The Treatment of Cutaneous Blastomycosis with Propamidine : A Preliminary Report

Abstract

The synthesis of propamidinef (4-4' diamidino-diphenoxypropane) was reported in 1942 by Ewins and his co-workers in the investigation of trypanocidal drugs (1). In 1943, the therapeutic activity of propamidine as a topical antiseptic against Cram positive cocci in chronic wound sepsis was demonstrated by Thrower and Valentine (2) and by other clinical investigators (3, 4, 5). In 1945, Elson reported the in vitro sensitivity of Btastomyces dermetitidis to propamidine (6). B. dermafitidis was completely inhibited by 3.75 micrograms of propamidine per cc. of yeast extract agar. Because of the marked in vitro sensitivity of B. dermatitidis and the absence of toxic symptoms in cases of wound sepsis treated with topical application of propamidine, therapeutic trial in eases of cutaneous blastomycosis seemed warranted. It should be emphasized that, in spite of the lack of toxic symptoms reported, when propamidine is used in concentration of 0.1% as a local antiseptic, this drug and related aromatic diamidines produce general toxic effects when given systemically. After the intravenous injection of 2 mgm. of propamidine per kg. of body weight in the treatment of African sleeping sickness, Lourie (7) noted the production of immediate and severe collapse which was alarming but transitory. Late toxic effects have also have been reported with the use of the aromatic diamidines. Delayed kidney and liver damage and dissociated anesthesia of the trigeminal nerve have been particularly serious. An excellent review of these compounds has been published recently by Sehoenbaeh and Greenspaa (5).