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Cutaneous Leishmaniasis
Published in Charles Theisler, Adjuvant Medical Care, 2023
Zinc Sulphate: In one study, oral zinc sulphate in doses of 2.5, 5, and 10 mg/kg/day for 45 days was an effective and safe treatment option. Cure rates in these groups ranged from 83.9%, 93.1%, and 96.9% respectively. Clinical cure with 2% intralesional zinc sulphate was comparable to meglumine antimoniate.1,2
Flies (Biting)
Published in Gail Miriam Moraru, Jerome Goddard, The Goddard Guide to Arthropods of Medical Importance, Seventh Edition, 2019
Gail Miriam Moraru, Jerome Goddard
Sand flies are relatively uncommon; thus, their bites are generally few and self-limiting. Soothing locations and antiseptic lotions may relieve itching and prevent secondary infection. Follow-up of patients with sand fly bites or persons with exposure to areas endemic with the several sand fly-transmitted diseases is needed to diagnose and treat these maladies. In the case of leishmaniasis, diagnosis is delayed by physicians unfamiliar with the clinical features and various forms of the disease. Cutaneous leishmaniasis is often initially described as a boil or ulcer that fails to heal. In addition, cutaneous leishmaniasis needs to be differentiated from other skin lesions such as those resulting from leprosy, tuberculosis cutis, sporotrichosis, histoplasmosis (Histoplasma duboisii), molluscum contagiosum, and cutaneous sarcoidosis. Treatment usually involves intralesional and parenteral pentavalent antimonals such as sodium stibogluconate and meglumine antimoniate, although these products may cause serious adverse side effects.29 The most current treatment recommendations for leishmaniasis can be obtained by consultation with the U.S. Centers for Disease Control and Prevention, Parasitic Diseases Division (770-488-7775).
Miltefosine
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Andrew Stewardson, Douglas Johnson
Subsequently, a placebo-controlled trial of miltefosine (2.5 mg/kg/day orally for 28 days) was performed for New World cutaneous leishmania in Colombia and Guatemala (Soto et al., 2004). In Colombia, where L. V. panamensis is common, the per-protocol cure rates for miltefosine and placebo were 91% (40/44 patients) and 38% (9/24), respectively. These values were similar to those expected with pentavalent antimony, the standard of care. In Guatemala, where L. V. braziliensis and L. mexicana mexicana are common, the per-protocol cure rates were 53% (20/38) for miltefosine and 21% (4/19) for placebo, both inferior to the historic cure rates of over 90% expected with pentavalent antimony (Soto et al., 2004). In a further trial undertaken among a Colombian army population with cutaneous leishmaniasis caused by L. braziliensis or L. panamensis, a per-protocol cure rate of 69.8% was reported for miltefosine and 85% for meglumine antimoniate (MA) (Velez et al., 2010).
Genetic disruption of nucleoside transporter 4 reveals its critical roles in malaria parasite sporozoite functions
Published in Pathogens and Global Health, 2023
Gozde Deveci, Mohd Kamil, Umit Kina, Binnur Aydogan Temel, Ahmed S. I. Aly
Earlier studies recognized NT4 as an important determining factor of pharmacokinetics where it plays major role in absorption and distribution of drugs and treatment of leishmaniasis [6]. Interestingly, one study has used codon-optimized synthetic NT4 sequences from P. falciparum and P. vivax to be expressed in Xenopus laevis oocytes and it showed that NT4 can transport Adenine and 2′-Deoxyadenosine [13]. Later, it was confirmed that NT4 in Leishmania major is involved in Adenine salvage [18]. The membrane transport capacity of NT4 makes it a crucial drug target. For example, Allopurinol is a purine analog which enters in cells through purine transporter, causing cell death to treat leishmaniasis. Meglumine antimoniate is another purine analog, which is now the first choice drug used to treat Leishmaniasis patients [19,20]. Moreover, the knockdown of NT4 using RNAi in L. major results in reduced infection in BALB/c mice [18].
Drugs and nanoformulations for the management of Leishmania infection: a patent and literature review (2015-2022)
Published in Expert Opinion on Therapeutic Patents, 2023
Mariana Verdan, Igor Taveira, Flávia Lima, Fernanda Abreu, Dirlei Nico
Pentavalent antimonials embrace sodium stibogluconate and meglumine antimoniate (Sb5+). In Brazil, meglumine antimoniate is the pentavalent antimonial distributed free of charge by the health ministry to treat infected individuals. These drugs have been used in treating leishmaniasis for over 70 years and remain the principal drug available. As the primary proposed mechanism of action, these drugs are known to act as prodrugs. After administration of the drug, the Sb5+ form is reduced to Sb3+, with Sb3+ coordinating with cysteine in glutathione and trypanothione [35]. The chemotherapy with meglumine antimoniate is realized via intravenous administration and under hospitalization of the patient since daily monitorization is necessary. Cardiotoxicity [36], nephrotoxicity [37], neurotoxicity [38], and hepatotoxicity [39] need to be evaluated throughout the treatment. The usual dose is shown in Tables 1 and 2.
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
Because of the hypothetical increase in the risk of late mucosal recurrence after local therapies for CL caused by L. brazilienzis, MA-IL therapy has been used for several years in Brazil only in few referral centers. Recently, the paradigm of parenteral therapy for the New World CL succumbed to the lack of evidence of a link between local therapeutic approaches and the risk of late mucosal lesion. In this context, in 2017, meglumine antimoniate intralesional infiltration (MA-IL) was included among the therapeutic alternatives for CL in Brazil in an attempt to reduce morbidity and death possibly related to the available parenteral therapeutic options. In fact, this late complication is also reported after parenteral treatment. Concerning efficacy, evidence of the equivalence between parenteral and intralesional infiltration meglumine antimoniate therapies, including a phase II clinical study performed between 2015 and 2017 at the Leishmaniasis Referral Center of Instituto René Rachou, FIOCRUZ, Minas Gerais, has accumulated in recent years [3,4]. Efficacy data obtained in that study have already been presented (cure rate of 87%, 77–96%) [5]. Currently, the clinical and laboratory monitoring data prospectively collected in that phase II study are the basis of the present analysis.