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Symmetrical cutaneous leishmaniasis.
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Immunological selection for Leishmania (Viannia) braziliensis antigens.
Comparative ELISA and selective immunoblotting procedures were used in attempts to identify differential serological indicators of infection with the Leishmania (Viannia) braziliensis complex, infection with the L. braziliensis species, and therapeutic cure of localized or mucocutaneous leishmaniasis (LCL or MCL). Although mean ELISA absorbance values were significantly higher for MCL sera than for LCL sera, absorbance could not be used as a reliable indicator of the clinical form of disease. Immunoblotting profiles were similar with sera from MCL and LCL. Pre-adsorption with heterologous trypanosomatid antigens indicated that recognition of antigens of about 56, 60, 66, 72, 88 and 110 kDa might be specific to the subgenus Viannia. In two-colour, sequential, dual ELISA-based immunoblotting, no antigens recognized only by sera from MCL patients were detected. After glucantime therapy, immunoblotting profiles with LCL sera were reduced both in intensity and in the range of antigens detected; a 104-kDa antigen was newly detected with post-treatment LCL sera. Overall, the results show the value of differential immunological detection strategies and support the close relationship between species of the subgenus Viannia but fail to indicate a prognostic antigen for MCL.
Studies on the chemotherapy of melaminyl arsenicals and antimonials in laboratory trypanosome infections.
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A note on the distribution and excretion of antimony in mice treated with sodium p-melaminylphenylstibonate.
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Suppressive management of schistosomiasis with antimony dimercaptosuccinate.
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Chemotherapy of visceral leishmaniasis (Leishmania donovani) in the squirrel monkey (Saimiri sciureus).
The relationship of the numbers of amastigotes in the liver to the duration of infection with two lines of a Khartoum strain of Leishmania donovani [designated the parent (P) line and the meglumine antimoniate (Glucantime) resistant (MAR) line] and the effect of meglumine antimoniate on these two lines of Leishmania were studied in the squirrel monkey. All experimental monkeys were inoculated via the saphenous vein with 32.5 X 10(6) amastigotes (per kg body weight), obtained from heavily-infected hamster spleens. Subsequently in Experiment I, liver biopsy samples were taken chronologically from all monkeys. Imprints of liver were made on glass slides and stained with Giemsa's staining solution, and parasite density per gram of liver tissue was determined. The parasites reached a maximum density of 6.2 X 10(6) amastigotes per gram between two to four weeks and 9.4 X 10(7) amastigotes per gram between four to six weeks in the monkeys receiving the P line and the MAR line, respectively. Parasite numbers then decreased, and all the livers and spleens of all monkeys became microscopically negative for Leishmania eight to 13 weeks post-infection. Comparison of the multiplication of the two lines of Leishmania indicated that the MAR line persisted longer in the livers than did the P line. A slight decrease in body weight was observed at eight weeks post-infection. Packed cell volume and haemoglobin were low at four to eight weeks post-infection, but were within the normal range.(ABSTRACT TRUNCATED AT 250 WORDS)
Humoral factors during South American visceral leishmaniasis.
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Glomerulonephritis in dogs with canine leishmaniasis.
Kidney specimens, obtained from 11 dogs of diverse species that had contracted spontaneous leishmaniasis, were submitted to a histopathological investigation using a classical preparation of sections embedded in paraffin, semi-thin and ultra-thin sections embedded in plastic, and sections frozen under immunofluorescence. Eight animals presented moderate to severe renal insufficiency. Two major categories of glomerular lesions were identified in the kidneys examined: acute glomerulonephritis and extra-membranous glomerulonephritis. These two categories were never associated and no transition from from one to the other was found. Immune complex deposits prevailed sharply over proliferative phenomena, which remained infrequent. Study of these glomerulonephrities could represent a model for better understanding of the immunological aspects of leishmaniasis.
Canine leishmaniasis: clinical, parasitological and entomological follow-up after chemotherapy.
Six naturally infected dogs [two with no signs of leishmaniasis ('asymptomatic'), two with a few signs ('oligosymptomatic') and two with many signs ('polysymptomatic')] were studied before and after chemotherapy. Another two, non-infected dogs were kept as controls. The dogs were studied clinically, haematologically and parasitologically five times over 11 months and their infectivity to sandflies was evaluated before and after the treatment. The 'asymptomatic' dogs were as infective to sandflies as the 'symptomatic' before treatment but all dogs were un-infective for at least a few months following chemotherapy. Treatment led to a temporary improvement in the clinical and biochemical condition of most of the dogs, the symptomatic dogs becoming asymptomatic, but parasitological cure was uncommon after 10 months' follow-up. There was often no correlation between clinical condition, parasitological condition and infectivity to sandflies. Some dogs from both the 'asymptomatic' and 'symptomatic' groups became infective to sandflies several months post-treatment.
Treatment of cutaneous leishmaniasis with antimony: intramuscular versus intralesional administration.
The various methods used to treat cutaneous leishmaniasis (CL) have not given consistent results. The aim of the present study was to compare the efficacy of a solution of meglumine antimoniate (MA; 85 mg Sb/ml) given intralesionally (i.l.) with that of the same solution given intramuscularly (i.m.). Eighty CL patients, with a total of 147 lesions, were randomly allocated into the two treatment groups. Forty were injected i.m. with MA (15 mg Sb/kg.day) on 6 days/week until 12 injections had been given to each. The lesions of the other 40 patients were infiltrated with MA (0.2-0.8 ml/lesion) every other day for 30 days. After 15 days' therapy, none of the lesions on those treated i.m. had fully healed (although five lesions showed some improvement) whereas two lesions on those treated i.l. had fully healed and 10 showed good improvement. After 30 days, 46 (68%) of the 68 lesions on those treated i.m. had healed completely, 11 (16%) had improved, and five (8%) worsened. The corresponding values for the 66 lesions on those treated i.l. were 48 (73%), 10 (15%) and three (5%). There was no statistically significant difference between the two treatment groups, either in terms of satisfactory response (lesions fully healed or improved) or unsatisfactory response (lesions unchanged or advanced), when assessed on day 30 (P > 0.5). Intralesional antimony is a rapidly effective, safe and economical method of treating simple CL, particularly in patients with cardiac, liver or renal disease, for whom antimonials are contra-indicated.
Comparative efficacy of meglumine antimoniate and aminosidine sulphate, alone or in combination, in canine leishmaniasis.
Thirty-two domestic dogs naturally infected with Leishmania infantum and showing viscero-cutaneous signs of canine leishmaniasis were treated with aminosidine sulphate (11 dogs) meglumine antimoniate (10 dogs) or with a combination of the two drugs (11 dogs) for 21 consecutive days. Clinical and laboratory assessments, made on day 21 and at 2, 4 and 6 months after initiation of treatment, showed that the drug combination gave the best score in terms of clinical efficacy, incidences of early clinical relapse, any clinical relapse or apparent parasitological cure, and reduction in parasite densities in bone-marrow and lymphnode aspirates (even though a lower dose of antimonial was used in the combination than for antimonial monotherapy). For each of the above parameters, however, the higher efficacy of the drug combination was not statistically significant, probably because of the large variations caused by using naturally infected animals of various ages and breeds.
Splenic granulomatous lesions in immunocompetent pediatric patients with visceral leishmaniasis.
Visceral focal lesions are rarely encountered in patients with leishmaniasis despite the fact that splenomegaly, and to a lesser extent hepatomegaly, predominate among the clinical features of the disease. We present, using high resolution ultrasonography, the first 3 reported cases of focal splenic involvement in immunocompetent children with visceral leishmaniasis. All patients showed a prompt response to the conventional anti-leishmanial treatment administered. This favorable outcome indicates that localized splenic lesions should not be considered as a poor prognostic factor and that alteration of the standard anti-leishmanial regimens is not justified.
Visceral leishmaniasis with pericarditis in an HIV-infected patient.
The clinical presentation of visceral leishmaniasis, or kala-azar, is variable but usually includes fever, severe cachexia, lymphadenopathy and hepatosplenomegaly. In immunocompromised patients the clinical course of the disease is even less specific and the diagnosis is often made by means of incidental detection of the parasites at atypical sites such as the gastrointestinal tract, peripheral blood, lungs and cerebrospinal fluid. We describe a case of pericardial leishmaniasis in an HIV-infected patient.
The effect of intravenous or subcutaneous administration of meglumine antimonate (Glucantime) in dogs with leishmaniasis. A randomized clinical trial.
The efficacy of i.v. versus s.c. administration of Glucantime (100 mg/kg of body weight/day) was studied in 41 dogs with leishmaniasis without serious renal insufficiency. Remission was obtained in 35 dogs (85.4%) after 3 to 6 weeks of treatment but there was a relapse within 1 year in 26 dogs (74.3%). The median period of remission was 6 months. Cross-over therapy resulted in remission in 17 of 20 dogs. The percentage of remission after initial and cross-over therapy, the median relapse free period, and survival did not differ significantly between the two groups. There were very few complications and most were of minor clinical importance. Thrombophlebitis developed in one dog after i.v. injection. In dogs with leishmaniasis without serious renal insufficiency, there is a 75% probability of survival for more than 4 years following treatment with Glucantime for 3 to 6 weeks, with additional treatment when relapses occur.
Visceral and cutaneous leishmaniasis in an European paediatric population.
Six children with leishmaniasis, aged 10 months to 10 years, were treated in the Paediatric Department. Four patients had visceral leishmaniasis (kala-azar): diagnosis was based on bone marrow examination and therapy consisted of a combination of Glucantime and Lomidine. The remaining two children had cutaneous leishmaniasis: diagnosis was made by skin biopsy and the patients were treated with Glucantime alone. In all children, serology was clearly positive at the time of the diagnosis and all patients improved. The only side effects were cough associated with fever in one child, and supraventricular premature beats in another one. They were ascribed to Glucantime, and proved reversible after discontinuation of the treatment.
Topical paromomycin/methylbenzethonium chloride plus parenteral meglumine antimonate as treatment for American cutaneous leishmaniasis: controlled study.
We determined the efficacy of the combination of the topical formulation 15% paromomycin sulfate/12% methylbenzethonium chloride (MBCL) and a short course (7 days) of parenteral meglumine antimonate (pentavalent antimony [Sb]) as treatment of American cutaneous leishmaniasis in Colombian patients. Patients were randomly assigned in unequal allocation (2:1:1:1) to group 1 (topical paromomycin/MBCL plus injectable Sb for 7 days), group 2 (topical placebo plus injectable Sb for 7 days), group 3 (topical paromomycin/MBCL plus injectable Sb for 3 days), and group 4 (injectable Sb for 20 days). Cure was defined as complete reepithelialization of all lesions without relapse. Cure rates among groups were as follows: 58% (34 of 59), group 1; 53% (16 of 30), group 2; 20% (6 of 30), group 3; and 84% (26 of 31), group 4. Seventy-one percent of the organisms identified to the species level were Leishmania braziliensis panamensis. We conclude that 10 days of therapy with paromomycin/MBCL does not augment the response of cutaneous leishmaniasis (predominately due to L. braziliensis panamensis) to a short course of treatment with meglumine antimonate.
Topical paromomycin/methylbenzethonium chloride plus parenteral meglumine antimonate as treatment of American cutaneous leishmaniasis: controlled study.
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