Background: In Israel, most cutaneous leishmaniasis (CL) is caused by Leishmania major. Recently a new focus of CL caused by Leishmania tropica has been described in Tiberias and the surrounding area of northern Israe...Background: In Israel, most cutaneous leishmaniasis (CL) is caused by Leishmania major. Recently a new focus of CL caused by Leishmania tropica has been described in Tiberias and the surrounding area of northern Israel. Objective: The aim of this study was to evaluate clinical (size, number, location, and type of lesion) and laboratory (culture and polymerase chain reaction [PCR] analysis) parameters at diagnosis, response to treatment, and outcome of patients with CL due to L tropica. Methods: Between September 2002 and March 2004, patients with direct smear- confirmed CL were evaluated; clinical records were reviewed and a telephone survey was performed. Results: Forty nine patients, 34 (69% ) male and 15 (31% ) female, were studied. Mean age was 31.1 years (median 26 years, range 1- 70); 76% of patients live in Tiberias and the surrounding area. The mean number of lesions was 2.6 (median 2, range 1- 10). Lesions were commonly located on the face (61% ) and upper limbs (57% ). PCR analysis was performed in 27 patients and was positive for L tropica in 26. Fifty percent of patients studied received multiple therapeutic regimens because of incomplete response or treatment failure. Topical paromomycin was used in 44 patients (90% ), with a complete response reported in only 17 (39% ); of the 9 patients treated with intralesional sodium stibogluconate, a complete response was reported in 6 (67% ); of the 5 patients treated with intravenous sodium stibogluconate, 4 (80% ) were cured. Limitations: The relatively small number of patients studied combined with the fact that some were assessed retrospectively limit our conclusions. In addition, 50% of the patients studied received multiple therapeutic regimens because of failure of, or incomplete responses to, their initial therapy, thereby making comparisons difficult. Conclusions: The cure rate in those completing a course of antimony therapy, either 10 or more days of intravenous therapy or therapy administered intralesionally,was 75% (95% confidence interval [CI], 50.5- 99.5% ) as compared with 45% (95% CI, 28.9- 60.5% ) among those completing at least 10 days of topical paromomycin. To date, no standardized, simple, safe, and highly effective regimen for treating L tropica exists. Large, controlled clinical trials to evaluate current treatment regimens as well as new medications for CL, and especially CL attributed to L tropica, are urgently needed.展开更多
Objective. The purpose of this study was to characterizethe number and distribution of epidermal Langerhans cells in different clinical forms of dry-type cutaneous leishmaniasis (CL). Methods. Sixteen cases of dry-typ...Objective. The purpose of this study was to characterizethe number and distribution of epidermal Langerhans cells in different clinical forms of dry-type cutaneous leishmaniasis (CL). Methods. Sixteen cases of dry-type cutaneous leishmaniasis caused by Leishmania tropica were studied. These cases were classified clinically as five cases of acute leishmaniasis with indurated papules, nodules and plaques with central crust formation and duration < 2years,sixcasesoflupoidleishmaniasis with characteristic papules around previous scars of cutaneous leishmaniasis with duration >2 years, and five cases of chronic nonlupoid type with nonhealing lesions of duration >2 years. Paraffin-embedded blocks were stained with hematoxylin and eosin (H&E) and stained immunohistochemically for CD1a. Results. The number of Langerhans cells per millimeter length of epidermis was increased in acute cases compared to chronic and lupoid cases. Conclusions. Lesions of acute leishmaniasis contain the greatest amounts of antigen for presentation, so Langerhans cells increase innumber and intrafficking to present antigens derived from Leishman bodies to the cellular immune system. In chronic leishmaniasis, the Langerhans cell population is reduced, perhaps because of exhaustion of the source of Langerhans cells, or because of reduced response to modified antigen.展开更多
文摘Background: In Israel, most cutaneous leishmaniasis (CL) is caused by Leishmania major. Recently a new focus of CL caused by Leishmania tropica has been described in Tiberias and the surrounding area of northern Israel. Objective: The aim of this study was to evaluate clinical (size, number, location, and type of lesion) and laboratory (culture and polymerase chain reaction [PCR] analysis) parameters at diagnosis, response to treatment, and outcome of patients with CL due to L tropica. Methods: Between September 2002 and March 2004, patients with direct smear- confirmed CL were evaluated; clinical records were reviewed and a telephone survey was performed. Results: Forty nine patients, 34 (69% ) male and 15 (31% ) female, were studied. Mean age was 31.1 years (median 26 years, range 1- 70); 76% of patients live in Tiberias and the surrounding area. The mean number of lesions was 2.6 (median 2, range 1- 10). Lesions were commonly located on the face (61% ) and upper limbs (57% ). PCR analysis was performed in 27 patients and was positive for L tropica in 26. Fifty percent of patients studied received multiple therapeutic regimens because of incomplete response or treatment failure. Topical paromomycin was used in 44 patients (90% ), with a complete response reported in only 17 (39% ); of the 9 patients treated with intralesional sodium stibogluconate, a complete response was reported in 6 (67% ); of the 5 patients treated with intravenous sodium stibogluconate, 4 (80% ) were cured. Limitations: The relatively small number of patients studied combined with the fact that some were assessed retrospectively limit our conclusions. In addition, 50% of the patients studied received multiple therapeutic regimens because of failure of, or incomplete responses to, their initial therapy, thereby making comparisons difficult. Conclusions: The cure rate in those completing a course of antimony therapy, either 10 or more days of intravenous therapy or therapy administered intralesionally,was 75% (95% confidence interval [CI], 50.5- 99.5% ) as compared with 45% (95% CI, 28.9- 60.5% ) among those completing at least 10 days of topical paromomycin. To date, no standardized, simple, safe, and highly effective regimen for treating L tropica exists. Large, controlled clinical trials to evaluate current treatment regimens as well as new medications for CL, and especially CL attributed to L tropica, are urgently needed.
文摘Objective. The purpose of this study was to characterizethe number and distribution of epidermal Langerhans cells in different clinical forms of dry-type cutaneous leishmaniasis (CL). Methods. Sixteen cases of dry-type cutaneous leishmaniasis caused by Leishmania tropica were studied. These cases were classified clinically as five cases of acute leishmaniasis with indurated papules, nodules and plaques with central crust formation and duration < 2years,sixcasesoflupoidleishmaniasis with characteristic papules around previous scars of cutaneous leishmaniasis with duration >2 years, and five cases of chronic nonlupoid type with nonhealing lesions of duration >2 years. Paraffin-embedded blocks were stained with hematoxylin and eosin (H&E) and stained immunohistochemically for CD1a. Results. The number of Langerhans cells per millimeter length of epidermis was increased in acute cases compared to chronic and lupoid cases. Conclusions. Lesions of acute leishmaniasis contain the greatest amounts of antigen for presentation, so Langerhans cells increase innumber and intrafficking to present antigens derived from Leishman bodies to the cellular immune system. In chronic leishmaniasis, the Langerhans cell population is reduced, perhaps because of exhaustion of the source of Langerhans cells, or because of reduced response to modified antigen.
