لطیفه عبداللهی

Iran is one of the most important hot spots for cutaneous leishmaniasis (CL) in the world. To date, no studies have been done on both epidemiological aspects along with the length of the treatment course of CL. This study aimed to determine the relative frequency of CL in patients with suspected skin lesions and the duration of healing after treatment with different regimens.

This cross-sectional study was conducted on patients with CL referred to the skin diseases and leishmaniasis research center (SDLRC) in Isfahan during the years 2018 to 2019. Among 389 patients with suspected skin lesions, 150 cases were included with proven CL. Information such as age, sex, education, location, size of the lesion, duration of treatment, and the rate of recovery were recorded. SPSS software version 20 was used for data analysis, the chi-square, Fisher´s Exact, and one Way ANOVA tests were used with a significant level of p < 0.05.

Among 350 admitted cases, 150 cases were CL. positive (42.85%). The rate of complete recovery was higher in cases with an average age of 33.55 ±18.9 years, but these differences were not statistically significant (P =0.077). There was 34 cases more than the other groups in this range of age. ( The rate of complete recovery in patients with a history of migration to endemic areas was higher than in patients without a history of migration (P = 0.81)). The rate of complete recovery in patients whose means treatment duration was 59.03 ± 41.43 days was higher than other recovery periods (P = 0.23).

The rate of complete recovery was higher in adult cases than the other groups. In this study, it was proved that the rate of recovery of patients had the significant relationship with the average duration of treatment.

Despite advances in diagnosis and treatment, leishmaniasis is now considered a severe public health problem, particularly in developing countries, such as Iran. Leishmaniasis is among the six most important, parasitic diseases of the world affecting 88 countries in almost every continent. The disease is complex with different clinical presentations such as visceral, cutaneous and mucocutaneous forms. Cutaneous leishmaniasis (CL) is the most common form of the disease in Iran. Antimony compounds are the first line treatment of CL. The treatment of leishmaniasis in endemic areas relies on chemotherapy, and in several parts of the world the mainstay remains the pentavalent antimony (SbV)-containing drugs Pentostam (sodium stibogluconate) and Glucantime (meglumine). There is no comprehensive study on treatment failure rate of this compounds. This study was designed to evaluate treatment failure rate and possible involving factors of antimonial resistance in CL to facilitate and improve treatment strategies of this disease.
All patients with CL referred to Skin Disease and Leishmaniasis Research Center (SDLRC), from October 2011 to October 2013, treated with antimony compounds were assessed in this study. Patient characteristics (gender, age and place of residence), number, type and location of the lesions, comorbidities and type of treatment were recorded and analyzed.
Rate of treatment failure with Meglusan was 4.3%. Failure rate in men and in patients with previous history of cutaneous leishmaniasis was more than women or patients without CL history (P= 0.000, 0.024 respectively). The results of this study showed that treatment failure was higher in patients with systemic treatment than intralesional (IL) or combination therapy (both IL and systemic treatment) group but this difference was not statistically significant. Also, size and number of the lesions, wound infection, the patient's age, location, education and occupation do not have a significant correlation with treatment failure.
Greater treatment failure rate of Meglusan compared to Glucantime (4.3% versus

Cutaneous leishmaniasis (CL) is an endemic parasitic disease of major health impact in many parts of the world and is caused by several species of the protozoan parasite Leishmania. Antimonial compounds (i.e glucantime and pentostam) are the first-line treatment for cutaneous leishmaniasis with emerging drug resistance as a problem. The control of Leishmania is further complicated by the emergence of drug-resistant parasites. In the clinical settings, resistance to SbV containing drugs is now well established and it was found to occur in South America, Europe, the Middle East and most notably in India. Clinical resistance to organic pentavalent antimonials, in the form of sodium stibogluconate (pentostam) or N-methylglucamine antimoniate (glucantime), has long been recognized. However, it is unknown whether the clinical failure of chemotherapy is attributable to the development of drug resistance mechanisms in the parasite or to a variety of host factors that might also contribute to low drug response. Reported rate of drug-resistance to antimonial compounds in Iran varies from 9.4% to 94.2% and there is not any comprehensive study on this issue. Indeed, in the endemic region treatment with SbV fails in more cases; thus, in general patients infected with resistant parasites are unresponsive although exceptions have been reported. This article aims to review the mechanisms of drug resistance to these compounds. The main resistance factors include genetical, enzymatic, intracellular (such as apoptosis and cytoskeleton changes) and resistance proteins. Also, mechanisms related to drug transport and intracellular activation are discussed. Various methods of drug resistance detection such as culture and molecular methods (i.e polymerase chain reaction) are reviewed. Although the exact mechanism of action glucantime is not clear, it seems that protein and gene factors involved in cellular drug entry are the main causes of drug resistance. Cross-sectional studies on meglumine antimoniate resistance in endemic areas of cutaneous leishmaniasis in Iran are highly recommended. Also, studies for evaluation of alternatives therapies for antimonial resistant cases are required.

Cutaneous leishmaniasis is a self-limited disease that does not cause a major problem in terms of death and disability compared to other diseases. However، permanent disfiguring scar، long-term period of wound healing، secondary infection، drug side effects، treatment duration and secondary effects caused by the drugs increase the impact of the burden of this disease. This study was designed to investigate the status of cutaneous leishmaniasis reinfection in patients referred to Skin Disease and Leishmaniasis Research Center (SDLRC)، Isfahan، Iran. Demographic information such as age، sex، number and place of lesion، migration to endemic areas، nationality، and occupation of the patients with cutaneous leishmaniasis referred to Skin Disease and Leishmaniasis Research Center parasitology laboratory in the years of 2012 and 2013 was collected. Of 1087 patients diagnosed as having cutaneous leishmaniasis، 75 patients (6. 8%) had reinfection. Mean age of these patients was 34. 73 ± 20. 91 years (ranging 1-75). Women (41، 54. 7%) were affected more than the men (34، 45. 3%) with no statistically significant difference. Some patients with the history of cutaneous leishmaniasis may suffer reinfection after several years of recovery. Less than 10% of patients had this problem in the our study population. Several factors such as genotype or strain variations and immune deficiency due to chronic backgrounds may be involved in the process of reinfection. Further researches are warranted to explore the underlying pathophysiology.

Diabetes mellitus is the most prevalent metabolic disorder worldwide with many subsequent medical complications. An important complication of diabetes is microalbuminuria which is a major indication for development of diabetic nephropathy. The prevalence of diabetic nephropathy in type 2 diabetic patients has been estimated to be 47%. Since the disorder initiates with microalbuminuria, its early detection and prevention are vital. On the other hand, helicobacter pylori infection is more common in diabetic patients due to their low immune tolerance. The vacA positive genotype is reported to be effective in microalbuminuria development in type 2 diabetic patients. In this study, we investigated the relation between H. pylori vacA and microalbuminuria in type 2 diabetic patients. This study included 88 type 2 diabetic patients among whom 60 had microalbuminuria. Stool samples were collected from all patients and DNA was extracted using QiaAmp Stool DNA Extraction Minikit. In order to detect H. pylori infection, a nested polymerase chain reaction (PCR) protocol was developed and all H. pylori positive samples were genotyped for cagA positivity. Overall, 16 patients (18.2%) were detected to be H. pylori positive out of whom 12 had microalbuminuria (75%). VacA positivity was detected in one patient without microalbuminuria. We could not establish a relationship between vacA positivity and microalbuminuria in the studied type 2 diabetic patients.