Progress of Mucocutaneous Leishmaniasis to Drug Nonresponsive Diffuse Cutaneous Leishmaniasis in Ethiopia. A Case Report
Banchamlak Tegegne,1 Getaneh Alemu2 1Amhara Public Health Institute, Bahir Dar, Ethiopia; 2Department of Medical Laboratory Science, Bahir Dar University, Bahir Dar, EthiopiaCorrespondence: Getaneh Alemu PO Box 79 Tel +251922842776Email getanehmlt@gmail.comBackground: Leishmaniasis is one of the neg...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2020-10-01
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| Series: | International Medical Case Reports Journal |
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| Online Access: | https://www.dovepress.com/progress-of-mucocutaneous-leishmaniasis-to-drug-nonresponsive-diffuse--peer-reviewed-article-IMCRJ |
| _version_ | 1828836234238099456 |
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| author | Tegegne B Alemu G |
| author_facet | Tegegne B Alemu G |
| author_sort | Tegegne B |
| collection | DOAJ |
| description | Banchamlak Tegegne,1 Getaneh Alemu2 1Amhara Public Health Institute, Bahir Dar, Ethiopia; 2Department of Medical Laboratory Science, Bahir Dar University, Bahir Dar, EthiopiaCorrespondence: Getaneh Alemu PO Box 79 Tel +251922842776Email getanehmlt@gmail.comBackground: Leishmaniasis is one of the neglected tropical diseases, yet it is associated with high mortality and morbidity. It is caused by intracellular protozoan parasites of the genus Leishmania. Based on the infecting parasite species and host factors, leishmaniasis could be manifested as cutaneous (localized or diffuse), mucocutaneous or visceral clinical forms. In Ethiopia, L. aethiopica is well known to cause all forms of cutaneous leishmaniasis, the localized form being mostcommon.Case Presentation: An adult patient from Yayu district, west Oromia region of Ethiopia presents with multiple skin lesions on his face, hands and mutilation of nose through both nostrils. Eight years before the present symptoms, he has developed spontaneously healed cutaneous ulcer on his face leaving a permanent scar. Physical examination revealed multiple nodular lesions on his hands, face and nose as well as swelling of the upper lip. Parasitological examination of ulcer lesion revealed presence of amastigotes, and the patient was diagnosed with mucocutaneous leishmaniasis. He was treated with sodium stibogluconate (20 mg/kg/day IM for 30 days) and clinically cured. After two years, he presented with clinical outcomes typical of diffuse cutaneous leishmaniasis. After confirmation by parasitological examination, he was put on sodium stibogluconate (20 mg/kg/day IM for 30 days) and paromomycin (15 mg/kg/day IM for 30 days) combination therapy. As he showed no progress, he was treated with prolonged sodium stibogluconate (20 mg/kg/day IM for 60 days) monotherapy. He was still nonresponsive and discharged uncured.Conclusion: The present case is unusual in Ethiopia with relapse of mucocutaneous leishmaniasis progressing to diffuse form. The later form was nonresponsive for both mono and combination therapy, therefore, formulating new drugs or evaluating other anti-Leishmania drugs is required.Keywords: mucocutaneous leishmaniasis, diffuse cutaneous leishmaniasis, case report |
| first_indexed | 2024-12-12T18:18:27Z |
| format | Article |
| id | doaj.art-629728c1298445d29b3d3306874ba886 |
| institution | Directory Open Access Journal |
| issn | 1179-142X |
| language | English |
| last_indexed | 2024-12-12T18:18:27Z |
| publishDate | 2020-10-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | International Medical Case Reports Journal |
| spelling | doaj.art-629728c1298445d29b3d3306874ba8862022-12-22T00:16:12ZengDove Medical PressInternational Medical Case Reports Journal1179-142X2020-10-01Volume 1355155558296Progress of Mucocutaneous Leishmaniasis to Drug Nonresponsive Diffuse Cutaneous Leishmaniasis in Ethiopia. A Case ReportTegegne BAlemu GBanchamlak Tegegne,1 Getaneh Alemu2 1Amhara Public Health Institute, Bahir Dar, Ethiopia; 2Department of Medical Laboratory Science, Bahir Dar University, Bahir Dar, EthiopiaCorrespondence: Getaneh Alemu PO Box 79 Tel +251922842776Email getanehmlt@gmail.comBackground: Leishmaniasis is one of the neglected tropical diseases, yet it is associated with high mortality and morbidity. It is caused by intracellular protozoan parasites of the genus Leishmania. Based on the infecting parasite species and host factors, leishmaniasis could be manifested as cutaneous (localized or diffuse), mucocutaneous or visceral clinical forms. In Ethiopia, L. aethiopica is well known to cause all forms of cutaneous leishmaniasis, the localized form being mostcommon.Case Presentation: An adult patient from Yayu district, west Oromia region of Ethiopia presents with multiple skin lesions on his face, hands and mutilation of nose through both nostrils. Eight years before the present symptoms, he has developed spontaneously healed cutaneous ulcer on his face leaving a permanent scar. Physical examination revealed multiple nodular lesions on his hands, face and nose as well as swelling of the upper lip. Parasitological examination of ulcer lesion revealed presence of amastigotes, and the patient was diagnosed with mucocutaneous leishmaniasis. He was treated with sodium stibogluconate (20 mg/kg/day IM for 30 days) and clinically cured. After two years, he presented with clinical outcomes typical of diffuse cutaneous leishmaniasis. After confirmation by parasitological examination, he was put on sodium stibogluconate (20 mg/kg/day IM for 30 days) and paromomycin (15 mg/kg/day IM for 30 days) combination therapy. As he showed no progress, he was treated with prolonged sodium stibogluconate (20 mg/kg/day IM for 60 days) monotherapy. He was still nonresponsive and discharged uncured.Conclusion: The present case is unusual in Ethiopia with relapse of mucocutaneous leishmaniasis progressing to diffuse form. The later form was nonresponsive for both mono and combination therapy, therefore, formulating new drugs or evaluating other anti-Leishmania drugs is required.Keywords: mucocutaneous leishmaniasis, diffuse cutaneous leishmaniasis, case reporthttps://www.dovepress.com/progress-of-mucocutaneous-leishmaniasis-to-drug-nonresponsive-diffuse--peer-reviewed-article-IMCRJmucocutaneous leishmaniasisdiffuse cutaneous leishmaniasiscase report |
| spellingShingle | Tegegne B Alemu G Progress of Mucocutaneous Leishmaniasis to Drug Nonresponsive Diffuse Cutaneous Leishmaniasis in Ethiopia. A Case Report International Medical Case Reports Journal mucocutaneous leishmaniasis diffuse cutaneous leishmaniasis case report |
| title | Progress of Mucocutaneous Leishmaniasis to Drug Nonresponsive Diffuse Cutaneous Leishmaniasis in Ethiopia. A Case Report |
| title_full | Progress of Mucocutaneous Leishmaniasis to Drug Nonresponsive Diffuse Cutaneous Leishmaniasis in Ethiopia. A Case Report |
| title_fullStr | Progress of Mucocutaneous Leishmaniasis to Drug Nonresponsive Diffuse Cutaneous Leishmaniasis in Ethiopia. A Case Report |
| title_full_unstemmed | Progress of Mucocutaneous Leishmaniasis to Drug Nonresponsive Diffuse Cutaneous Leishmaniasis in Ethiopia. A Case Report |
| title_short | Progress of Mucocutaneous Leishmaniasis to Drug Nonresponsive Diffuse Cutaneous Leishmaniasis in Ethiopia. A Case Report |
| title_sort | progress of mucocutaneous leishmaniasis to drug nonresponsive diffuse cutaneous leishmaniasis in ethiopia a case report |
| topic | mucocutaneous leishmaniasis diffuse cutaneous leishmaniasis case report |
| url | https://www.dovepress.com/progress-of-mucocutaneous-leishmaniasis-to-drug-nonresponsive-diffuse--peer-reviewed-article-IMCRJ |
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