Types Of Leishmaniasis Research Articles

Antiparasitic Agents

In recent years, introduction of new and more effective agents has improved the overall therapy for parasitic infections. This field, however, is still plagued by numerous problems, including the development of resistance to antimicrobial agents (especially with malaria), unavailability of agents in the United States or lack of approval by the Food and Drug Administration, and major toxicities or lack of experience in pregnant women and children, which limits use in these groups of patients. Widespread resistance of Plasmodium falciparum to chloroquine and other agents has complicated the treatment and prophylaxis of this type of malaria. A combination of quinine and Fansidar is usually effective oral therapy for falciparum malaria; quinidine may be administered if intravenous therapy is needed. Mefloquine, which is currently recommended for prophylaxis against chloroquine-resistant P. falciparum, is also effective for single-dose oral treatment, although this regimen has not yet been approved by the Food and Drug Administration. Metronidazole has been widely used for treatment of gastroenteritis due to Entamoeba histolytica and Giardia lamblia (not approved by the Food and Drug Administration for the latter) and is considered safe and effective. A new macrolide, azithromycin, has been reported to be effective for cryptosporidiosis in experimental animals; currently, no effective therapy is available for human infections. Combinations of sulfonamides with other antifolates, trimethoprim or pyrimethamine, are recommended therapy for Pneumocystis carinii pneumonia or toxoplasmosis, respectively. Therapies for the various types of leishmaniasis and trypanosomiasis are complex, often toxic, and often of limited efficacy. The benzimidazoles are effective for roundworm infections, although thiabendazole has severe toxic effects. The recent introduction of ivermectin has revolutionized the treatment and control of onchocerciasis. Another relatively new agent, praziquantel, is a true broad-spectrum anthelmintic agent that is effective against most trematodes, many adult cestodes, and larval cestodes as well (especially cysticerci of Taenia solium).

Adenopatía leishmaniásica

We report a 12 year old patient from the rural area of San Nicolás in Quipile (Cundinamarca) who presented a 8 x 5 cm left inguinal mass. A leishmania looking ulcer was found during the physical examination on the inferior part of the same leg. The skin biopsy got lost in the mail and the surgical resection of the inguinal mass showed lymph nodes with granulomas suggestive of sarcoidosis. The clinico-pathological and epidemiological correlation allowed us to diagnose and to treat this patient as cutaneous leishmaniasis; there was a prompt cure of his leg ulcer and the remaining inguinal mass. It was possible to demostrate, retrospectively, amastigotes when reviewing lymph node section and tissue embedded for electron microscopy . Using monoclonal antibodies anti-amastigotes of leishmania, it was possible to show a few phagocitosed parasites in macrophages of the lymph node granulomas. Leishmania adenopathy may be the initial reason to visit a phisician and it should be taken into account in the diagnosis of granulomatous inflamrnation of lymph nodes. By means of clinical, epidemiological, parasitological, histopathological and imrnunological criteria, it should be stablished if a given adenopathy is visceral or some other type of leishmaniasis.

AMERICAN LEISHMANIASIS

On a recent trip to Peru to study verruga peruana, I saw some cases of cutaneous leishmaniasis and discussed this subject with numerous Peruvian colleagues. Following my visit to Sao Paulo, Brazil, in 1929, I realized that there was a form of cutaneous leishmaniasis which occurs mainly in the forest regions of the Americas, extending from Mexico to the northern part of Argentina. 1 This disease has been observed in every country of South America except Chile, though by far the greatest number of cases are found in the tropical forests of Brazil, Peru and Bolivia. The type of leishmaniasis in question differs clinically from oriental sore in that it affects the mucous membranes of the nose and throat in perhaps 20 per cent of the cases and as a result may cause permanent and often severe deformity. The investigations of Noguchi, in 1925, by agglutination tests apparently showed that

AMERICAN LEISHMANIASIS

Since the publication in 1914 of McEwen's¹paper entitled "Oriental Sore in the Americas," there has been a good deal of discussion regarding the type of leishmaniasis in the New World. Many investigators are now convinced that it differs sufficiently from the oriental sore of the Old World to warrant its being classed as a separate though closely allied disease. In recent years an extensive literature on American leishmaniasis has appeared, including more or less exhaustive monographs by Laveran,²Escomel³and Inchaustegui.⁴My object in this report is to point out differences between the forms of leishmaniasis mentioned and to cite some personal observations made during a recent trip to Brazil. I am not concerned here with the visceral type of leishmaniasis known as kala-azar and caused by<i>Leishmania donovani</i>. I am interested at present only in the types of leishmaniasis that affect the skin. The