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      Efficacy of Intralesional Amphotericin B for the Treatment of Cutaneous Leishmaniasis

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          Abstract

          Background:

          Antimoniate compounds have been used as gold standard treatment for cutaneous leishmaniasis since many years ago, but with increase in incidence of drug as well as individual contraindications, more attention has been given to alternative treatments.

          Aim:

          The aim of this study was to evaluate the efficacy of intralesional amphotericin B as an alternative treatment for cutaneous leishmaniasis in Mashhad, Iran, during 2007-2009.

          Materials and Methods:

          Non-random sampling from both sexes and without any age limitation of cases eligible for this alternative treatment was done. Size and induration of lesions were measured before beginning and weakly during the treatment. Amphotericin B (2 mg/ml) was injected into lesions weekly for up to 12 weeks and the cases were followed up for the treatment responses, possible side effects and recurrence of the disease.

          Results:

          A total of 93 patients with a mean age of 20.81 ± 15.26 years were included in this study. At the end of 12 th week, 61.4% of the patients were recovered completely (more than 90% reduction in size and induration), 21.6% had partial remission (60-90% reduction in size and induration), and 17% had less than 60% reduction in size and induration of skin lesions. Injection side effects were insignificant and did not lead to premature discontinuation of treatment in any patients.

          Conclusion:

          Weekly intralesional injection of amphotericin B looks promising, considering the fact that most of the patients in this study were resistant to antimoniates.

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          Most cited references30

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          The increase in risk factors for leishmaniasis worldwide.

          P Desjeux (2001)
          Economic development leads to changing interactions between humans and their physical and biological environment. Worldwide patterns of human settlement in urban areas have led in developing countries to a rapid growth of mega-cities where facilities for housing, drinking-water and sanitation are inadequate, thus creating opportunities for the transmission of communicable diseases such as leishmaniasis. Increasing risk factors are making leishmaniasis a growing public health concern for many countries around the world. Certain risk factors are new, while others previously known are becoming more significant. While some risk factors are related to a specific eco-epidemiological entity, others affect all forms of leishmaniasis. Risk factors are reviewed here entity by entity.
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            A review of the geographic distribution and epidemiology of leishmaniasis in the New World.

            A review of the epidemiologic aspects of the New World leishmaniases, including their known geographic distribution, etiologic agents, zoonotic reservoirs, and insect vectors, based on biological and molecular characterization of Leishmania isolates is presented. Data summarized in this paper on parasite taxonomy and geographic distribution come from our studies of greater than 1,000 New World Leishmania isolates identified by species-specific monoclonal antibodies using an indirect radioimmune binding assay and from scientific literature.
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              Lipsosomal amphotericin B for treatment of cutaneous leishmaniasis.

              Treatment options for cutaneous leishmaniasis in the United States are problematic because the available products are either investigational, toxic, and/or of questionable effectiveness. A retrospective review of patients receiving liposomal amphotericin B through the Walter Reed Army Medical Center for the treatment of cutaneous leishmaniasis during 2007-2009 was conducted. Twenty patients who acquired disease in five countries and with five different strains of Leishmania were treated, of whom 19 received a full course of treatment. Sixteen (84%) of 19 experienced a cure with the initial treatment regimen. Three patients did not fully heal after an initial treatment course, but were cured with additional dosing. Acute infusion-related reactions occurred in 25% and mild renal toxicity occurred in 45% of patients. Although the optimum dosing regimen is undefined and the cost and toxicity may limit widespread use, liposomal amphotericin B is a viable treatment alternative for cutaneous leishmaniasis.
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                Author and article information

                Journal
                Indian J Dermatol
                Indian J Dermatol
                IJD
                Indian Journal of Dermatology
                Medknow Publications & Media Pvt Ltd (India )
                0019-5154
                1998-3611
                Nov-Dec 2014
                : 59
                : 6
                : 631
                Affiliations
                [1] From the Department of Dermatology, Cutaneous Leishmaniasis Research Center, School of Medicine, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
                Author notes
                Address for correspondence: Dr. Ahmad Reza Taheri, Cutaneous Leishmaniasis Research Center, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. E-mail: taheriar@ 123456mums.ac.ir
                Article
                IJD-59-631b
                10.4103/0019-5154.143571
                4248523
                25484415
                67341b62-11d5-4295-945a-f713f4ca2dd0
                Copyright: © Indian Journal of Dermatology

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : October 2013
                : February 2013
                Categories
                E-IJD Therapeutic Round

                Dermatology
                amphotericin b,antimoniate compounds,cutaneous leishmaniasis
                Dermatology
                amphotericin b, antimoniate compounds, cutaneous leishmaniasis

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