Case Report: Miltefosine Failure and Spontaneous Resolution of Cutaneous Leishmaniasis braziliensis

2021 ◽  
Author(s):  
Sheridan Joseph ◽  
Timothy J. Whitman ◽  
Frederick S. Buckner ◽  
Anna L. Cogen
Keyword(s):  
Case Report ◽  
South America ◽  
Treatment Failure ◽  
Cutaneous Leishmaniasis ◽  
Young Woman ◽  
Spontaneous Resolution ◽  
Clinical Monitoring ◽  
Leishmania Braziliensis ◽  
Oral Medications ◽  
Mucocutaneous Leishmaniasis

Cutaneous leishmaniasis (CL) is often caused by Leishmania braziliensis (L. braziliensis) in South America. Because of the risk for mucocutaneous leishmaniasis, L. braziliensis is frequently treated with parenteral or oral medications. Here, we present a case of a young woman with L. braziliensis (CL) that did not respond to miltefosine but eventually experienced spontaneous resolution. This case highlights the potential for treatment failure and the importance of clinical monitoring in the setting of cutaneous leishmaniasis caused by L. braziliensis.

scholarly journals Variable gene expression and parasite load predict treatment outcome in cutaneous leishmaniasis

2019 ◽  
Vol 11 (519) ◽  
pp. eaax4204 ◽  
Author(s):  
Camila Farias Amorim ◽  
Fernanda O. Novais ◽  
Ba T. Nguyen ◽  
Ana M. Misic ◽  
Lucas P. Carvalho ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Treatment Failure ◽  
Cutaneous Leishmaniasis ◽  
Point Of Care ◽  
Parasite Load ◽  
Clinical Samples ◽  
Leishmania Braziliensis ◽  
Variable Expression ◽  
Pentavalent Antimony ◽  
Marker Profile

Patients infected with Leishmania braziliensis develop chronic lesions that often fail to respond to treatment with antiparasite drugs. To determine whether genes whose expression is highly variable in lesions between patients might influence disease outcome, we obtained biopsies of lesions from patients before treatment with pentavalent antimony and performed transcriptomic profiling on these clinical samples. We identified genes that were highly variably expressed between patients, and the variable expression of these genes correlated with treatment outcome. Among the most variable genes in all the patients were components of the cytolytic pathway, and the expression of these genes correlated with parasite load in the skin. We demonstrated that treatment failure was linked to the cytolytic pathway activated during infection. Using a host-pathogen marker profile of as few as three genes, we showed that eventual treatment outcome could be predicted before the start of treatment in two separate cohorts of patients with cutaneous leishmaniasis (n = 21 and n = 25). These findings raise the possibility of point-of-care diagnostic screening to identify patients at high risk of treatment failure and provide a rationale for a precision medicine approach to drug selection in cutaneous leishmaniasis. This work more broadly demonstrates the value of identifying genes of high variability in other diseases to better understand and predict diverse clinical outcomes.

scholarly journals Toward a Novel Experimental Model of Infection To Study American Cutaneous Leishmaniasis Caused by Leishmania braziliensis

2005 ◽  
Vol 73 (9) ◽  
pp. 5827-5834 ◽  
Author(s):  
Tatiana R. de Moura ◽  
Fernanda O. Novais ◽  
Fabiano Oliveira ◽  
Jorge Clarêncio ◽  
Almério Noronha ◽  
...  
Keyword(s):  
Lymph Node ◽  
Cutaneous Leishmaniasis ◽  
Experimental Model ◽  
Leishmania Braziliensis ◽  
Polymorphonuclear Cells ◽  
Mucocutaneous Leishmaniasis ◽  
American Cutaneous Leishmaniasis ◽  
Lymph Node Cells ◽  
Draining Lymph Node ◽  
Ifn Γ

ABSTRACT Leishmania spp. cause a broad spectrum of diseases collectively known as leishmaniasis. Leishmania braziliensis is the main etiological agent of American cutaneous leishmaniasis (ACL) and mucocutaneous leishmaniasis. In the present study, we have developed an experimental model of infection that closely resembles ACL caused by L. braziliensis. In order to do so, BALB/c mice were infected in the ear dermis with 105 parasites and distinct aspects of the infection were evaluated. Following inoculation, parasite expansion in the ear dermis was accompanied by the development of an ulcerated dermal lesion which healed spontaneously, as seen by the presence of a scar. Histological analysis of infected ears showed the presence of a mixed inflammatory infiltrate consisting of both mononuclear and polymorphonuclear cells. In draining lymph nodes, parasite replication was detected throughout the infection. In vitro restimulation of draining lymph node cells followed by intracellular staining showed an up-regulation in the production of gamma interferon (IFN-γ) and in the frequency of IFN-γ-secreting CD4+ and CD8+ T cells. Reverse transcription-PCR of ears and draining lymph node cells showed the expression of CC chemokines. The dermal model of infection with L. braziliensis herein is able to reproduce aspects of the natural infection, such as the presence of an ulcerated lesion, parasite dissemination to lymphoid areas, and the development of a Th1-type immune response. These results indicate that this model shall be useful to address questions related to the concomitant immunity to reinfection and parasite persistence leading to mucocutaneous leishmaniasis.

scholarly journals In VitroSensitivity of PairedLeishmania(Viannia)braziliensisSamples Isolated before Meglumine Antimoniate Treatment and after Treatment Failure or Reactivation of Cutaneous Leishmaniasis

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Cibele Baptista ◽  
Luciana de Freitas Campos Miranda ◽  
Maria de Fátima Madeira ◽  
Leonor Laura Pinto Leon ◽  
Fátima Conceição-Silva ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Cutaneous Leishmaniasis ◽  
Drug Exposure ◽  
Lethal Dose ◽  
Poor Response ◽  
Leishmania Braziliensis ◽  
Meglumine Antimoniate ◽  
Intralesional Administration ◽  
The Difference

This study evaluated thein vitrosensitivity of pairedLeishmania braziliensissamples isolated from the same patient before pentavalent antimonial treatment (Sample A) and after treatment failure or cutaneous leishmaniasis reactivation (Sample B) in patients undergoing intralesional administration or injections (5 mgSbV/kg/d) of meglumine antimoniate. Fourteen samples from 7 patients were studied. After 24 h of drug exposure, 50% lethal dose (LD50) values for promastigotes ranged from 0.37 mg/mL to 5.86 mg/mL for samples obtained before treatment (A) and 0.89 mg/mL to 7.80 mg/mL for samples obtained after treatment (B). After 48 h, LD50values ranged from 0.37 mg/mL to 5.75 mg/mL and 0.70 mg/mL to 7.68 mg/mL for A and B samples, respectively. After 48 h, LD50values for amastigotes ranged from 11.7 to 44.3 μg/mL for A samples and 13.7 to 52.7 μg/mL for B samples. Of 7 patients, 1 discontinued treatment and 6 were cured after retreatment with amphotericin B (4 cases) or meglumine antimoniate (2 cases). Overall the B samples had higher LD50values than A samples; however the difference was not significant. These results do not support the hypothesis that low-dose and intralesional treatments induce selection of resistant parasitesin vitroand suggest that other factors may influence therapeutic outcome in patients with poor response to initial treatment.

A Case Report of the Occurrence of a Rare Middle Mediastinal Thymoma in a Young Woman

2008 ◽  
Vol 58 (6) ◽  
pp. 583
Author(s):  
Jae Myeong Lee ◽  
Ghi Jai Lee ◽  
Jae Chan Shim ◽  
Ho Kyun Kim ◽  
Jung Ho Suh ◽  
...  
Keyword(s):  
Case Report ◽  
Young Woman

ROLE OF RETINOL AND TOCOPHEROL IN COMBATING SMOG CAUSED ILLNESS AMONG YOUNG WOMAN

2019 ◽  
Author(s):  
Bisma Laeeque
Keyword(s):  
Case Report ◽  
Vitamin A ◽  
Young Woman ◽  
Good Health ◽  
Health Condition ◽  
Strong Positive Correlation ◽  
Daily Diet ◽  
Food And Nutrition ◽  
Good Health Condition

Retinol and Tocopherol are commonly known as fat soluble Vitamin A and D. This research was undertaken with the objective to study Vitamin A and D’s effect in combating smog caused illness among females. This case report highlights diseases caused among young woman of Lahore due to smog. Hypothesis formulated for this study was accepted after testing that intake of daily-recommended amount of Vitamin A and D by females helps them in fighting diseases caused by smog. An intervention based on Food and Nutrition Board’s Recommended Dietary Allowances (RDAs) was planned. After the analysis of data by SPSS and excel, it was indicated that women could fight smog caused diseases better by including Vitamin A and D in their daily diet. It was also found that a strong positive correlation existed between good health condition among females and intake of Vitamin A and D.

An Invasive Hemolymphangioma of the Pancreas in a Young Woman

2019 ◽  
Vol 21 (10) ◽  
pp. 798-800 ◽  
Author(s):  
Zhijun Zhang ◽  
Qinghong Ke ◽  
Weiliang Xia ◽  
Xiuming Zhang ◽  
Yan Shen ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Young Woman ◽  
Benign Tumor ◽  
Abdominal Distension ◽  
Accurate Diagnosis ◽  
Cystic Tumor ◽  
Rare Benign Tumor ◽  
Radical Surgical Resection

Background: Hemolymphangioma is a rare benign tumor. To the best of our knowledge, there were only 10 reports of this tumor of the pancreas until March 2018. Case Report: Here, we reported a large invasive hemolymphangioma of the pancreas in a young woman with a complaint of abdominal distension and an epigastric mass about 3 weeks. She was found to have a huge multilocular cystic tumor at the neck and body of pancreas on computed tomography. She was eventually diagnosed with hemolymphangioma of the pancreas after operation. After 2 years of follow-up, there was no signs of recurrence. Conclusion: From our case and literature, we can conclude that hemolymphangioma of the pancreas is uncommon benign tumor, and it is hard to make an accurate diagnosis preoperatively. Radical surgical resection should be performed whenever possible. The prognosis of this disease seems good.

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