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      First case report of atypical disseminated cutaneous leishmaniasis in an opium abuser in Iran

      case-report

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          ABSTRACT

          Leishmaniasis is a worldwide tropical infectious disease caused by different species of intracellular protozoa parasites of the genus Leishmania . Herein, we report a 78-year-old man with unusual diffuse cutaneous leishmaniasis (DCL) who had a history of opium abuse and chronic obstructive pulmonary disease (COPD). He had multiple papular, crusted and severely ulcerated lesions extended to his arm and chest. Direct smears and skin punch biopsy of the lesions were suggestive of leishmaniasis. Parasite DNA was amplified from ulcers, and identified as Leishmania major by PCR-RFLP, confirmed by sequencing analyses. The aim of the current study was to bring to attention this atypical form of disease in CL endemic countries. Thus, this is the first case of DCL in an opium abuser with COPD due to L. major in Northeastern Iran indicating that atypical and extensive forms of CL (DCL) owing to L. major are increasing in Iran.

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          Arginase activity in pathogenic and non-pathogenic species of Leishmania parasites

          Alireza Badirzadeh, Tahereh Taheri, Yasaman Taslimi … (2017)
          Proliferation of Leishmania (L.) parasites depends on polyamine availability, which can be generated by the L-arginine catabolism and the enzymatic activity of arginase (ARG) of the parasites and of the mammalian hosts. In the present study, we characterized and compared the arginase (arg) genes from pathogenic L. major and L. tropica and from non-pathogenic L. tarentolae. We quantified the level of the ARG activity in promastigotes and macrophages infected with pathogenic L. major and L. tropica and non-pathogenic L. tarentolae amastigotes. The ARG's amino acid sequences of the pathogenic and non-pathogenic Leishmania demonstrated virtually 98.6% and 88% identities with the reference L. major Friedlin ARG. Higher ARG activity was observed in all pathogenic promastigotes as compared to non-pathogenic L. tarentolae. In vitro infection of human macrophage cell line (THP1) with pathogenic and non-pathogenic Leishmania spp. resulted in increased ARG activities in the infected macrophages. The ARG activities present in vivo were assessed in susceptible BALB/c and resistant C57BL/6 mice infected with L. major, L. tropica and L. tarentolae. We demonstrated that during the development of the infection, ARG is induced in both strains of mice infected with pathogenic Leishmania. However, in L. major infected BALB/c mice, the induction of ARG and parasite load increased simultaneously according to the time course of infection, whereas in C57BL/6 mice, the enzyme is upregulated solely during the period of footpad swelling. In L. tropica infected mice, the footpads' swellings were slow to develop and demonstrated minimal cutaneous pathology and ARG activity. In contrast, ARG activity was undetectable in mice inoculated with the non-pathogenic L. tarentolae. Our data suggest that infection by Leishmania parasites can increase ARG activity of the host and provides essential polyamines for parasite salvage and its replication. Moreover, the ARG of Leishmania is vital for parasite proliferation and required for infection in mice. ARG activity can be used as one of the main marker of the disease severity.
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            Diffuse and disseminated cutaneous leishmaniasis: clinical cases experienced in Ecuador and a brief review

            Yoshihisa Hashiguchi, Eduardo L. Gomez, Hirotomo Kato … (2016)
            Background In Ecuador, cutaneous leishmaniasis (CL) is prevalent countrywide, but only one case of diffuse-CL and two cases of disseminated-CL were experienced during our research activities more than 30 years from 1982 to date. These three patients suffered from multiple lesions distributed at a wide range of the body surface, revealing difficulty to clinically differentiate each other. Methods There is a considerable confusion of the use and/or differentiation of the terminologies (terms) between the two disease forms, diffuse-CL and disseminated-CL. One of the aims of the present study is to clarify the difference between the two disease forms, mainly based on the cases experienced in Ecuador. Results The disseminated-CL case newly reported here was clinically very similar to the diffuse-CL case, but the former showed the following marked differences from the latter: (1) the organisms isolated were identified as the parasites of Leishmania (Viannia) guyanensis/panamensis, which are also known as the causative agents of disseminated-CL in different endemic countries of the New World; (2) the patient was sensitive against antimonials; and (3) mucosal involvement was observed, which is never observed in diffuse-CL. Conclusions In the text, three clinical cases, one diffuse-CL and two disseminated-CL, were presented. Furthermore, a bibliographic comparison of the features between the two disease forms was made, and a brief comment was also given.
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              Opiates and infection.

              Jack M Risdahl, Kristen V Khanna, Phillip Peterson … (1998)
              This review on the effects of opiate use on infectious diseases discusses the complete spectrum of infections in the opiate user, including those of the lung, the GI tract, the skin, the skeletal system, and the CNS. There is both increased prevalence and increased severity of bacterial and viral infections in injection drug users with the outcome of increased morbidity and mortality. The experimental administration of opiates has lead to a greater understanding of the effects on susceptibility to and progression of infectious diseases. Animal models of opiate dependence and infection are reviewed with specific attention to cases in which the opiate-mediated effects are harmful and in which cases they are beneficial.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Rev Inst Med Trop Sao Paulo
                Journal ID (iso-abbrev): Rev. Inst. Med. Trop. Sao Paulo
                Journal ID (publisher-id): rimtsp
                Title: Revista do Instituto de Medicina Tropical de São Paulo
                Publisher: Instituto de Medicina Tropical
                ISSN (Print): 0036-4665
                ISSN (Electronic): 1678-9946
                Publication date (Electronic): 15 February 2018
                Publication date Collection: 2018
                Volume: 60
                Electronic Location Identifier: e5
                Affiliations
                [1 ]North Khorasan University of Medical Sciences, Vector-borne Diseases Research Center, Bojnurd, Iran
                [2 ]Shahid Beheshti University of Medical Sciences, School of Medicine, Department of Medical Parasitology and Mycology, Tehran, Iran
                [3 ]Razi Vaccine and Serum Research Institute, Mashhad, Iran
                Author notes
                Correspondence to: Alireza Badirzadeh. Shahid Beheshti University of Medical Sciences, School of Medicine, Department of Medical Parasitology and Mycology, Koodak-yar Ave., Daneshjoo Blvd, Evin, Chamran Highway, P.O. Box 19395-4719, Tehran, Iran. Tel: +98 21 23872564. E-mail: badirzadeh@ 123456gmail.com Sadaf Sabzevari. North Khorasan University of Medical Sciences, Vector-borne Diseases Research Center, Taleghani Street. P.O.Box 74877-94149, Bojnurd, Iran. Tel: +98 936 936 7632. E-mail: sadafsabzevari@ 123456gmail.com
                [†]

                These authors (AB and SS) contributed equally to this work

                ETHICAL APPROVAL

                The current case report was approved by the local Ethics Committee of North Khorasan University of Medical Sciences, Bojnurd, Iran and a written consent was obtained from the patient.

                CONFLICT OF INTERESTS

                We declare that we have no conflict of interest in relation to this work.

                Article
                Other ID: 00501
                DOI: 10.1590/S1678-9946201860005
                PMC ID: 5813668
                PubMed ID: 29451599
                SO-VID: 237fa9b4-0817-4048-8978-1ff8998114e7
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 17 July 2017
                Date accepted : 16 October 2017
                Page count
                Figures: 3, Tables: 0, Equations: 0, References: 22, Pages: 1
                Categories
                Subject: Case Report

                Keywords: dcl,opium,l. major,leishmaniasis,copd,pcr-rflp,iran
                Data availability:
                Keywords: dcl, opium, l. major, leishmaniasis, copd, pcr-rflp, iran

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