rifampin and Leishmaniasis--Cutaneous

Case management in children with cutaneous leishmaniasis (CL) is mainly based on studies performed in adults. We aimed to determine the efficacy and harms of interventions to treat CL in children.. We conducted a systematic review of clinical trials and cohort studies, assessing treatments of CL in children (≤12 years old). We performed structured searches in PubMed, CENTRAL, LILACS, SciELO, Scopus, the International Clinical Trials Registry Platform (ICTRP), clinicaltrials.gov and Google Scholar. No restrictions regarding ethnicity, country, sex or year of publication were applied. Languages were limited to English, Spanish and Portuguese. Two reviewers screened articles, completed the data extraction and assessment of risk of bias. A qualitative summary of the included studies was performed.. We identified 1092 records, and included 8 manuscripts (6 Randomized Clinical Trials [RCT] and 2 non-randomized studies). Most of the articles excluded in full-text review did not report outcomes separately for children. In American CL (ACL), 5 studies evaluated miltefosine and/or meglumine antimoniate (MA). Their efficacy varied from 68-83% and 17-69%, respectively. In Old-World CL (OWCL), two studies evaluated systemic therapies: rifampicin and MA; and one study assessed efficacy of cryotherapy (42%, Per Protocol [PP]) vs intralesional MA (72%, PP). Few studies (4) provided information on adverse events (AEs) for children, and no serious AEs were reported in participants. Risk of bias was generally low to unclear in ACL studies, and unclear to high in OWCL studies.. Information on efficacy of treatment for CL in children is scarce. There is an unmet need to develop specific formulations, surveillance of AEs, and guidelines both for the management of CL and clinical trials involving the pediatric population.. The protocol of this review was registered in the PROSPERO International register of systematic reviews, number CRD42017062164.

Topics: Antiprotozoal Agents; Clinical Trials as Topic; Humans; Leishmania; Leishmaniasis, Cutaneous; Meglumine Antimoniate; Phosphorylcholine; Rifampin

Cutaneous leishmaniasis occurs worldwide in both old and new world countries with their own endemic foci. Many of those infected often experience a delay in diagnosis and inappropriate treatment.. To review the literature in terms of the various treatment options described for cutaneous leishmaniasis.. Literature on the treatment of cutaneous leishmaniasis retrieved by searching Index Medicus, PubMed and IndMed were reviewed.. Review reveals no uniform pattern or definite guidelines for its therapy. The varied and contradictory experience of different workers further confounds the clinicians involved in the care of these patients. Selection of an appropriate and customized treatment schedule is a discretion the treating clinician has to make.

Topics: Amphotericin B; Antimony; Antiprotozoal Agents; Dapsone; Humans; Imidazoles; Leishmaniasis, Cutaneous; Rifampin

Daily doses of 0.5 mg of rifampicin given intraperitoneally to mice after a challenge dose of 104 amastigotes of L. amazonensis led to a significant reduction of the size of local lesions. On the other hand, daily doses of 20 mg/kg to children or 1200 mg to adult patients infected with L. braziliensis did not bring any sign of improvement after 30 days of treatment. Our results formally contradict rifampicin as an alternative drug in Leishmania braziliensis infections.

Topics: Adolescent; Adult; Animals; Child; Disease Models, Animal; Female; Humans; Injections, Intraperitoneal; Leishmania; Leishmania braziliensis; Leishmaniasis, Cutaneous; Leprostatic Agents; Mice; Rifampin

This study was conducted on 50 patients of Anthroponotic cutaneous leishmaniasis (oriental sore) to assess the efficacy of rifampicin and omeprazole through a double blind, randomised placebo control study.. The diagnosis of Anthroponotic cutaneous leishmaniasis (ACL) caused by Leishmania tropica was done by demonstration of Leishmania tropica (LT) bodies from the painless, dry ulcerative lesion. Each patient was assessed clinically in the beginning of the study, at the end of 2,4 and 6 weeks and all observations were compared in both the groups. Twenty-five patients received rifampicin with omeprazole (Group A) whereas other 25 patients received placebo (Group B) for a period of six weeks.. Altogether 23 cases in group Aand 21 cases in group B completed the study. About 16 (69.7%) cases in group A and 3 (14.29%) cases in group B had complete healing, whereas 3 patients (13.04%) of group A and 4 patients (19.05%) of group B had partial response and 4 patients (17.93%) of group A and 14 patients (66.67%) of group B had no response at the end of study. The difference of two groups was statistically highly significant (p < 0.00025). All patients tolerated the drug and placebo very well and no side effect was reported.. In our opinion rifampicin and omeprazole is a highly effective, less toxic and cheaper alternative for the management of cutaneous leishmaniasis.

Topics: Adolescent; Adult; Aged; Animals; Antiprotozoal Agents; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Leishmania tropica; Leishmaniasis, Cutaneous; Male; Middle Aged; Omeprazole; Rifampin; Treatment Outcome

We assessed the efficacy of rifampicin in the treatment of cutaneous leishmaniasis (oriental sore) using a double-blind placebo-controlled study. We studied 46 patients with cutaneous leishmaniasis, of whom 23 received rifampicin (group A) and another 23 received placebo (group B) for a period of 4 weeks. Each patient was assessed clinically for size of lesion, type of lesion, duration of lesion, number of lesions, and distribution of lesions, initially, and at the end of 1 week, 2 weeks and 4 weeks. Biochemical tests including enzyme studies were done to detect any toxic effects of the drug. Group A patients received rifampicin 1200 mg/day in two divided doses and group B patients received two doses of an identical placebo capsule. Seventeen (73.9%) of the 23 patients receiving rifampicin had complete healing. Two (8.6%) had partial healing and four (17.3%) showed no response, whereas out of 23 patients receiving placebo one patient (4.3%) showed complete healing, eight (34.7%) patients showed partial healing and 14 (60. 98%) patients showed no healing or exacerbation of lesion. The difference was statistically significant in favour of response to rifampicin. This dose of rifampicin was well-tolerated and no side-effects were seen in any patient. In cases of cutaneous leishmaniasis where injectable treatment is not feasible or not acceptable, as in cases of multiple lesions, rifampicin is a better alternative oral treatment. It is simple to administer, cheap, more effective and less toxic than other available oral drugs, and well-tolerated by patients.

Topics: Adolescent; Adult; Aged; Antiprotozoal Agents; Biopsy; Child; Child, Preschool; Double-Blind Method; Enzyme Inhibitors; Female; Humans; Infant; Infant, Newborn; Leishmaniasis, Cutaneous; Male; Middle Aged; Rifampin; Treatment Outcome

Daily doses of 0.5 mg of rifampicin given intraperitoneally to mice after a challenge dose of 104 amastigotes of L. amazonensis led to a significant reduction of the size of local lesions. On the other hand, daily doses of 20 mg/kg to children or 1200 mg to adult patients infected with L. braziliensis did not bring any sign of improvement after 30 days of treatment. Our results formally contradict rifampicin as an alternative drug in Leishmania braziliensis infections.

Topics: Adolescent; Adult; Animals; Child; Disease Models, Animal; Female; Humans; Injections, Intraperitoneal; Leishmania; Leishmania braziliensis; Leishmaniasis, Cutaneous; Leprostatic Agents; Mice; Rifampin

Diffuse cutaneous leishmaniasis (DCL) is a rare parasitic infection caused by the Leishmania species. Diffuse cutaneous leishmaniasis commonly presents as non-ulcerating papules and nodules over the face, neck, and arms. A middle-aged female presented with multiple nodular lesions on her face, neck, and chest region. Histopathology of the lesions showed multiple amastigotes, confirming the diagnosis of DCL. She was successfully treated with a combination course of rifampicin and fluconazole. Here, we report the first case of DCL in north India, a non-endemic area for cutaneous leishmaniasis.

Topics: Female; Fluconazole; Humans; Leishmania; Leishmaniasis, Cutaneous; Leishmaniasis, Diffuse Cutaneous; Middle Aged; Rifampin

Topics: Administration, Topical; Animals; Antiprotozoal Agents; Chitosan; Disease Models, Animal; Drug Delivery Systems; Flow Cytometry; Humans; Leishmaniasis, Cutaneous; Macrophages; Mice; Nanogels; Nanoparticles; Polyethylene Glycols; Polyethyleneimine; Rats; Rifampin

Cutaneous leishmaniasis (CL) is one of the common tropical protozoal diseases caused by various Leishmania species, and transmitted by the sand-fly vectors, Phlebotomus and Lutzomyia species. Herein, we report for the first time a case of CL that presented as large eczematous plaques occurring on the dorsi of both feet in a Libyan drug addicted, alcoholic patient with HIV infection.. A 34 year-old HIV-positive, alcoholic, drug addicted Libyan male presented to us with a history of a non-itchy skin lesions on the dorsi of both feet of 5-weeks duration. Systemic and topical antibiotics were given without improvement. Diagnosis of this patient was confirmed by observation of Leishmania amastigote bodies in stained slit-skin smear skin biopsy. After parenteral administration of sodium stiboglyconate (Pentostam) (20 mg/kg/day) for 28 days the lesions did not show any marked improvement. Concurrently, combination therapy of oral rifampicin (600 mg/day) and isoniazide (300 mg/day) was given for 8 weeks. Complete healing of lesions was achieved after this treatment and skin-slit smears turned negative.. Localized cutaneous leishmaniasis should be remembered in deferential diagnosis of unresponsive contact dermatitis especially for HIV-positive patients in CL endemic areas.This patient was not responding to Pentostam therapy, which is not very common in Libya. Interestingly, combination of oral rifampicin (600 mg/day) and isoniazide (300 mg/day) can be a successful alternative therapy.

Topics: Adult; Antiprotozoal Agents; Drug Therapy, Combination; Fatty Acid Synthesis Inhibitors; HIV Infections; Humans; Isoniazid; Leishmaniasis, Cutaneous; Male; Nucleic Acid Synthesis Inhibitors; Rifampin; Skin

Cutaneous leishmaniasis (CL) is endemic in the Bikaner region situated in the Thar Desert of Rajasthan, India. This study describes clinicoepidemiological data of pediatric CL in pre-school children (0-5 years of age) from this region during 2001-2012. In total, 151 patients with 217 lesions were reported during the study period. The mean age of the study group was 3.29 ± 1.43 years (0.25-5 years), with many (41.7%) cases being in the age group of 2-4 years. Face was the most common site involved, and morphologically, the lesions were either plaque type or papulonodular. Smear for parasitologic examination was positive in 84 (70%) of 120 cases, and histopathologic examination confirmed CL in 10 (55.55%) of 18 cases. Parasite species identification conducted for 13 randomly selected patients by polymerase chain reaction identified Leishmania tropica as the causative species. Intralesional sodium stibogluconate was the most commonly used treatment and found to be well-tolerated. Other therapies that were effective included oral rifampicin, oral dapsone, radiofrequency heat therapy (RFHT), and combinations of the three therapies.

Topics: Administration, Oral; Antimony Sodium Gluconate; Child, Preschool; Dapsone; Female; Humans; Incidence; India; Infant; Injections, Intralesional; Leishmaniasis, Cutaneous; Male; Polymerase Chain Reaction; Pulsed Radiofrequency Treatment; Retrospective Studies; Rifampin

We have established Leishmania tropica as the causative agent of cutaneous leishmaniasis (CL) in the region of India where the disease is endemic. The association between localized and circulating levels of immune-determinants in CL patients was evaluated. Reverse transcription-polymerase chain reaction analysis revealed up-regulation of interferon-gamma (IFN-gamma), interleukin (IL)-1beta, IL-8, tumour necrosis factor-alpha (TNF-alpha), IL-10 and IL-4 in dermal lesions at the pretreatment stage (n = 31) compared with healthy controls (P < 0.001) and a significant down-regulation after treatment (n = 14, P < 0.05). The results indicated that an unfavourable clinical outcome in CL was not related to an inadequate T helper 1 (Th1) cell response, but rather to impairment in multiple immune functions. Comparative assessment of treatment regimes with rifampicin (RFM) or sodium antimony gluconate (SAG) revealed tissue cytokine levels to be significantly reduced after treatment with RFM (P < 0.005), while no significant decrease was evident in the levels of IFN-gamma, TNF-alpha and IL-10 (P > 0.05) as a result of treatment with SAG. Increased transcripts of monocyte chemoattractant protein-1 (MCP-1) (P < 0.001) and inducible nitric oxide synthase (iNOS) (P < 0.05) were evident before treatment in tissue lesions and remained high after treatment. Immunohistochemistry demonstrated strong expression of myeloperoxidase (MPO) and IL-8, and moderate expression of iNOS in dermal lesions. The expression levels of IL-8, MCP-1 and nitric oxide (NO) were high in patient sera before treatment, as determined using cytokine bead array and enzyme-linked immunosorbent assay (ELISA). At the post-treatment stage, the serum IL-8 levels had decreased; however, the levels of MCP-1 and NO remained high. These data suggest that IL-8 is an effector immune-determinant in the progression of CL, whereas NO facilitates the parasite killing by macrophages via MCP-1-mediated stimulation.

Topics: Adolescent; Adult; Antimony Sodium Gluconate; Antiprotozoal Agents; Chemokine CCL2; Child; Child, Preschool; Female; Humans; India; Interferon-gamma; Interleukin-10; Interleukin-4; Interleukin-8; Leishmania tropica; Leishmaniasis, Cutaneous; Macrophages; Male; Middle Aged; Nitric Oxide; Nitric Oxide Synthase Type II; Nucleic Acid Synthesis Inhibitors; Peroxidase; Retrospective Studies; Rifampin; Th1 Cells; Tumor Necrosis Factor-alpha; Up-Regulation

A patient with an ulcerated cutaneous leishmaniasis of the pinna had suppurative otochondritis after a first unsuccessful course of treatment with meglumine antimoniate. Although the Leishmania ulceration healed after a second course of meglumine antimoniate, and despite three oral dicloxacillin or pristinamycin courses, the otochondritis extended and an abscess developed. Pus from the abscess revealed a pure culture of Pseudomonas aeruginosa. Five days of oral ciprofloxacin plus rifampin led to a marked improvement. The P. aeruginosa isolate was sensitive to ciprofloxacin but fully resistant to rifampin. Healing with minimal mutilation was obtained at the end of a six-week course of multiple antibiotic therapy. Pseudomonas aeruginosa otochondritis was a co-factor of cartilage mutilation in this patient. Thus, infection with P. aeruginosa should be promptly treated when present in tender cutaneous or mucosal leishmaniasis lesions near cartilaginous areas.

Topics: Adult; Animals; Anti-Infective Agents; Antimony; Antiprotozoal Agents; Cartilage; Ciprofloxacin; Ear, External; Humans; Immunocompetence; Leishmaniasis, Cutaneous; Male; Meglumine; Meglumine Antimoniate; Organometallic Compounds; Pseudomonas Infections; Rifampin

Cutaneous leishmanial lesions as well as serum samples from both infected human and Swiss-albino mice were used to investigate the role of Fas system (Fas-FasL) as an inducer of apoptosis and other leishmanicidal cytokines in the disease development in cutaneous leishmaniasis. Soluble Fas was estimated by ELISA, other leishmanicidal cytokines were detected by PAP technique and tissue Fas by RT-PCR. Results showed a significant increase in interferon-gamma (IFN-gamma), tumour necrosis factor-alpha (TNF-alpha), nitric oxide (NO) and soluble Fas in both infected human and mice. As regards the tissue Fas, there was marked expression in human samples while in murine samples, the expression was reduced in chronic infected mice than in the late acute infected animals which can explain the progression of the lesion in the animals. This study confirms the role of Fas system as an inducer of apoptosis.

Topics: Animals; Antimony; Apoptosis; Enzyme-Linked Immunosorbent Assay; Fas Ligand Protein; fas Receptor; Female; Humans; Leishmania major; Leishmaniasis, Cutaneous; Male; Membrane Glycoproteins; Mice; Rifampin; RNA, Messenger; Skin