Levamisole and immune response phenomena in cutaneous leishmaniasis

Impact of levamisole in co-administration with benznidazole on experimental Chagas disease

Levamisole (Lms) is an anthelminthic drug with immunomodulatory activity. Chagas disease (CD) is caused by Trypanosoma cruzi and there is very low access to the drugs available, benznidazole (Bz) and nifurtimox, both far from ideal. In a drug-repurposing strategy to test potential activity as antiparasitic and immunomodulatory agent for CD, Lms was assayed on acute T. cruzi murine infection, alone and in co-administration with Bz. During protocol standardization, 100 and 10 mpk of Bz given for five consecutive days resulted in parasitaemia suppression and 100% animal survival only with the highest dose. Flow cytometry showed that both optimal (100 mpk) and suboptimal (10 mpk) doses of Bz equally decreased the plasma levels of cytokines commonly elevated in this acute infection model. Lms alone (10-0.5 mpk) did not decrease parasitaemia nor mortality rates. Co-administration was investigated using the suboptimal dose of Bz and different doses of Lms. While Bz 10 mpk did not alter parasitaemia, the combo partially reduced it but only slightly promoted animal survival. This effect could be related to Th1-response modulation since interleukin-6 and interferon-γ were higher after treatment with the combo.

Successful treatment of lupoid cutaneous leishmaniasis with glucantime and topical trichloroacetic acid (a case report)

Lupoid leishmaniasis is a unique form of cutaneous leishmaniasis characterized by unusual clinical features and a chronic relapsing course, mostly caused by infection with Leishmania tropica. In this clinical form, 1-2 yr after healing of the acute lesion, new papules and nodules appear at the margin of the remaining scar. Herein, we describe a case of this clinical form that was resistant to 2 courses of treatments: systemic glucantime and then a combination therapy with allopurinol and systemic glucantime. However, marked improvement was seen after a combination therapy with topical trichloroacetic acid solution (50%) and systemic glucantime, and there were no signs of recurrence after 1 yr of follow-up.

Levamisole in dermatology : a review

Levamisole, an anthelmintic agent with a wide range of immunomodulatory actions, has been used successfully as monotherapy and an adjunct to treatment in a variety of diseases. Since 1990, combination therapy of levamisole and fluorouracil has played an important role in the treatment of resected Dukes stage C adenocarcinoma of the colon. Because of its immunomodulating effects levamisole has been used in a wide range of diseases with and without success. In dermatologic disease levamisole has been successfully used in the treatment of parasitic, viral and bacterial infections including leprosy, collagen vascular diseases, inflammatory skin diseases and children with impaired immune a variety of reasons. It has also been used in combination with other drugs for treating a number of dermatologic disorders, e.g. in combination with cimetidine for treating recalcitrant warts, with prednisolone for treating lichen planus, erythema multiforme and aphthous ulcers of the mouth. Adverse affects of levamisole are mild and infrequent and include rash, nausea, abdominal cramps, taste alteration, alopecia, arthralgia, and a flu-like syndrome. It can rarely cause agranulocytosis. More studies need to be undertaken to study the full potential of levamisole in dermatologic diseases.

Treatment of recurrent cutaneous Leishmaniasis

BACKGROUND

Cutaneous leishmaniasis is endemic in Iran. One of the clinical pictures of this disease is leishmaniasis recidivans (LR). Most of the drugs used for cutaneous leishmaniasis are ineffective in LR.

METHODS AND PATIENTS

Twenty-five patients (13 women and 12 men), who had LR and whose disease had been proved by previous direct smears, were accepted for the study. The duration of disease in all patients was more than 2 years and they had previously been treated for their cutaneous leishmaniasis by different methods. All patients were treated with a combination of allopurinol (AL) (20 mg/kg/day for 30 days) and meglumine antimoniate (MA) (70 mg/kg/day for 15 days). Laboratory tests including hemograms, liver function, and kidney function tests, were done both at baseline and at the end of therapy.

RESULTS

Twenty-four out of 25 patients (96%) responded well to treatment and after 1 year follow-up no relapse had occurred. The drugs were well tolerated by the patients producing no side effects nor any significant changes in laboratory values.

CONCLUSIONS

A combination of AL and antimoniate is an effective method for the treatment of LR and for patients with cutaneous leishmaniasis who are resistant to the usual treatments.

Current treatment recommendations for leishmaniasis

OBJECTIVE

To review the epidemiology, clinical presentation, risk factors for transmission, and pathogenesis of leishmaniasis, as well as current treatment options for this disease. DATA SOURCES/DATA SELECTION: We reviewed unclassified medical-threat briefing material, subject-matter reviews, and case reports from the world's infectious disease literature. We concentrated on literature pertaining to the pathogenesis and management of leishmaniasis indigenous to Southwest Asia.

DATA EXTRACTION

Data from subject reviews published in the English language were evaluated. Case reports and clinical trials provided supplemental data on evolving theories and management options.

DATA SYNTHESIS

The clinical presentation of leishmaniasis is highly variable. Management relies heavily upon the use of parenteral antimonial drugs. Although these agents are effective in most cases, toxicity and the emergence of resistance limit the usefulness of standard therapies. Alternative treatment modalities include heat, surgical curettage, ketoconazole, metronidazole, pentamidine, rifampin, amphotericin B, aminoglycosides, allopurinol, and immunotherapy.

CONCLUSIONS

Although the number of reported cases of leishmaniasis in the US has generally been low, there is a possibility that more cases may be reported in the future because of the large number of military personnel returning to this country from endemic areas. Medical personnel, particularly those working in governmental institutions, should be familiar with the pathogenesis of this unusual infection as well as potential treatment options.

Dermal leishmaniasis and rifampicin

In an uncontrolled study, the effectiveness of rifampicin was assessed in cutaneous leishmaniasis. Twelve of 15 patients (80%) showed good response. The treatment ranged from 2 to 12 weeks. Tolerance of the drug was excellent and apart from red discolouration of the urine, no other side effects were encountered. Rifampicin appears to have a place in the management of cutaneous leishmaniasis.

Intralesional therapy of cutaneous leishmaniasis with sodium stibogluconate antimony

One hundred and thirty lesions of cutaneous leishmaniasis in 60 patients were treated with intralesional injections of Pentostam and 30 lesions were left untreated as controls. The injections were given at 8-day intervals and the patients followed-up for 42 days. One hundred and four lesions (80%) needed one injection only, 20 (15.4%) needed two and six (4.6%) needed three injections. One hundred and twenty three of the treated lesions (94.6%) showed a good clinical response with complete healing or marked improvement within the follow-up period. None of the control lesions showed marked improvement or complete healing. Scarring was minimal or absent following healing of treated lesions. The only side-effect was some localized pain following the injection. We recommend intralesional Pentostam as a safe and effective method of treating acute cutaneous leishmaniasis.

Leishmaniasis: the touch preparation as a rapid means of diagnosis

A 31-year-old man from Yemen presented with a 6-month history of a nonhealing ulcerated plaque on his right elbow. Initial evaluation included hematoxylin-and-eosin and Giemsa stains of a skin biopsy specimen. These preparations were interpreted as consistent with leishmaniasis, but no organisms were seen. A second biopsy specimen was obtained for culture on special media. A touch preparation demonstrated amastigotes, and cultures demonstrated leishmanial organisms at 2 weeks. The touch preparation as a rapid means of diagnosing leishmaniasis is discussed in detail, and a review of leishmanial disease and treatment is presented.

Some aspects of the epidemiology of cutaneous leishmaniasis in the Al-Kharaj area of Saudi Arabia

Four hundred and thirteen patients with skin ulcers were clinically diagnosed as suffering from cutaneous leishmaniasis; 82 (approximately 20%) of these cases were confirmed microscopically. Ulceration occurred mainly on the exposed parts of the body. Of the total cases 69% were Egyptian labourers, 14% Saudis and the remaining 17% Syrian, Pakistani, Yemeni or Filippino. Most of the Saudi patients were children aged up to ten years. Two Rattus rattus collected during the study had skin ulcerations on the face, indicating possible infection with leishmaniasis. Poor living conditions on the farms seem partly responsible for the high rate of incidence of cutaneous leishmaniasis among the labourers.

Dermatologic therapy: December, 1981, through November, 1982

In this paper I have reviewed the literature on dermatologic therapy from December, 1981, through November, 1982. This information was presented to a forum at the 41st Annual Meeting of the American Academy of Dermatology in New Orleans in December, 1982. Readers should review the original article in toto before attempting any new, experimental, or controversial therapy summarized.