scholarly journals Miltefosine for the treatment of cutaneous leishmaniasis—A pilot study from Ethiopia

2021 ◽  
Vol 15 (5) ◽  
pp. e0009460
Author(s):  
Saskia van Henten ◽  
Annisa Befekadu Tesfaye ◽  
Seid Getahun Abdela ◽  
Feleke Tilahun ◽  
Helina Fikre ◽  
...  
Keyword(s):  
Side Effects ◽  
Cutaneous Leishmaniasis ◽  
Systemic Treatment ◽  
Initial Response ◽  
Tablet Form ◽  
Leishmania Aethiopica ◽  
Mucosal Involvement ◽  
Observational Cohort ◽  
Good Improvement ◽  
Favorable Side Effect Profile

Background Cutaneous leishmaniasis (CL) in Ethiopia, caused by Leishmania aethiopica, is often severe and hard to treat compared to CL caused by other species elsewhere. Miltefosine is the only oral anti-leishmanial drug, with a favorable side-effect profile compared to routinely available sodium stibogluconate (SSG), but evidence about its use for L. aethiopica is lacking. Methodology and principal findings In an observational cohort study, treatment outcomes, safety and adherence among CL patients who required systemic treatment and received miltefosine for 28 days in Boru Meda Hospital and University of Gondar Hospital were studied. Patient cure was defined as 100% flattening for non-ulcerated lesions and 100% flattening and 100% re-epithelization for ulcerated lesions. Outcomes were documented for day 28, 90 and 180, both per site, and pooled, adjusting for site as a fixed effect with effect coding. Among 94 included patients (32 in Gondar, 62 in Boru Meda), median lesion duration was 12 months, median size six cm, and mucosal involvement (46.8%) and diffuse (30.9%) lesions were common. Adherence to miltefosine was good, and side-effects were tolerable. Initial outcomes at day 28 were promising, with 68.8% and 94.0% of patients having good improvement or cure in Gondar and Boru Meda respectively. In Boru Meda, outcomes were good with 72.7% and 72.9% cure at day 90 and day 180 respectively. In Gondar, results were less promising, with only 12.5% and 26.7% cure at day 90 and day 180, although confidence intervals were wide. In pooled estimates, 48.7% of patients reached cure at day 180, and 32.3% relapsed. Outcomes were better in Boru Meda Hospital, for smaller lesions and for mucosal lesions. Conclusions/Significance Based on miltefosine’s good initial response, tolerable side-effects, tablet-form, we propose to include miltefosine for future clinical trials using extended treatment schedules, combination therapy, or targeting specific subgroups. Trial registration ClinicalTrials.gov NCT04004754.

scholarly journals Leishmaniasis recidivans in Ethiopia: cutaneous and mucocutaneous features

2017 ◽  
Vol 11 (01) ◽  
pp. 106-110 ◽  
Author(s):  
Federica Dassoni ◽  
Frehiwot Daba ◽  
Bernard Naafs ◽  
Aldo Morrone
Keyword(s):  
Cutaneous Leishmaniasis ◽  
New World ◽  
Leishmania Braziliensis ◽  
Leishmania Tropica ◽  
Clinical Form ◽  
Leishmania Aethiopica ◽  
Mucosal Involvement ◽  
Leishmania Panamensis ◽  
First Time ◽  
Leishmania Guyanensis

Cutaneous leishmaniasis (CL) is endemic in Ethiopia. An unusual clinical form of this disease is leishmaniasis recidivans (LR), a prolonged, relapsing form of cutaneous leishmaniasis resembling tuberculosis of the skin that may persist for many years with a chronic and relapsing course. This rare variant has been shown to be caused by Leishmania tropica species in the Old World and by Leishmania braziliensis, Leishmania amazonensis, Leishmania panamensis, and Leishmania guyanensis in the New World, as reported in various studies. To our knowledge, there are no reports from Ethiopia, and mucocutaneous involvement of LR has not been described to date. This was a retrospective analysis of the patients seen at the Italian Dermatological Center in Mekelle on the Tigrean highlands over a three-year period (2008–2011). Seven patients with typical clinical features of LR were seen. Two of them presented with signs of mucosal involvement. To date, Leishmania aethiopica is shown to be the only species causing CL that is endemic in the Ethiopian highlands. Therefore, it had to be assumed that the lesions in these patients were caused by this species. The aims of this communication are to report, for the first time, the presence of LR, most likely due to Leishmania aethiopica, in Ethiopia, and to report mucosal involvement in this rare clinical form of CL.

scholarly journals Leishmania (Viannia) panamensis - induced cutaneous leishmaniasis in susceptible and resistant mouse strains

1995 ◽  
Vol 37 (6) ◽  
pp. 475-481 ◽  
Author(s):  
H. Goto ◽  
J. I. Rojas ◽  
L. Sporrong ◽  
P. de Carreira ◽  
C. Sánchez ◽  
...  
Keyword(s):  
Cutaneous Leishmaniasis ◽  
Post Infection ◽  
Proliferative Response ◽  
Cellular Response ◽  
Initial Response ◽  
Mouse Strains ◽  
Resistant Mouse ◽  
Inoculation Site ◽  
Lymph Node Cells ◽  
Foot Pad

We studied the susceptibility to Leishmania (Viannia) panamensis in strains of mice. The C57BL/6 strain was resistant and showed self-controlled lesion at the injected foot pad. The BALB/c and DBA/2J strains were susceptible and showed a foot swelling that started day 20 post-infection and progressed to a tumour-like lesion in later period of observation. The CBA/HJ strain was found to be of intermediary resistance. In contrast to other known cutaneous leishmaniasis in mice, the lesion in L. (V.) panamensis-infected mice was restricted to the inoculation site in the skin. In addition, we studied the development of cellular response and antibodies against Leishmania antigen in BALB/c and C57BL/6 strains. The proliferative response of lymph node cells against L. (V.) panamensis antigen was biphasic in both strains. An initial response was seen on day 20, followed by a refractory period between 40 and 80 days and a second response around fourth month post-infection. The response in the latter period was higher in C57BL/6 strain than in BALB/c strain. BALB/c strain presented much higher anti-Leishmania antibody level than C57BL/6 strain. The model and the correlation of immunological variables and the course of the infection are discussed.

scholarly journals Comparison of Oral Zinc Sulfate with Systemic Meglumine Antimoniate in the Treatment of Cutaneous Leishmaniasis

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Mohamad Javad Yazdanpanah ◽  
Mahnaz Banihashemi ◽  
Fakhrozaman Pezeshkpoor ◽  
Mohammad Khajedaluee ◽  
Sororozaman Famili ◽  
...  
Keyword(s):  
Side Effects ◽  
Cutaneous Leishmaniasis ◽  
Side Effect ◽  
Zinc Sulfate ◽  
Cure Rate ◽  
Meglumine Antimoniate ◽  
Treatment Groups ◽  
Significant Difference

The purpose of this study was to investigate comparison between oral zinc sulfate and meglumine antimoniate in the treatment of cutaneous leishmaniasis (CL). So 100 patients with CL were included and randomly divided into two groups. The first group was treated with oral zinc sulfate (10 mg/kg/day during 45 days period), and the second group was treated with systemic meglumine antimoniate (20 mg/kg/day intramuscularly for 20 days). Acceptable cure after completing 45 days of followup occurred in 30.2% of lesions in first group, while this was 35.5% for the second group. There is not any significant difference between the two treatment groups (P=0.42). Serious side effects resulting in treatment discounting occurred in only meglumine antimoniate group. Although cure rate of systemic meglumine antimoniate group was better the treatment with zinc sulfate is much easier, cheaper, more convenient in consumption, safer, and nearly close cure percentage to systemic meglumine antimoniate injections without serious side effect.

scholarly journals Cutaneous Leishmaniasis Due to Leishmania aethiopica

2018 ◽  
Vol 6 ◽  
pp. 69-81 ◽  
Author(s):  
Saskia van Henten ◽  
Wim Adriaensen ◽  
Helina Fikre ◽  
Hannah Akuffo ◽  
Ermias Diro ◽  
...  
Keyword(s):  
Cutaneous Leishmaniasis ◽  
Leishmania Aethiopica

Long-term use of anagrelide in young patients with essential thrombocythemia

Blood ◽  
2001 ◽  
Vol 97 (4) ◽  
pp. 863-866 ◽  
Author(s):  
Elizabeth C. Storen ◽  
Ayalew Tefferi
Keyword(s):  
Side Effects ◽  
Essential Thrombocythemia ◽  
Young Patients ◽  
Drug Efficacy ◽  
Initial Response ◽  
Drug Dosage ◽  
Similar Proportion ◽  
Term Therapy ◽  
Long Term Treatment

Abstract Anagrelide is a novel platelet-lowering agent that has recently been approved for use in essential thrombocythemia (ET) and related disorders. Short-term drug efficacy and toxicity data have previously been presented. The purpose of this study was to obtain additional information regarding long-term anagrelide use. This is a retrospective series of 35 young patients (17 to 48 years) with ET who received anagrelide treatment before 1992. Initial drug dosage ranged between 1 and 10 mg/d, and the median maintenance dosage was 2.5 mg/d. The overall initial response rate of 94% included 74% complete remissions and 20% partial remissions. Of the 33 responding patients, 27 (82%) remained on anagrelide therapy for a median of 10.8 years (range, 7 to 15.5). Of these, 66% maintained a complete and 34% a partial remission over the study period. In general, the reporting of somatic side effects decreased over time, and anemia was the only new side effect that emerged after long-term therapy. Eight patients (24%) experienced a more than 3 g/dL decrease in hemoglobin level. Despite active therapy, 20% of the patients experienced a total of 10 thrombotic episodes, and a similar proportion experienced major hemorrhagic events. All thrombohemorrhagic complications occurred at a platelet count of more than 400 × 109/L. It is concluded that long-term treatment of ET with anagrelide is associated with decreased reporting of initial side effects and the development of mild-to-moderate anemia. Complete normalization of platelet counts may be needed to minimize residual thrombohemorrhagic risk during therapy.

Rifampicin in Cutaneous Leishmaniasis

1978 ◽  
Vol 6 (4) ◽  
pp. 280-285 ◽  
Author(s):  
I Onsy Iskandar
Keyword(s):  
Side Effects ◽  
Cutaneous Leishmaniasis ◽  
Clinical Resolution ◽  
Endemic Areas

A study is described which aimed at assessing the efficacy of rifampicin in the treatment of cutaneous leishmaniasis. A total of thirteen patients suffering from this condition were admitted to the study and were given rifampicin 600 mg daily. Three patients dropped out due to reasons unconnected with the trial and one patient left when the lesions improved appreciably and continued treatment abroad. The remaining patients continued under treatment until clinical resolution was attained, and this occurred in a period of one to four months. The author was impressed by the marked clinical resolution and the lack of scarring and side-effects, and recommends that further trials be carried out in the endemic areas where more cases can readily be found, treated and observed for longer periods of time than in this study.

scholarly journals NEPHROTOXICITY ATTRIBUTED TO MEGLUMINE ANTIMONIATE (GLUCANTIME) IN THE TREATMENT OF GENERALIZED CUTANEOUS LEISHMANIASIS

1999 ◽  
Vol 41 (1) ◽  
pp. 33-37 ◽  
Author(s):  
M.L.O. RODRIGUES ◽  
R.S. COSTA ◽  
C.S. SOUZA ◽  
N.T. FOSS ◽  
A.M.F. ROSELINO
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Side Effects ◽  
Serum Creatinine ◽  
Cutaneous Leishmaniasis ◽  
Urine Osmolarity ◽  
Hepatic Enzyme ◽  
Meglumine Antimoniate ◽  
Tubular Necrosis ◽  
Electrocardiographic Abnormalities

Background: Pentavalent antimonials have became of basic importance for the treatment of leishmaniasis. Their most severe side effects have been reported to be increased hepatic enzyme levels and electrocardiographic abnormalities. Nephrotoxicity has been rarely related. Observations: We report a case of generalized cutaneous leishmaniasis involving a 50-year old male patient who was submitted to treatment with meglumine antimoniate (Glucantime). He developed acute renal failure (ARF) due to acute tubular necrosis (ATN), followed by death after receiving a total of 53 ampoules of Glucantime. Conclusions: The treatment with Glucantime was responsible by ARF diagnosed in this patient. The previous urine osmolarity and serum creatinine levels were normal and the autopsy showed ATN. It should be pointed out if ARF may also be explained by massive deposits of immunocomplexes by leishmania antibodies and antigens due to the antigenic break by the antimonial compound, since our patient presented countless lesions covering the entire tegument, similar to the Hexheimer phenomenon, but at the autopsy no glomerular alterations were seen.

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