phenylephrine-hydrochloride and Leishmaniasis--Cutaneous

Erysipeloid cutaneous leishmaniasis (ECL) is known as the chronic form of cutaneous leishmaniasis (CL). However, keeping its clinical presentation in view, there is a need to revisit this form of the disease.. To describe ECL in view of clinical features and treatment modalities.. We include a case series seen in Sfax (Southern Tunisia) from January 2017 to January 2021. All patients clinically suggestive and laboratory confirmed with a diagnosis of CL were registered. Patients of all age groups and of either gender having cutaneous lesions resembling erysipela on the face were included in the study. Different demographic features of the patients and clinical aspects were identified. Descriptive statistics were used for analysis.. Of 1300 registered patients with CL, 40 (3%) were diagnosed as ECL. Ages ranged from 15 to 65 years, and duration of lesions varied from 15 to 180 days. All patients had lesions over the face. Clinically, a painful infiltrated inflammatory placard of the central facial area with a butterfly shape was observed in 14 cases, as well as zones of the cheekbone (11 cases), cheekbone and nose (5 cases), cheekbone and eyelid (8 cases), and cheekbone with ear (2 cases). Several therapeutic methods were prescribed with a sufficient result with no recurrence.. ECL is a rare presentation that typically occurs on the face, looking like erysipelas, in patients who are native from an endemic region of CL.

Topics: Erysipeloid; Eyelids; Humans; Infant; Infant, Newborn; Leishmaniasis, Cutaneous; Nose; Tunisia

Multi-staged forehead flaps are a well-recognised reconstructive workhorse for subtotal and total nasal defects. It carries the disadvantage of repeated trips to theatre for revisional surgery, which is not suited to all patient cohorts. The single-stage islanded forehead flap eliminates this need. We detail our indications and outcomes of using this flap to highlight the maintained versatility of the technique without significant compromise on reconstructive and patient outcome.. A prospective surgical database was collated where patients were categorised as partial or total reconstruction. We detail surgical technique and review of rationale of patient selection. Patient demographics, perioperative data and follow-up course were recorded.. A total of 22 patients were recorded from both the U.K. and Ethiopia via working with the charity Facing Africa. Defects occurred from a mixture of trauma, Noma and cancer resections. Thirteen were total nasal reconstructions and nine partial. The mean follow-up period was 2.25 years. We experienced two major complications which required minor revision in the theatre and two minor complications, all resolved satisfactorily.. We demonstrate good outcomes and safety of the procedure in this first report of a varied cohort of nasal reconstructions in a heterogenous cohort of patients. We advocate the use of this flap in the multi-morbid patient where recovery can be expedited or those who have limitations from economical restraints.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Female; Follow-Up Studies; Forehead; Humans; Leishmaniasis, Cutaneous; Male; Middle Aged; Nose; Nose Neoplasms; Postoperative Complications; Rhinoplasty; Surgical Flaps; Young Adult

Feline leishmaniasis (FeL) is an emerging infectious disease of cats caused by Leishmania infantum with global distribution. This study investigated the cause of chronic progressive cutaneous lesions in two cats from Central-west Brazil by using cytological, histopathologic, and immunohistochemical (IHC) analyses. Clinically, both cats had ulcerative cutaneous lesions at the nasal planum and ear resulting in a tentative diagnosis of squamous cell carcinoma (SCC). Moreover, both cats had varying degrees of onychogryphosis. However, cytology revealed chronic inflammatory reactions associated with intralesional amastigotes; histopathology confirmed chronic ulcerative dermatitis associated with intralesional and intracytoplasmic parasitic organisms consistent with amastigotes of Leishmania spp. within histiocytes. The IHC assay demonstrated that the intralesional parasitic structures identified by cytology and histopathology were immunoreactive to antigens of Leishmania spp., confirming the participation of this infectious disease agent in the development of the cutaneous lesions of these cats. The observation of onychogryphosis must be highlighted, since this lesion is frequently observed in dogs with visceral leishmaniasis but is underreported in FeL. Collectively, the pathologic and IHC findings of the chronic cutaneous disease confirmed active infections due to Leishmania spp. in these cats. Additionally, FeL with associated lesions to the ear and nasal planum must be considered as differential diagnosis for SCC in cats.

Topics: Animals; Biopsy, Fine-Needle; Brazil; Carcinoma, Squamous Cell; Cat Diseases; Cats; Cities; Diagnosis, Differential; Ear, External; Female; Forelimb; Hindlimb; Immunohistochemistry; Leishmania infantum; Leishmaniasis, Cutaneous; Nose; Skin Neoplasms

Midline destructive lesions of the face (MDL) have a wide range of etiologies. Cutaneous Leishmaniasis (CL) is rarely reported as a possible cause.. Fifteen patients with solitary nasal lesions caused by CL were studied. The clinical data, biopsies/scrapings and PCR were collected/performed. Ridley's Pattern (RP) and Parasitic Index (PI) were documented.. Patients' age ranged from 1 to 60 years including 7 males and 8 females. The duration of the observed lesions ranged from 1 to 18 months. Clinically, the lesions showed 6 patterns varying from dermal erythematous papulonodular with no epidermal changes to destructive erythematous plaque with massive central hemorrhagic crust. The clinical impression ranged from neoplastic to inflammatory processes. RP varied among the cases [RP 3 (n = 6), RP 4 (n = 3), RP 5 (n = 6)]. All cases show low PI [PI 0 (n = 7), PI 1 (n = 6), PI 2 (n = 1), and PI 3 (n = 1)]. Higher PI was noted in the pediatric group [average age 24 years for PI 0-1 vs. 6.5 years for PI 2-3]. Molecular speciation showed Leishmania tropica (n = 13) and Leishmania major (n = 2). All the patients received Meglumine Antimoniate (Glucantine) injections and had initial cure defined as complete scarring and disappearance of inflammatory signs within 3 months.. Leishmaniasis may cause MDL especially in endemic areas. PCR is instrumental in confirming the diagnosis. MDL caused by CL showed wide spectrum of clinical and microscopic presentation.

Topics: Adolescent; Adult; Biopsy; Child; Child, Preschool; Female; Humans; Infant; Leishmaniasis, Cutaneous; Male; Meglumine; Meglumine Antimoniate; Middle Aged; Nose; Nose Diseases; Organometallic Compounds; Polymerase Chain Reaction; Young Adult

We report the epidemiological and clinical characteristics of the erysipeloid form of cutaneous leishmaniasis as well as its diagnostic and therapeutic challenges.. A 63-year-old woman, with no medical history, presented with a one-month history of erythematous nasal swelling. The lesion appeared after an accidental trauma. Erythematous infiltrative plaque was noted on the center of the face. There were also crust formations on the traumatic region. Despite local treatment and oral antibiotherapy, there was no improvement. The diagnosis of cutaneous leishmaniasis was confirmed by positive skin smears. Histopathological examinations of a skin biopsy showed no malignancy. The patient was treated intramuscularly with 10mg/kg per day systemic meglumine antimoniate with partial regression of symptoms.. The erysipeloid type is a rare and unusual presentation of cutaneous leishmaniasis that often causes late diagnosis. Diagnosis is confirmed by the demonstration of the parasite by skin smear, histopathological examination and polymerase chain reaction. There are various therapeutic options. The evolution is generally favourable.

Topics: Antiprotozoal Agents; Biopsy; Diagnosis, Differential; Erysipeloid; Facial Dermatoses; Female; Humans; Leishmaniasis, Cutaneous; Meglumine; Meglumine Antimoniate; Middle Aged; Nose; Nose Diseases; Organometallic Compounds; Polymerase Chain Reaction; Skin

Topics: Adult; Arm; Humans; Leishmania tropica; Leishmaniasis, Cutaneous; Male; Nose

It has been reported that anti-tumor necrosis factor-alpha therapy increases the risk of opportunistic infections including rare case reports of leishmaniasis. Here we report a case of latent cutaneous leishmaniasis, which was provoked by anti-tumor necrosis factor-alpha therapy in a patient with rheumatoid arthritis.

Topics: Adult; Amphotericin B; Animals; Anti-Bacterial Agents; Antibodies, Monoclonal; Antiprotozoal Agents; Antirheumatic Agents; Arthritis, Rheumatoid; Biopsy; Female; Humans; Leishmania; Leishmaniasis, Cutaneous; Nasal Mucosa; Nose; Treatment Outcome; Tumor Necrosis Factor-alpha

The erysipeloid form of cutaneous leishmaniasis is considered as an unusual and rare clinical presentation in Tunisia. Our prospective study on 4 observations, aimed at examining the clinical, histological and progressive features of the "erysipeloid" form of cutaneous leishmaniasis. Our patients were 3 females and one male more than 62 years old. Their cutaneous leishmaniasis was clinically characterised by an infiltrated and extensive plaque which was localised on the face covering the nose and cheeks looking like erysipelas. The treatment was intramuscular meglumine antimoniate (Glucantime) in three cases and metronidazole in one case. A regression without scar was noticed in all the cases. On the histological examination, we observed an intense epidermic and constant hyperplasia with presence of amastigotes in 3 cases. Our study shows the lesional polymorphism of the old word cutaneous leishmaniasis in our region. The "erysipeloid" form of cutaneous leishmaniasis is a rare clinical presentation which generally affects women. If the clinical aspect is very meaningful, the histological aspect is meaningful but not specific.

Topics: Female; Humans; Leishmaniasis, Cutaneous; Male; Middle Aged; Nose; Skin; Vomer

A case of leishmaniasis in a domestic cat (Felis domesticus) is described. The animal showed a single, nodular lesion on the nose and many nodules of different size on the ears and digital regions of all the paws. Diagnosis was made by microscopic detection of amastigotes in Giemsa-stained smears from the lesions. By monoclonal antibodies the aetiological agent was identified as Leishmania (Leishmania) amazonensis, one of the seven species implicated in human leishmaniasis in Brazil. The clinical signs in feline leishmaniasis are unspecific and similar to those observed in other diseases such as cryptococcosis and in sporotrichosis, commonly found in cats. Leishmaniasis should therefore, be added to the differential diagnosis by feline veterinary practitioners and adequate investigations should carried out for dermal leishmaniasis in the area where the feline infection is detected.

Topics: Animals; Antibodies, Monoclonal; Brazil; Cat Diseases; Cats; Ear; Fatal Outcome; Female; Fluorescent Antibody Technique, Indirect; Foot; Leishmania; Leishmaniasis, Cutaneous; Nose

The skin ulcer in Leishmania major infection is known to be variable according to the inoculation sites even in a susceptible host. The present study traced the immunoblot patterns by the site of inoculation and duration of infection in BALB/c mice. L. major were subcutaneously inoculated on the nose, footpad, and back of the mice, in a dose of 3 x 10(6) promastigotes. Sera of the mice were collected every 10 days after inoculation. SDS-PAGE separated soluble protein bands of the promastigotes and immunoblot was carried out with the infection sera. The skin ulcer first appeared on the nose at 15 days, and on the footpad at 17 days after inoculation. The ulcer on the back appeared after 90 days. In the mice with ulcer on the nose or footpad, serum IgG antibody reacted to 202, 139, 98, 83, 81, 67 65, 62, 59, 54, 52, 42, 26 and 23 kDa bands at 20 days after inoculation. In mice inoculated on the back, however, the immunoblot showed visible reactions with 202, 83, 81, 74, 67, 65, 62, 59, 54, 52, 20 and 17 kDa bands at 90 days after inoculation. The present result showed that the antigenic protein bands of L. major promastigotes were differed by the inoculation site and duration of infection. Since the skin ulcer and the serum antibodies to antigenic bands between 67-52 kDa appeared simultaneously, it is suggested that the serum IgG antibodies may play a role in formation of the skin ulcer in BALB/c mice.

Topics: Animals; Antibodies, Protozoan; Antigens, Protozoan; Back; Foot; Immunoblotting; Immunoglobulin G; Leishmania major; Leishmaniasis, Cutaneous; Mice; Mice, Inbred BALB C; Nose; Skin Ulcer; Time Factors

This study reports intraspecific variations of native isolates of Leishmania (Viannia) braziliensis from patients with leishmaniasis from Salta, Argentina. These isolates induced skin lesions in golden hamsters, initially showing rapid development, reaching their largest size between 28 and 35 days postinfection (PI). Thereafter, the infections were self-limiting and total regression was observed at 80-150 days PI. The majority of the native isolates were characterized by low infectivity in the experimental animals, and a classic pattern of dissemination to systemic organs was established. However, unusual features for L. braziliensis were displayed by two isolates; one showed evidence of high infectivity in hamsters characterized by a short prepatent period and larger, severe and persistent lesions at the inoculation site. The other isolate, of low infectivity, showed cutaneous metastasis and recurrent systemic dissemination in the same animals, suggesting dissociation between infectivity and pathogenicity. Metastasis has been frequently described in hamsters infected with L. (V) guyanensis and L. (V) panamensis, but not in infections induced by L. (V) braziliensis, as was observed in this study. Active and/or regressive histopathologic lesions were observed, depending on the stage of the infection. An exudative and mixed inflammatory pattern with microabscesses and necrotic areas was observed during early infection, while well-defined granulomas and collagen formation were the predominant features detected at a later time. Amastigotes were easily detected in the tissues, although in low numbers. Schaumann bodies were always detected. The characterization of the unique features of these native isolates, and the verification of their reproducibility in vitro and in vivo will be useful tools in tests related to immunoprophylaxis and chemotherapy.

Topics: Animals; Argentina; Cricetinae; Disease Models, Animal; Granuloma; Humans; Leishmania braziliensis; Leishmaniasis, Cutaneous; Macrophages; Mesocricetus; Necrosis; Nose; Skin

The nasal mucosa is affected in mucosal leishmaniasis and the skin of the nose, but not the mucosa, may be involved in cutaneous leishmaniasis (oriental sore) and in post kala-azar dermal leishmaniasis (PKDL). These clinical forms all occur in the Sudan and, particularly when advanced, may be confused with each other since mucosal leishmaniasis may extend to the skin of the upper lip and both cutaneous leishmaniasis and PKDL may spread to the anterior nares although they do not extend into the mucosa. Illustrative examples of the three conditions are described. Distinctive features of each form are given. The importance of making the correct diagnosis is stressed, since the different forms respond differently to anti-leishmanial drugs.

Topics: Adult; Child; Diagnosis, Differential; Female; Humans; Leishmaniasis, Cutaneous; Leishmaniasis, Mucocutaneous; Lip; Male; Middle Aged; Nose; Nose Diseases; Sudan

Topics: Adult; Antimony Sodium Gluconate; Female; Granuloma; Humans; Leishmaniasis, Cutaneous; Nose; Nose Diseases; Postoperative Complications

Topics: Animals; Child; Humans; Leishmania tropica; Leishmaniasis, Cutaneous; Male; Nose

Two cases of ACL which showed extreme variation of cutaneous disease encountered in infection with Leishmania tropica were reported. Biochemically, the two isolates proved to be L. tropica (Zymodeme LON 72, one isolate and 71 second isolate.

Topics: Animals; Child; Humans; Leishmania tropica; Leishmaniasis, Cutaneous; Lip; Male; Nose; Saudi Arabia