Cryosurgery in cutaneous leishmaniasis

Thirty patients with cutaneous leishmaniasis were treated with cryotherapy using a CO2 cryomachine and all were cured without noticeable scarring within 4-5 weeks, with no relapse. Histopathological examination showed that cryotherapy eradicated all parasites in less than 1 hour. Leishmania tropica, L. ethiopica and L. brasiliensis are all markedly thermosensitive and thus cryotherapy seems parasiticidal to all types. Adequate cryotreatment of cutaneous leishmaniasis will preclude the development of mucocutaneous extension, and its use in mucocutaneous disease is also recommended.     

Visceral and cutaneous leishmaniasis

BACKGROUND: Use of sodium bicarbonate (NaHCO3) may result in intracellular acidosis due to the generation of CO2. Carbicarb, has been reported to be superior to sodium bicarbonate (NaHCO3) because of lesser generation of CO2. The present study was designed to investigate whether Carbicarb or NaHCO3 is superior to normal saline in the treatment of hypoxic lactic acidosis. METHODS: Hypoxia was induced by ventilation with 8% O(2) in 30 piglets with fixed ventilation. When the pH fell to < 7.2, hypoxia was reversed by placing the animals in 21% O2 (experiment 1) or 100% O(2) (experiment 2) and either saline, Carbicarb or NaHCO3 were given. Data were collected for 120 minutes after therapy. RESULTS: In both experiment 1 (severe acidosis, pH < or = 7.1) and 2 (moderate acidosis, pH < or = 7.2) use of Carbicarb and NaHCO3 increased the arterial carbon dioxide tension (pCO2) significantly (p < 0.05). With moderate acidosis: 1) use of alkalinizing agents compared to saline resulted in an initial improvement in arterial pH at 1 minute, but thereafter, the differences were not statistically significant; and 2) there were no differences in hemodynamic variables and plasma lactic acid concentration between the three groups. CONCLUSIONS: The data demonstrate that 1) both Carbicarb and NaHCO3 significantly increase arterial pCO2; and 2) use of either alkalinizing agent in moderate acidosis does not alter the course of acidosis.     

The epidemiology of cutaneous leishmaniasis in Kuwait

Studies in Kuwait have suggested that sandflies feed on man and domestic animals, but not on rodents in different habitats. Of 1129 feral and wild rodents, none showed evidence of leishmanial infection nor did their incidental lesions resemble those produced by inoculating a human strain. Five out of 30 patients with lesions of cutaneous leishmaniasis claimed they had never been outside the country, but the validity of these claims is questioned. Cutaneous leishmaniasis in Kuwait is essentially an imported disease, with no substantial evidence that it is yet endemic.     

Activity of liposomal amphotericin B against experimental cutaneous leishmaniasis

The polyene antibiotic amphotericin B is currently a second-line treatment for visceral leishmaniasis (VL) and mucocutaneous leishmaniasis. Lipid-amphotericin B formulations with lower toxicity than the parent drug that were developed for the treatment of systemic mycoses have proved to be an effective treatment for VL, especially AmBisome, a small unilamellar negatively charged liposome. In vitro, free amphotericin B was three to six times more active than the liposomal formulation AmBisome against both Leishmania major promastigotes in culture and amastigotes in murine macrophages. In a BALB/c L. major model of cutaneous infection, liposomal amphotericin B administered once a day on six alternate days by the intravenous route produced a dose-response effect between 6.25 and 50 mg/kg. Liposomal amphotericin B administered subcutaneously close to a lesion had no significant activity. Free drug was ineffective at nontoxic doses. The results suggest that liposomal amphotericin B may be useful in the treatment of cutaneous leishmaniasis.     

Multiple cutaneous leishmaniasis after a stay in Central America

Leishmaniasis is a protozoal disease affecting at least 12 millions persons, with 400,000 new cases per year. It is transmitted by a small insect, the phlebotomine sand fly. Clinical syndromes include visceral leishmaniasis and various cutaneous affections. We describe here the case of a patient affected by a multiple lesions New World cutaneous leishmaniasis, after staying in Costa Rica for tourism; we discuss the differential diagnosis and make a short summary of the principles of treatment.     

Visceral and cutaneous leishmaniasis comparative ultrastructure of host-parasite interactions

The comparative ultrastructure of host-parasite interactions is described for the first time in patients with visceral (VL) and cutaneous (CL) leishmaniasis. In patients with VL, the parasite invades the bone marrow (BM) macrophages (Mcs) and neutrophils, while in patients with CL, the parasite invades the dermal fibroblasts in addition to Mcs. The skin Mcs seem to have more lethal effects on the parasite than the BM Mcs; this is possibly due to the presence of numerous melanosomes with acid phosphatase activity in the Mcs digestive vacuole. In patients with high level of VL parasitaemia, the parasite may induce the BM reticulocytes to phagocytose both the parasite and mature erythrocytes, i.e. lost recognition. In patients with low level of VLparasitaemia, the parasite may induce the BM Mcs to be haemophagocytic, i.e. temporarily mimick malignant histiocytosis until the course of treatment. In early stages of CL infection, the cellular infiltrate consists of the monocyte-macrophage system, plasma cells, lymphocytes and fibroblasts; while in the late stages, two types of epithelioid cells (ECs) are added to the infiltrate and are involved in the formation of tuberculous granulomas. Type I ECs thought to produce a granuloma factor, while type II ECs possibly precedes healing by fibrosis. However, the severity of host-parasite interactions seems to depend mainly on species of the parasite, the degree of parasitaemia, the type of infected tissue(s), and the variation of host tissue reaction against the parasite from one patient to another.     

Some aspects of cutaneous leishmaniasis in Riyadh. Saudi Arabia

One hundred and sixty nine out of 310 outpatients of Riyadh's hospitals and 104 out of 209 inhabitants from El Kharj showed Leishmania bodies in smears obtained by puncture of indurated edge of sores. Collection of sand flies yielded P. papatasi, Paraphlebotomus caucasicus and S. squamipleuris. The results were discussed.     

Short report epidemiologic studies on cutaneous leishmaniasis in eastern Panama

In this study, we investigate the innervation to the feline ophthalmic artery by the horseradish peroxidase (HRP) tracing method. Five adult cats with body weights ranging between 2.0 and 3.0 kg were used. Under microscopic dissection, the ophthalmic artery was identified and isolated. A gelfoam (Upjohn Co.), 1 x 3 mm in size, containing 0.1 ml of HRP was applied to the prepared artery segment for 2 h. The cat was sacrificed 3 days later. The trigeminal, stellate, superior cervical, middle cervical and nodal ganglia, and oculomotor, trochlear and abducens nuclei were removed, sectioned and stained for HRP-positive cells. HRP-labeled neurons were found in the ipsilateral trigeminal (TRG) and superior cervical ganglia (SCG). The middle cervical, stellate, Edinger-Westphal, trochlear and abducens nuclei were all deemed negative for HRP-labeled cells. In the TRG, HRP-labeled neurons ranged from 21 to 250 (mean +/- SE = 93.8 +/- 42.5/ganglion). The labeled neurons were distributed primarily in the ophthalmic branch. In the SCG, the HRP-labeled neurons were distributed evenly in the ganglion, ranging from 6 to 180 (mean +/- SE = 91.6 +/- 31.5/ganglion). Two additional cats having received a sham operation revealed a negative finding. The feline ophthalmic artery is innervated by the ipsilateral TRG and SCG. Such innervation may play a role in regulating blood flow to the optic nerve.     

Changing patterns of cutaneous leishmaniasis in Israel and neighbouring territories

The most frequent form of cutaneous leishmaniasis (CL) in Israel and the neighbouring territories is due to Leishmania major, which is endemic mainly in the Jordan Valley and in the Rift Valley. CL due to L. tropica is much less common, and in the past only sporadic cases have been reported. In this study we present data obtained during the years 1988-1992 regarding CL in the area. Our clinic has diagnosed a total of 371 leishmaniasis cases, most of whom acquired the infection in the Jordan Valley, mainly during June and July. About one-third of the patients had single lesions, and one-third more than 5 lesions. We also describe an outbreak of leishmaniasis in Kfar Adumim, a village 15 km east of Jerusalem, where leishmaniasis was previously unknown. Parasites were characterized by the polymerase chain reaction and by immunostaining, and found to be both L. tropica and L. major. The localization of the homes of the affected people on a slope where hyraxes were abundant suggests that these animals might have been involved in the transmission of L. tropica in this area.     

A clinico-pathological study of cutaneous leishmaniasis in British troops from Belize

Thirty-four cases of cutaneous leishmaniasis contracted by British soldiers in Belize were studied. Pre- and post-treatment biopsies were taken from all patients. The range of histological appearances is described and the value of histological examination (including Giemsa staining and immunohistochemistry), cytological preparations and microbiological culture in diagnosis and clinical management assessed. Histology and culture were found to be complementary techniques in reaching a positive diagnosis, whilst cytological preparations were of no additional value. Histological examination of post-treatment biopsies merely confirmed the clinical impression of healing or non-healing whilst culture identified viable organisms in apparently healed lesions, which were subsequently re-treated.     

Atypical cutaneous histological features of visceral leishmaniasis in acquired immunodeficiency syndrome

OBJECTIVE: A sex hormone imbalance has been reported in patients with hepatocellular carcinoma (HCC). We investigated the serum levels of eight sex hormones in patients with alcohol-related and non-alcohol-related cirrhosis and HCC. METHODS: Luteinizing hormone, follicle-stimulating hormone, estradiol, progesterone, testosterone, androstenedione, dehydroepiandrosterone and sex hormone binding globulin were assayed in 81 patients with cirrhosis (59 men, 22 women) and 97 with HCC and cirrhosis (82 men, 15 women). Hepatitis B or hepatitis C virus infection was present in 58% of patients with cirrhosis and 69% of patients with HCC. Alcohol abuse was the aetiopathogenetic factor in the remaining patients. RESULTS: In men, mean testosterone levels were at the lower limit of the normal range for both patients with HCC and for controls with cirrhosis. Mean estradiol levels were increased both in patients with HCC and in those with cirrhosis, but patients with alcohol-related HCC had higher estradiol levels (P = 0.0002). An index of sex hormone imbalance, the estradiol to testosterone ratio (ETR), was calculated. The ETR was significantly higher in patients with alcohol-related HCC (P = 0.0002). Multiple regression analysis showed that the ETR correlated best with patients' diagnosis (P < 0.05). In women, the ETR was significantly lower in patients with HCC than in controls with cirrhosis. CONCLUSIONS: Men with alcohol-related HCC are characterized by an oestrogen and androgen imbalance and have a higher ETR than patients with other types of liver damage. Since sex hormones modulate hepatocellular proliferation, our data suggest that a sex hormone imbalance plays a role in hepatocarcinogenesis in patients with alcohol-related cirrhosis.     

Efficacies of KY62 against Leishmania amazonensis and Leishmania donovani in experimental murine cutaneous leishmaniasis and visceral leishmaniasis

Carcass measurements of 12th-rib fat thickness (CARCFAT), longissimus muscle area (CARCLMA), and weight (CARCWT) on 2,028 Brangus and Brangus-sired fed steers and heifers, as well as yearling weights (YWT) and ultrasound measures of 12th-rib fat thickness (USFAT) and longissimus muscle area (USLMA) on 3,583 Brangus bulls and heifers were analyzed to estimate genetic parameters. Data were analyzed using a six-trait animal model and an average information REML algorithm. The model included fixed effects for contemporary group and breed of dam, covariates for age at slaughter or measurement, and random animal and residual effects. Heritabilities for CARCFAT, CARCLMA, CARCWT, USFAT, USLMA, and YWT were .27+/-.05, .39+/-.05, .59+/-.06, .11+/-.03, .29+/-.04, and .40+/-.04, respectively. Genetic correlations between CARCFAT and USFAT, CARCLMA and USLMA, and CARCWT and YWT were .69+/-.18, .66+/-.14, and .61+/-.11, respectively. The favorable and moderately strong genetic correlations between carcass measurements and similar yearling breeding-animal ultrasound measurements indicate that such measurements of 12th-rib fat and longissimus muscle area are useful in predicting genetic values for carcass leanness and longissimus muscle area. Selection using yearling ultrasound measurements of breeding cattle should result in predictable genetic improvement for carcass characteristics. Inclusion of yearling ultrasound measurements for fat thickness and longissimus muscle area should enhance national cattle evaluation programs.     

Historical note on the discovery of cutaneous leishmaniasis transmission by Phlebotomus]

Compared to the past, modern dentistry offers a wide range of treatment options to the public. These options are more likely to be appreciated and accepted when we take the feelings of our patients into account. Dr. T. J. Murray, a former dean of Dalhousie University's medical school, says: "I believe it is just as important now, in the era of scientific medicine and dentistry, to practise the art of our profession as it ever was. Our professions were always a balance of caring and healing. In modern times, the concepts and approaches to healing have had a scientific underpinning, but they have not supplanted the need for humanistic care. In fact, many persons have problems and illnesses that are not amenable to scientific treatment or cure, and the approach is for caring, understanding, explanation, reassurance, and 'being there' for the patient."