Maryam Khalili; Saman Mohammadi; Mohamadhosein Saeidi; Rezvan Amiri; Amireh Heshmatkhah; Simin Shamsi Meymandi; Mahin Aflatoonian
Abstract
Background: Treatment failure of antimony drugs for anthroponoticcutaneous leishmaniasis (ACL) is rising. Recognizing predictivefactors of unresponsiveness to treatment can substantiallyinfluence better ACL management. The goal of this study wasto investigate predictive factors associated with treatment ...
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Background: Treatment failure of antimony drugs for anthroponoticcutaneous leishmaniasis (ACL) is rising. Recognizing predictivefactors of unresponsiveness to treatment can substantiallyinfluence better ACL management. The goal of this study wasto investigate predictive factors associated with treatment failurein ACL in Kerman, southeast Iran.Methods: This case-control study was conducted retrospectivelyon 2,128 ACL cases in Kerman over ten years from 2011 to 2020.The case group included patients whose lesions failed to resolveafter one treatment course. The control group included thosewhose lesions were cured after one treatment course.Results: Treatment failure was observed in 13.5% of cases (10.7%of systemic therapy and 16.7% of local therapy). No significantdifference was reported between the type of treatment andtreatment failure. The association of treatment failure withwinter-onset (P = 0.001, OR = 1.39, CI = 1.23–1.56), face (P = 0.001,OR = 1.86, CI = 1.38–2.49), ulceration (P = 0.01, OR = 0.51, CI = 0.30–0.85), small diameter (P = 0.005, OR = 0.57, CI = 0.38-0.84) andlong duration of lesions (P = 0.01, OR = 1.57, CI = 1.11–2.21) wasvalidated by multivariate logistic regression analysis.Conclusion: Efficient detection and timely management of ACLcases are essential to reduce resistant cases, as lesions lastinglonger than four months show poor response to treatment.Furthermore, early treatment of facial lesions with systemictherapy is suggested to optimize results and reduce the risk ofdisfiguring scars. Further surveys are required to determine thereason behind more treatment failure in winter-onset lesions.
Rahmat-allah Salmanpour; Mohammad Bahmani
Volume 10, Issue 4 , 2007, , Pages 278-282
Abstract
Background and aim: Cutaneous leishmaniasis is a common disease in the world and is an endemic disease in Iran. Highly variable results of systemic treatment of cutaneous leishmaniasis with levamisole have been reported in literature so far. The purpose of this study was to evaluate the efficacy and ...
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Background and aim: Cutaneous leishmaniasis is a common disease in the world and is an endemic disease in Iran. Highly variable results of systemic treatment of cutaneous leishmaniasis with levamisole have been reported in literature so far. The purpose of this study was to evaluate the efficacy and tolerability of levamisole as an adjuvant therapy with intralesional Glucantime.Materials and methods: Sixty patients with cutaneous leishmaniasis were included in this clinical trial. The patients were divided randomly in two groups. Thirty patients in group 1 received intralesional Glucantime along with placebo (vitamin B complex tablets, 1 tablet every 8 hours for 2 successive days per week) and 30 patients in group 2 received intralesional Glucantime plus levamisole 150 mg tablet every 8 hours in two successive days per week in adults and 3-5 mg/kg for children under 30 kg for 6 weeks.Results: The clinical response of combination therapy (78%) was significantly better then group 1 (64%), the difference was statistically significant (p<0.001). The difference in rate of re-epithelization between the two groups was also statistically significant (p<0.01).Conclusion: This study demonstrated that levamisole can he used as an adjuvant therapy in combination with intralesional Glucantime for the treatment of cutaneous leishmaniasis.
Nilforoushzadeh Mohammad Ali; Haftbaradaran Elaheh; Siadat Amir Hossein
Volume 10, Issue 3 , 2007, , Pages 240-244
Abstract
Cutaneous leishmaniasis is an endemic disease in Iran and there is no curative treatment. The disfiguring scar that remains after it subsides is a major psychologic and emotional problem in these patients. Chronic leishmaniasis is a rare form of this malady which is seen in 5-7 percent of cases. In this ...
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Cutaneous leishmaniasis is an endemic disease in Iran and there is no curative treatment. The disfiguring scar that remains after it subsides is a major psychologic and emotional problem in these patients. Chronic leishmaniasis is a rare form of this malady which is seen in 5-7 percent of cases. In this article we report a 46-year-old man who was refered to us for a large leishmaniasis lesion consisting of a scaling erythematous plaque with several papules on the right side of face and nose. This patient was treated by a combination of systemic Glucantime, 50% trichlroacetic acid and oral fluconazole. Complete resolution was achieved after 4 months.
Giti Sadeghian; Masoomeh Sadeghi
Volume 10, Issue 1 , 2007, , Pages 9-12
Abstract
Background and aim: Antimonial compounds are regarded as the treatment of choice for cutaneous leishmaniasis (CL). Systemic administration of these drugs have some side effects such as cardiotoxicity. The objective of this study was to evaluate the electrocardiographic (ECG) changes in patients with ...
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Background and aim: Antimonial compounds are regarded as the treatment of choice for cutaneous leishmaniasis (CL). Systemic administration of these drugs have some side effects such as cardiotoxicity. The objective of this study was to evaluate the electrocardiographic (ECG) changes in patients with CL treated with systemic Glucantime.Materials and methods: This study with simple sampling method was done on patients with CL who had indication for treatment with systemic Glucantime. Before and during the treatment (weekly) and 1 month after stopping the treatment ECGs were taken from patients. The patients with baseline abnormal ECG were not included in the study.Results: 131 patients were enrolled in this study. The most common change was prolonged QT interval that was seen in 19% of patients. ST depression occurred in 6.1% and minimal ST elevation occurred in 3%, inverted T was observed in 7.4% of patients. Single PAC and single PVC occurred in 0.7% and 2.29%, respectively. Also we observed bradycardia in 10.6% and left bundle branch block in 0.7% of the patients. All of these changes reversed 1 month after treatment except for left bundle branch block.Conclusion: Important ECG changes are minimal in CL patients with normal baseline ECG treated with Glucantime and its administration seems to be safe.
Layegh Pouran; Panah Mohammad Javad Yazdan; Dadkhah Seyed Masoud; Shakeri Mohammad Taqi; Vosough Elham Mohammadi
Volume 9, Issue 4 , 2006, , Pages 303-307
Abstract
Background and aim: Complications and resistance to pentavalent antimonial agents in cutaneous leishmaniasis, exhibit the need for effective alternative drugs. The aim of this study was to compare the efficacy of oral azithromycin with systemic meglumine antimoniate (Glucantime) in the treatment of cutaneous ...
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Background and aim: Complications and resistance to pentavalent antimonial agents in cutaneous leishmaniasis, exhibit the need for effective alternative drugs. The aim of this study was to compare the efficacy of oral azithromycin with systemic meglumine antimoniate (Glucantime) in the treatment of cutaneous leishmaniasis. Materials and Methods: Forty-seven patients with cutaneous leishmaniasis visited at the dermatology department of Qaem hospital were randomly divided to two groups. Twenty patients (with 29 lesions) were treated with oral azithromycin 500 mg/day for 5 successive days each month for 4 months and 27 patients (with 58 lesions) were treated with systemic Glucantime 60 mg/kg/day for 20 days. Azithromycin group patients were visited monthly and control group patients were visited in last day of treatment and 45 days later. Results:At the end of our study 10.3% of lesions in azithromycin group showed complete response, 27.6% lesions partial response and 62.1% no response. In Glucantime group 34.5% of lesions showed complete response, 13.8% partial response and 51.7% no response (P=0.036).Conclusion: In treatment of cutaneous leishmaniasis systemic Glucantime is superior to oral azithromycin. Differences between our result and previous studies may be due to difference between strains of Leishmanias and in vitro studies may be necessary to resolve this paradox. On the other hand, change in dosage and course of treatment with azithromycin may affect the efficacy of this agent.
F Jafari; Sh Moradi; MA Nilforoush Zadeh; R Derakhshan; N Ansari
Volume 9, Issue 3 , 2006, , Pages 211-216
Abstract
Background and aim: Cutaneous leishmaniasis is an endemic disease in Iran. Although there are many different treatments for this disease, there is not any effective treatment yet. Since there has been a number of different reports on the effectiveness of Cassia fistula plant in the treatment of leishmaniasis, ...
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Background and aim: Cutaneous leishmaniasis is an endemic disease in Iran. Although there are many different treatments for this disease, there is not any effective treatment yet. Since there has been a number of different reports on the effectiveness of Cassia fistula plant in the treatment of leishmaniasis, the efficacy of concentrated boiled extract and hydro alcoholic extract of Cassia fistula on the leishmaniasis disease was compared with intralesional injection of Glucantime in this study.Materials and Methods: In this randomized clinical trial a total of 165 patients, 6 to 60 years old, who had a positive leishmania smear refered to the Isfahan Skin and Leishmaniasis Research Center were divided into three groups using list of random numbers and were treated with: concentrated boiled extract of Cassia fistula, hydroalcholic extract of Cassia fistula, or intralesional injection of Glucantime. The patients were treated for 4 weeks and followed for three months after the study started. The efficacy of treatment was reported as complete cure, partial improvement and no improvement on the basis of clinical and parasitological evidence.Results: In the present study 63/6% of patients treated with the concentrated boiled extract, 52/7% of the hydroalcoholic extract and 45/5% of the Glucantime group were men. 22 patients (40%) of the concentrated boiled extract of Cassia fistula, 20 pateints (36/4%) of the hydroalcoholic extract of Cassia fistula group and 36 patients (65/5%) of the Glucantime group showed complete cure. The efficacy in the third group was much more than the first (P<0.02) and second groups (P<0.005), but there was not any difference between concentrated boiled extract and hydroalcoholic extract of Cassia fistula.Conclusion: The results of this study showed that this plant might be used topically along with Glucantime for decreasing the time and dose of treatment with Glucantime.
MA Nilforoush Zadeh; Sh Moradi; R Derakhshan; E Haft Baradaran; F Jafari
Volume 9, Issue 3 , 2006, , Pages 221-226
Abstract
Background and aim: Cutaneous leishmaniasis (CL) is an edemic disease widely spread in Iran. Although several treatments have been tried, none has been found as simple and effective. Honey has been used in the treatment of chronic ulcers and its anti-leishmanial effects have also been reported. So we ...
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Background and aim: Cutaneous leishmaniasis (CL) is an edemic disease widely spread in Iran. Although several treatments have been tried, none has been found as simple and effective. Honey has been used in the treatment of chronic ulcers and its anti-leishmanial effects have also been reported. So we assessed the efficacy of honey in acute CL.Materials and Methods: In a randomized clinical trial, 100 patients with CL referred to Skin and Leishmaniasis Research Center were treated with either weekly intra-lesional injection of Glucantime alone or combined with twice daily topical application of honey. The patients were evaluated clinically 2 ,3 and 4 months after treatment.Results: Ninety patients completed the study, forty-five patients were treated in each group. At the end of trial, 32 patients (71/1%) of these treated with Glucantime alone and 23 patients (51/1%) treated with honey were cured (P=0.04).Conclusion: Drug interference and inhibition of bioavailability of Glucantime by honey may decrease the efficacy of Glucantime in treatment of CL.
G Sadeghian; MA Nilforoush Zadeh
Volume 9, Issue 1 , 2006, , Pages 17-21
SZ Famili; F Pezeshk Poor; V Sepehr; M Vahedian
Volume 8, Issue 2 , 2005, , Pages 97-100
Abstract
Background: Cutaneous leishmaniasis is an important skin parasitic disease. Ideal treatment is not found yet and seeking for proper drugs continues. Objective: Comparison of the efficacy of fluconazole with systemic glucantime in patients with acute cutaneous leishmaniasis in Ghaem hospital in Mashhad ...
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Background: Cutaneous leishmaniasis is an important skin parasitic disease. Ideal treatment is not found yet and seeking for proper drugs continues. Objective: Comparison of the efficacy of fluconazole with systemic glucantime in patients with acute cutaneous leishmaniasis in Ghaem hospital in Mashhad in 2002. Patients and Methods: During one year of study, all patients with cutaneous leishmaniasis were divided to two group. Thirty-one patients were treated with oral fluconazole (100 mg twice a day) for 6 weeks and 29 patients were treated with intra-muscular glucantime (20 mgSb/kg) for 21 days. Both groups were evaluated 3 and 6 weeks after onset of treatment. T-test and Chi-square test were used for statistical analyses and (P0.05). Conclusion: It seems that efficacy of fluconazole in acute cutaneous leishmaniasis is lower than glucantime. A larger clinical trial is recommended.
MA Nilforoush Zadeh; F Jaffari; B Malek Afzali
Volume 7, Issue 3 , 2004, , Pages 136-139
Abstract
Background: In spite of different methods of treatment, there is not a simple, safe and complete curative treatment for cutaneous Leishmaniasis (CL), yet. Objective: To compare the efficacy of intralesional Glucantime injection alone, with the combined triple therapy of cryotherapy, paramomycin ointment ...
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Background: In spite of different methods of treatment, there is not a simple, safe and complete curative treatment for cutaneous Leishmaniasis (CL), yet. Objective: To compare the efficacy of intralesional Glucantime injection alone, with the combined triple therapy of cryotherapy, paramomycin ointment and intralesional Glucantime in the treatment of CL. Materials and methods: 157 patients with CL were randomly allocated into 2 groups, 81 patients in group 1 were injected with intralesional Glucantime (Twice a week up to healing to the lesions or maximum 6 weeks). 76 patients in group 2 were treated with Paramomycin ointment (15% in 10% urea, twice a day), cryotherapy (Maximum 3 times 2 weeks) apart and injection of intralesional Glucantime (Once a week), for the same period as group 1. Results: After 6 weeks, complete cure rate in group 2 (89.5%) was significantly more than group 1 (70.4%) (P<0.05). Conclusion: Our results indicating of more efficacy of the triple therapy is in accordance with the previous studies of combined cryotherapy and Paramomycin. It could be recommended as a better treatment modality for CL wherever possible.
A Asilian; A Momeni; G Faghihi; V Sadeghi; M Sadeghi; H Sadeghi
Volume 6, Issue 2 , 2003, , Pages 30-33
Abstract
Background: Cutaneous leishmaniasis (CL) is a parasitic disease caused by leishmania species. An ideal treatment for CL has not found yet. Objectives: To evaluate the efficacy of cryotherapy alone and combined with intralesional glucantime injection in the treatment of papulonodular CL. Patients and ...
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Background: Cutaneous leishmaniasis (CL) is a parasitic disease caused by leishmania species. An ideal treatment for CL has not found yet. Objectives: To evaluate the efficacy of cryotherapy alone and combined with intralesional glucantime injection in the treatment of papulonodular CL. Patients and Methods: 300 patients with CL were randomly assigned to two treatment groups in this clinical trial. In group 1, 100 patients with 149 lesions were treated with cryotherapy plus intralesional glucantime injection every 2 weeks. In group 2, 200 patients with 230 lesions were treated only with cryotherapy, every 2 weeks. Both groups were followed for 6 months after last treatment. Results: Clinical and parasitological cure were seen in 90% of cases in group 1 and 57.3% in group 2 (P<0.05). Conclusion: Combination of cryotherapy and intralesional glucantime injection is an effective treatment modality in early lesions of CL.
