Clinical Presentation and Response to Therapy in Children with Cutaneous Leishmaniasis

Abstract Background Cutaneous leishmaniasis (CL) caused by L. braziliensis is characterized by a single ulcer or multiple cutaneous lesions with raised borders. Cure rates below 60% are observed in response to meglumine antimoniate therapy. We investigated the impact of obesity on CL clinical presentation and therapeutic response. Methods A total of 90 age-matched CL patients were included (30 obese, 30 overweight and 30 with normal BMI). CL was diagnosed through documentation of L. braziliensis DNA by PCR or identification of amastigotes in biopsied skin lesion samples. Serum cytokine levels were determined by chemiluminescence. Antimony therapy with Glucantime (20mg/kg/day) was administered for 20 days. Results Obese CL patients may present hypertrophic ulcers rather than typical oval, ulcerated lesions. A direct correlation between BMI and healing time was noted. After one course of Antimony, cure was achieved in 73% of patients with normal BMI, 37% of overweight subjects, yet just 18% of obese CL patients (p<0.01). Obese CL cases additionally presented higher leptin levels than overweight patients or those with normal BMI (p<0.05). Conclusions Obesity modifies the clinical presentation of CL and host immune response, and is associated with greater failure to therapy.

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Impaired Th1 Response Is Associated With Therapeutic Failure in Patients With Cutaneous Leishmaniasis Caused by Leishmania braziliensis

The Journal of Infectious Diseases ◽

10.1093/infdis/jiaa374 ◽

2020 ◽

Author(s):

Augusto M Carvalho ◽

Luiz H Guimarães ◽

Rúbia Costa ◽

Maíra G Saldanha ◽

Iana Prates ◽

...

Keyword(s):

T Cells ◽

Cutaneous Leishmaniasis ◽

Cd8 T Cells ◽

Clinical Presentation ◽

Granzyme B ◽

Therapeutic Failure ◽

Response To Therapy ◽

Delayed Type Hypersensitivity ◽

Leishmania Braziliensis ◽

Th1 Response

Abstract Background Leishmania skin test (LST) evaluates the delayed type hypersensitivity to Leishmania antigens (LA) and has been used for diagnosis of cutaneous leishmaniasis (CL). In CL patients LST is usually positive but a small percentage have negative LST. The aim of this study was to determine the clinical and immunologic features and response to antimony therapy in LST-negative CL patients. Methods We compare the clinical presentation, response to therapy, and immune response of CL patients with negative vs positive LST. Results The clinical presentation was similar in both groups but LST-negative patients had a lower cure rate. In the lesions, LST-negative patients displayed less inflammation and necrosis, and higher frequency of CD8+ T cells. Mononuclear cells from LST-negative patients had a poor T helper 1 cell (Th1) response but levels of interleukin-1β (IL-1β), IL-6, IL-17, granzyme B, and metalloproteinase-9 (MMP-9) were similar to the LST-positive group upon stimulation with LA. Leishmania internalization and killing by macrophages were similar in both groups. Cure of disease was associated with restoration of Th1 response. Conclusions In LST-negative patients, impaired Th1 response is associated with therapeutic failure. Increased frequency of CD8+ T cells and high production of inflammatory cytokines, granzyme B, and MMP-9 contributes to immunopathology.

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T-cell lymphomas: immunologic, histologic, clinical, and therapeutic analysis of 63 cases.

Journal of Clinical Oncology ◽

10.1200/jco.1988.6.10.1584 ◽

1988 ◽

Vol 6 (10) ◽

pp. 1584-1589 ◽

Cited By ~ 49

Author(s):

B Coiffier ◽

F Berger ◽

P A Bryon ◽

J P Magaud

Keyword(s):

T Cell ◽

Clinical Presentation ◽

Performance Status ◽

Stage Iv ◽

Poor Performance ◽

Large Cell ◽

Response To Therapy ◽

Poor Performance Status ◽

T Cell Lymphomas ◽

Stage Iv Disease

Sixty-three patients with T-cell lymphoma (TCL) were analyzed to correlate morphological and immunological features with clinical presentation, response to therapy, and survival. Clinical presentation was severe, with 59% of patients having stage IV disease, 60% B symptoms, 35% poor performance status, 44% large tumoral mass, and 40% a high number of extranodal localizations. Morphological subtypes were small-cell in four cases, diffuse-mixed in 29 cases, monomorphic medium-sized in two cases, immunoblastic in 21 cases, anaplastic large-cell in four cases, and unclassified in three cases. Immunological phenotypes were immature T in 11 cases, CD4 in 26 cases, CD8 in 13 cases, and undefined (CD4 + CD8) in ten cases. Response to therapy was poor except for the 39 patients treated by an intensive and sequential regimen (non-Hodgkin's lymphoma [LNH]-80 or LNH-84) that gave a 77% complete remission (CR) rate with a 23% relapse rate. Median survival was 35 months. No correlation was found between morphological subtypes and other variables. Helper (CD4) phenotype seemed to have a better prognosis than other phenotypes. Variables associated with long survival for all the patients were localized disease and absence of large tumoral mass and for the subgroup of patients treated by the LNH regimens CD4 phenotype, absence of B symptoms, absence of a large tumoral mass, and less than two extranodal sites of disease.

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Anaplastic Wilms' tumor: clinical and pathologic studies.

Journal of Clinical Oncology ◽

10.1200/jco.1985.3.4.513 ◽

1985 ◽

Vol 3 (4) ◽

pp. 513-520 ◽

Cited By ~ 91

Author(s):

J F Bonadio ◽

B Storer ◽

P Norkool ◽

V T Farewell ◽

J B Beckwith ◽

...

Keyword(s):

Lymph Node ◽

Lymph Node Metastases ◽

Clinical Presentation ◽

Wilms Tumor ◽

Response To Therapy ◽

Tumor Study ◽

Localized Disease ◽

Node Metastases

A review of almost 1,200 children participating in the first and second National Wilms' Tumor Study (NWTS-1 and -2) has demonstrated a number of significant differences in the clinical presentation and response to therapy of anaplastic and nonanaplastic Wilms' tumor. Compared to their counterparts, children with anaplastic Wilms' tumor were generally one to two years older at diagnosis, more were non-white, and more had lymph node metastases at diagnosis. Consistent with previous studies, children with anaplastic Wilms' tumor survived for a significantly shorter time than those with non-anaplastic Wilms' tumor. A hopeful outlook, however, was suggested by the NWTS-2 experience since the more aggressive chemotherapies used in this study appear to have substantially improved the survival of patients with diffusely anaplastic tumors. Also, the survival of NWTS-2 patients with anaplastic Wilms' tumor was determined in part by clinicopathologic stage. It may be possible therefore to refine therapy according to stage so as to provide children with localized disease a chance for cure with fewer untoward treatment-related sequelae.

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Non-MALT marginal zone B-cell lymphomas: a description of clinical presentation and outcome in 124 patients

Blood ◽

10.1182/blood.v95.6.1950 ◽

2000 ◽

Vol 95 (6) ◽

pp. 1950-1956 ◽

Cited By ~ 211

Author(s):

Françoise Berger ◽

Pascale Felman ◽

Catherine Thieblemont ◽

Thierry Pradier ◽

Lucille Baseggio ◽

...

Keyword(s):

B Cell ◽

Malt Lymphoma ◽

Marginal Zone ◽

Clinical Presentation ◽

B Cell Lymphoma ◽

Complete Response ◽

Response To Therapy ◽

Time To Progression ◽

Retrospective Nature ◽

Clinical Description

Abstract Marginal zone B-cell lymphoma (MZL) is a recently individualized lymphoma that encompasses mucosa-associated lymphoid tissue (MALT) lymphoma, splenic lymphoma with or without villous lymphocytes, and nodal lymphoma with or without monocytoid B-cells. If the clinical description and outcome of MALT lymphoma is well known, this is not the case for the other subtypes. We reviewed 124 patients presenting non-MALT MZL treated in our department to describe the morphologic and clinical presentation and the outcome of these lymphomas. Four clinical subtypes were observed: splenic, 59 patients; nodal, 37 patients; disseminated (splenic and nodal), 20 patients; and leukemic (not splenic nor nodal), 8 patients. These lymphomas were usually CD5-, CD10-, CD23-, and CD43-, but the detection of one or, rarely, two of these antigens may be observed. Bone marrow and blood infiltrations were frequent, except in the nodal subtype, but these locations were not associated with a poorer outcome. Splenic and leukemic subtypes were associated with a median time to progression (TTP) longer than 5 years, even in the absence of treatment or of complete response to therapy. Nodal and disseminated subtypes were associated with a median TTP of 1 year. However, in all these subtypes, survival was good with a median survival of 9 years, allowing these lymphomas to be classified as indolent. Because of the retrospective nature of this analysis, no conclusion may be drawn on the therapeutic aspects, but conservative treatments seem recommended for leukemic and splenic subtypes.

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Amiodarone-Induced Thyrotoxicosis in Adults with Congenital Heart Disease - Clinical Presentation and Response to Therapy

Endocrine Practice ◽

10.4158/ep13059.or ◽

2014 ◽

Vol 20 (1) ◽

pp. 33-40 ◽

Cited By ~ 12

Author(s):

Marius Stan ◽

Matheni Sathananthan ◽

Carole Warnes ◽

Michael Brennan ◽

Prabin Thapa ◽

...

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Congenital Heart ◽

Clinical Presentation ◽

Response To Therapy

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Histopathology of Cutaneous Leishmaniasis Caused by Leishmania donovani in Sri Lanka

BioMed Research International ◽

10.1155/2020/4926819 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Harshima Wijesinghe ◽

Nayana Gunathilaka ◽

Saveen Semege ◽

Nishantha Pathirana ◽

Nuwani Manamperi ◽

...

Keyword(s):

Sri Lanka ◽

Cutaneous Leishmaniasis ◽

Leishmania Donovani ◽

Clinical Presentation ◽

Cross Sectional Study ◽

Causative Organism ◽

Variable Intensity ◽

Cross Sectional ◽

The North ◽

Parasitic Load

Cutaneous leishmaniasis (CL) is a neglected tropical disease that is gaining importance in Sri Lanka and internationally. The clinical presentation, pathology, and method of parasite elimination in CL vary according to the species. Leishmania donovani is the causative organism for leishmaniasis in Sri Lanka. This collaborative cross-sectional study describes the clinicopathological features of cutaneous leishmaniasis among personnel of the tri-forces serving in the North and East of the country. The histology of fifty cases of CL confirmed by at least two methods (slit skin smear, lesion aspirate, tissue impression, and histology) was reviewed. The parasitic load was assessed semiquantitatively. The histological features were correlated with the clinical presentation and organism load. The majority (89.8%; n=44) presented with a single lesion mostly located in the upper limb (69.4%). The lesion types included papule (34.7%), nodule (32.7%), and an ulcer (30.6%). The evolution time of lesions averaged 31.55 weeks. Epidermal changes were observed in 49 of the biopsies and included hyperkeratosis (90.0%; n=45), acanthosis (44.0%; n=22), atrophy (34.0%; n=17), and interface change (66%; n=33). Dermal changes were seen in all cases and were characterized by a lymphohistioplasmacytic inflammatory infiltrate of variable intensity with ill-formed granuloma in 19 cases (38%) and well-formed epithelioid granulomas in 22 cases (44%). Focal necrosis was present in 20% (n=10). Leishmania amastigote forms were observed in 88% (n=44). Transepidermal elimination (P=0.025), granuloma (P=0.027) formation, and type of lesion (P=0.034) were significantly associated with the organism load. Granuloma formation was associated with a reduction in organism load, indicating that the macrophage activation played an important role in the control of the organism.

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A Retrospective Study of Feline Gastric Lymphoma in 16 Chemotherapy-Treated Cats

Journal of the American Animal Hospital Association ◽

10.5326/jaaha-ms-5989 ◽

2014 ◽

Vol 50 (1) ◽

pp. 46-52 ◽

Cited By ~ 15

Author(s):

Tanya L. Gustafson ◽

Armando Villamil ◽

Bonnie E. Taylor ◽

Andrea Flory

Keyword(s):

Retrospective Study ◽

Clinical Presentation ◽

Gastric Lymphoma ◽

Response To Therapy ◽

Response To Treatment ◽

Survival Times ◽

Comparative Efficacy ◽

Prognostic Variables ◽

Ancillary Study ◽

First Remission

The purposes of this study were to describe cases of feline gastric lymphoma with regards to signalment, clinical presentation, laboratory and ancillary study findings, response to therapy, and outcomes and to identify prognostic variables. Sixteen cats with stage I and II gastric lymphoma treated with chemotherapy were included in this study. Seventy-five percent of cats experienced remission. Overall, first remission duration was 108 days. Response to treatment was prognostic as in other types of feline lymphoma. Cats with a complete remission (CR) had longer survival times compared with cats with a partial remission (PR). Sex and treatment with a rescue protocol were found to be prognostic with castrated males having longer survivals than spayed females. Cats that received rescue chemotherapy had shorter first remission durations than those that did not. Prior treatment with steroids and stage were not found to be significant prognostic variables. This study characterizes gastric lymphoma treated with chemotherapy in cats. Further studies are needed to determine the comparative efficacy of surgical and chemotherapeutic treatments for feline gastric lymphoma.

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