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Gaps in Knowledge, Current and Future Needs
Published in Yamuna Deepani Siriwardana, Leishmaniasis in Sri Lanka, 2023
It is encouraging to note that recently emerged cases of visceral leishmaniasis have responded well to currently available antimony compounds in spite of reports of poor response among cases of CL. However, the most challenging issue would be the prevention or delaying the emergence of drug resistance in the country. Evidence-based selection and careful use of treatment modalities are very important especially with the emergence of poor treatment response in cutaneous leishmaniasis. Local examination of new options including physical methods (for CL, non-pharmacological) and indigenous methods of treatment backed up by long-term and adequate follow up to look for resistance and recurrence will be some challenges facing the new researcher. The need for attending to patient perspectives such as quality of life, recurrence, and sterile cure, scar formation, stigmatization, and disability in CL drug trial design is now recommended (Erber et al., 2020).
The Twentieth Century and Beyond
Published in Scott M. Jackson, Skin Disease and the History of Dermatology, 2023
Medications with diuretic properties were used for many chronic inflammations, and quinine was used for pityriasis rubra pilaris, leprosy, chronic urticaria, and furunculosis. Antimony was helpful for acute and subacute eczema, prurigo, and psoriasis. Antipyrine was an antipyretic and analgesic that was used for itching and for the pain of zoster. Oral sulfur was prescribed for hyperhidrosis, furunculosis, and severe acne. Iodine and iodides were useful in tertiary syphilis and tuberculous skin diseases such as lupus vulgaris; mercury, administered most commonly in the corrosive sublimate form, was prescribed for syphilis until the discovery of salvarsan after the turn of the century (see Interlude 3).
Cardiac Hypertrophy, Heart Failure and Cardiomyopathy
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
Heavy metals may cause DCM. This fact was first recognized in North America following the addition of cobalt to beer to maintain its frothy head in the drinking glass. The striking feature histologically is vacuolation of myocytes. Cobalt-related cardiomyopathy probably results from interference with energy production and contractile mechanisms. Antimony may cause lethal oxidative stress and cell death mediated by elevation in intracellular calcium. Mercury toxicity includes glutathione depletion, production of reactive oxygen species (ROS), and interruption in selenium-dependent endogenous enzymatic reactions. The existence of a lithium-induced cardiomyopathy is still debated.
Evaluation of the antileishmanial effect of polyclonal antibodies and cationic antimicrobial peptides
Published in Pathogens and Global Health, 2023
Mahsa Esmaeilifallah, Hossein Khanahmad, Zahra Ghayour, Sedighe Saberi, Reza Kalantari, Seyed Hossein Hejazi
CL, the most dominant form of leishmaniasis, is a parasitic disease transmitted by the bites of infected sandflies and leads to significant tissue destruction and deformation [1]. Although it is not life-threatening, it is a social disease that severely impacts life through skin mutilation and stigma [2]. Leishmaniasis has been studied for over 120 years, but combating all types of the disease is a hot topic yet [3]. Today, antimony-based drugs are still used as a part of a wide range of treatments for the disease [4]. In 2014, the World Health Organization reviewed the global impact of neglected tropical diseases in the developing world and prioritized the control of leishmaniasis worldwide and its elimination in the endemic areas [5]. Targeted drugs address many therapeutic problems that directly affect host molecules or pathways critical for pathogen invasion, survival, and proliferation [3,4].
Safety profile of meglumine antimoniate intralesional infiltration for cutaneous leishmaniasis
Published in Expert Review of Anti-infective Therapy, 2020
Herbert J. Fernandes, Rosiana E. da Silva, Dario B. Ramalho, Marta G. Aguiar, Josiane N. Silveira, Gláucia Cota
To our knowledge, this study is the largest prospectively performed analysis to date to assess the safety profile of the MA-IL approach in the Americas. Using an active and comprehensive strategy, we observed that 86.9% of the patients presented at least one clinical AE during follow-up. Despite this high rate, most AEs (84.9%) were related to the lesion site and were of typically mild to moderate intensity. Only two intense (grade 3) events occurred, both considered hypersensitivity reactions and led to early discontinuation of treatment. Systemic adverse events were reported in 50% of the patients, and the three most frequent were myalgia, arthralgia and headache. No serious adverse events were reported. Electrocardiographic alteration of QTc prolongation and elevation of liver or pancreatic enzymes were observed in 25% and 22% of the treated patients, respectively. Although no association with plasma antimony levels was observed, these laboratorial abnormalities suggest the systemic absorption of antimony via the intralesional route and its potential risk to cause hepatic, pancreatic and cardiac toxicity.
Mechanisms of toxic cardiomyopathy
Published in Clinical Toxicology, 2019
Antimony is still the mainstay for the treatment of Leishmaniosis. Significant modifications of the electrocardiogram, and even “torsades de pointe” and sudden death have been reported in patients undergoing therapy with antimonials; these effects are related to the dose and duration of the treatment. While modifications of T wave or ST segment and arrhythmias have been documented in experimental models, contradictory results have appeared regarding the effects of antinomy on contractility. The cardiac effects could be related to oxidative stress producing lipid peroxidation, glutathione (GSH) decrease, inhibition of glutathione peroxidase, significant alterations in cellular thiol homeostasis and lactate dehydrogenase (LDH) release [68–69]. It seems also that antimony is able to interfere with intracellular calcium handling [68].