Comparative Efficacy of Three Control Protocols of Head Lice (Pediculus Humanus Capitis) Infesting Schoolchildren in Mashhad City, Iran

Background: Head lice infestation constitutes a serious health problem in marginalized areas where schoolchildren and their families are mostly affected. This study aimed to compare 3 lice control protocols approved by Ministry of  Health and Medical Education, based on 1% permethrin shampoo, 4% dimethicone lotion and (1:1) vinegar wet combing for the treatment of outpatients of Imam Reza Hospital of Mashhad city (Iran). Materials and Methods: The quasi-experimental before-and-after design was applied to evaluate the effectiveness of protocols, using SPSS  software version 16.0. The study involved 154 infested individuals from both sexes during 2015 and 2016. The patients were clustered into 4-age categories; 13-year-old and their demographics were recorded. The results were recorded on weekly basis by a hospital-based dermatologist and an entomologist. Application times of permethrin, dimethicone and vinegar were 8-10 min, 8 h and 20-30 min respectively. Results: Age, gender, familly size and hair length were the most significant demographic variants involved in treatments outcomes at P ≤ 0.05. The protocols showed different efficacies a week after intervention keeping the same trend to the end. The dimethicone treated group indicated the highest control levels (86% and 74%). The recovery rates at first endpoint were 86, 64.2 and 60.8%, and at the second endpoint were 74, 45.3 and 45.1% for dimethicone, permethrin and vinegar respectively. Dimethicone was 4.3 times more potent than either of vinegar or permethrin (

The effect of oral miltefosine in treatment of antimoniate resistant anthroponotic cutaneous leishmaniasis: An uncontrolled clinical trial.

BackgroundRecent circumstantial evidence suggests increasing number of Iranian patients with cutaneous leishmaniasis (CL) who are unresponsive to meglumine antimoniate (MA), the first line of treatment in Iran. Oral meltifosine was previously reported to be effective in visceral leishmaniasis as well CL. The current study is designed to determine efficacy and safety of oral miltefosine for the treatment of anthroponotic cutaneous leishmaniasis (ACL) cases who were refractory to MA in Iran.Methodology/principal findingsMiltefosine was orally administered for 27 patients with MA resistant ACL with approved L.tropica infection, at a dosage of ∼2.5 mg/kg daily for 28 days. Patients were evaluated on day 14 and 28, as well as 3, 6 and 12 month post treatment follow up sessions. Laboratory data were performed and repeated at each visit. Data were analyzed using SPSS version 17. Twenty-seven patients including 16 men (59.25%) and 11 women (40.74%) with mean age of 28.56 ± 4.8 (range 3-54 years old) were enrolled. Total number of lesions were 42 (1-4 in each patient). Most of lesions were on face (76.19%). Mean lesions' induration size was 2.38 ± 0.73 cm at the base-line which significantly decreased to1.31 ± 0.58 cm and 0.61 ±0.49 cm after 14 and 28 days of therapy, respectively (p value ConclusionOral miltefosine could be an effective alternative for the treatment of MA-resistant ACL

The Effect of Sun Radiation on the Course of Cutaneous Leishmaniasis in BALB/c Mice

Objective(s)Studies have described immunomedulatory effects of sun exposure and ultraviolet radiation on infectious and neoplastic diseases. Here the effect of exposure to low potency radiation of sun on the course of leishmaniasis in mice was studied. Materials and MethodsFifteen BALB/c mice were exposed to suberythemogenic doses of sun (mean 180 mJ/cm2/day of UVB) 2 months before and 4 months after Leishmania major inoculation to food pad. Control group was kept in the sun protected environment. From 2nd to 17th week after inoculation, size of the lesion was recorded in each group weekly and at last week the parasite burden in spleen was detected. Results were compared between two groups. ResultsSeven mice from case group and 9 mice from control group survived up to last week. The mean lesion size was 0.90±0.59 cm in exposed and 4.01±3.59 cm in unexposed mice (P= 0.037). Parasite burden in spleen of case and control groups were 5.5±4.61 and 106.94±279.76 respectively (P= 0.006).ConclusionChronic exposure of BALB/c mice to suberythemogenic doses of sun suppressed skin lesion and decreased the extension of L. major to spleen

Salvage therapy with Sodium chlorosum (formerly DAC N-055) for cases of refractory lupoid cutaneous leishmaniasis: results from a compassionate use study with 0.09% Sodium chlorosum in amphiphilic basic cream

Background Lupoid cutaneous leishmaniasis (LCL) is known as a rare but serious complication of anthroponotic cutaneous leishmaniasis (ACL) resistant to conventional treatments. Sodium chlorosum, a pro-oxidative preparation of pharmaceutical sodium chlorite (NaClO2), has been successfully used for the treatment of Old World cutaneous leishmaniasis lesions (OWCL) and of some LCL cases in Afghanistan. This clinical trial study aimed to evaluate the effect of a last resort therapy with topical 0.09% sodium chlorosum on LCL in Iran. Methods Twenty Iranian patients (12 women and 8 men) with LCL refractory to treatment were included in this salvage study. A magistral preparation of sodium chlorosum (10 mM NaClO2 in amphiphilic basic cream) was applied twice daily to the lesions for 6 weeks and continued up to 12 weeks in patients who showed a clinical response within the first 6 weeks. Responders were followed up for a maximum of 1 year. Lesions were photographed during weekly visits. Disappearance of erythema and indurated lesions were rated as complete clinical response. Results Patients with a mean age of 28.6 (±24.3) and with an ACL proven lesion history of 3.8 (±1.4) years were treated for an average of 7.9 (±1.8) weeks. At the end of the treatment period (12th week), a complete response was observed in 9 of 20 patients (45%). During the one-year follow-up period, LCL lesions recurred in 4 of these 9 patients (with one patient showing only a tiny lesion) and one case lost to follow up whereas the other four remained completely lesion-free. Mild temporary side-effects such as erythema and itching were seen in 4 of 20 patients (20%). Conclusions Topical sodium chlorosum showed promising therapeutic results and can be considered as safe, painless, and relatively effective treatment for LCL, an ethical prerequisite for a two-armed controlled trial. Trial registration This study was registered in Iranian registry of clinical trials on 2019-02-02 with registration number IRCT20190114042356N1

Higher serum vitamin D levels have a positive association with the incidence of recidivans form of cutaneous leishmaniasis; A cross-sectional study

Background: Several manifestations of cutaneous leishmaniasis are related to the host's immune system and the species of parasite. Objective: There have been some studies on the relationship between vitamin D statuses in infectious diseases including cutaneous leishmaniasis. However, the results of these studies have been inconsistent. Materials and Methods: In this cross-sectional study, 147 patients with leishmaniasis were recruited and divided into the following categories: acute cutaneous leishmaniasis (<1 year) (n = 51), chronic cutaneous leishmaniasis (more than 1 year) (n = 26), and leishmaniasis recidivans (the appearance of new papular lesions around a previous scar) (n = 20), and a group of participants without leishmaniasis (n = 50), as a control group. Serum 25-hydroxyvitamin D [25(OH) D] level was analyzed. Result: There were significant differences in serum 25(OH) D between the groups with acute or chronic leishmaniasis and those with recidivans leishmaniasis (P = 0.013 and P = 0.022, respectively). The median serum level of vitamin D in the acute group was 13.7 ng/mL, in the chronic group was 16.05 ng/mL, in the recidivans group was 21.75 ng/mL, and in the control group was 17.97 ng/mL. Conclusion: Higher serum concentrations of 25(OH) vitamin D levels being associated with leishmaniasis recidivans

Molecular signatures of anthroponotic cutaneous leishmaniasis in the lesions of patients infected with Leishmania tropica

Anthroponotic cutaneous leishmaniasis (CL) caused by Leishmania tropica (L. tropica) represents a public health challenge in several resource poor settings. We herein employed a systems analysis approach to study molecular signatures of CL caused by L. tropica in the skin lesions of ulcerative CL (UCL) and non-ulcerative CL (NUCL) patients. Results from RNA-seq analysis determined shared and unique functional transcriptional pathways in the lesions of the UCL and NUCL patients. Several transcriptional pathways involved in inflammatory response were positively enriched in the CL lesions. A multiplexed inflammatory protein analysis showed differential profiles of inflammatory cytokines and chemokines in the UCL and NUCL lesions. Transcriptional pathways for Fcγ receptor dependent phagocytosis were among shared enriched pathways. Using L. tropica specific antibody (Ab)-mediated phagocytosis assays, we could substantiate Ab-dependent cellular phagocytosis (ADCP) and Ab-dependent neutrophil phagocytosis (ADNP) activities in the lesions of the UCL and NUCL patients, which correlated with L. tropica specific IgG Abs. Interestingly, a negative correlation was observed between parasite load and L. tropica specific IgG/ADCP/ADNP in the skin lesions of CL patients. These results enhance our understanding of human skin response to CL caused by L. tropica.ISSN:2045-232