorhinolaryngologic Diseases

Topics: Amphotericin B; Animals; Antimony; Cricetinae; Evaluation Studies as Topic; Gluconates; Guinea Pigs; Injections, Intraperitoneal; Injections, Subcutaneous; Leishmaniasis, Mucocutaneous; Mice; Sorbitol; Tissue Extracts; Virulence

Topics: Amidines; Amphotericin B; Antimony; Arsenicals; Drug Tolerance; Furazolidone; Humans; Immunotherapy; Leishmaniasis, Mucocutaneous

Topics: Allergy and Immunology; Amphotericin B; Animals; Animals, Laboratory; Cricetinae; Drug Resistance; Drug Resistance, Microbial; Drug Therapy; Electrons; Epidemiology; Fluorescent Antibody Technique; Humans; Leishmaniasis; Leishmaniasis, Cutaneous; Leishmaniasis, Mucocutaneous; Mice; Microscopy; Microscopy, Electron; Pathology; Rodentia; Venezuela

Topics: Administration, Intravenous; Amphotericin B; Argentina; Humans; Injections; Injections, Intravenous; Leishmaniasis; Leishmaniasis, Mucocutaneous; Pharmacology; Toxicology

Topics: Adolescent; Amphotericin B; Humans; Leishmaniasis; Leishmaniasis, Cutaneous; Leishmaniasis, Mucocutaneous; Mucous Membrane

Topics: Amphotericin B; Humans; Leishmaniasis; Leishmaniasis, Mucocutaneous; United States

Topics: Amphotericin B; Antifungal Agents; Humans; Leishmaniasis; Leishmaniasis, Cutaneous; Leishmaniasis, Mucocutaneous

Topics: Amphotericin B; Antifungal Agents; Fungicides, Industrial; Humans; Leishmaniasis; Leishmaniasis, Cutaneous; Leishmaniasis, Mucocutaneous; United States

Topics: Amphotericin B; Antifungal Agents; Humans; Leishmaniasis; Leishmaniasis, Mucocutaneous; United States