Disseminated cutaneous leishmaniasis on lymphedema following radiotherapy

Sadeghian, G; Iraji, Fariba; Nilfroushzadeh, Mohammad Ali

doi:10.1111/j.1365-4632.2004.02350.x

Cited by 10 publications

(10 citation statements)

References 9 publications

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“…Since the lymphatic system controls important immunological functions, it is clear that, whatever the cause, inadequate lymph drainage of a given region makes it an immunologically vulnerable area, 1,2 i.e. a privileged site for a subsequent development of immunocompetencerelated diseases, such as tumours, infections, and immune disorders [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] (Table 2).…”

Section: Regional Chronic Lymphoedemamentioning

confidence: 99%

The immunocompromised district: a unifying concept for lymphoedematous, herpes‐infected and otherwise damaged sites

Ruocco¹,

Brunetti

Puca

et al. 2009

Acad Dermatol Venereol

206

275

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Systemic immunodeficiency is known to facilitate the onset of opportunistic infections, tumours and immune disorders in any district of the body. There are clinical events, such as chronic lymphoedema, herpetic infections, vaccinations and heterogeneous physical injuries which can selectively damage and immunologically mark the cutaneous district they act upon. After the causing event has disappeared, the affected district may appear clinically normal, but its immune behaviour is often compromised forever. An immunocompromised district becomes a site which is particularly susceptible to subsequent outbreaks of opportunistic infections, tumours and immune disorders confined to the district itself. In this review, there is an ample case-report collection of opportunistic disorders (infectious, neoplastic, immune) which appeared in immunocompromised districts. The cases have been grouped according to the clinical settings responsible for the local immune imbalance: regional chronic lymphoedema; herpes-infected sites, which feature the well-known Wolf's isotopic response; and otherwise damaged areas, comprising sites of vaccination, ionizing or UV radiation, thermal burns and traumas. Whatever the immunocompromising factor, a common denominator which facilitates the occurrence of tumours, infections and dysimmune reactions in an immunocompromised district may reside in locally hampered lymph drainage and/or locally altered neuromediator signalling. In fact, any obstacle to the normal trafficking of immunocompetent cells through lymphatic channels or any interference with the signals that the neuropeptides and neurotransmitters released by peripheral nerves send to cell membrane receptors of immunocompetent cells, can significantly alter the local immune response, thus paving the way for heterogeneous opportunistic disorders in the immunocompromised district.

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Section: Regional Chronic Lymphoedemamentioning

confidence: 99%

The immunocompromised district: a unifying concept for lymphoedematous, herpes‐infected and otherwise damaged sites

Ruocco¹,

Brunetti

Puca

et al. 2009

Acad Dermatol Venereol

206

275

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“…Sodium stibogluconate -a drug now known to have over a 60 % resistance rate 48 and cryotherapy, a treatment modality used for many other dermatological conditions are used to treat leishmaniasis in Sri Lanka. Sodium stibogluconate is available for leishmaniasis treatment only in some dermatology clinics in Sri Lanka.…”

Section: Treat or Leave To Self-heal?mentioning

confidence: 99%

“…47 India already reports over 60% drug resistant rate for pentavalent antimonials. 48 In addition, such irrational drug usage can prevent development of host immunity resulting in visceralization or it can also trigger local spread of a lesion. 49 The pros and cons of drug treatment of cutaneous L. donovani in Sri Lanka remain debatable.…”

Section: Treat or Leave To Self-heal?mentioning

confidence: 99%

Leishmaniasis in Sri Lanka: a decade old story

Siriwardana

Chandrawansa

Sirimanna

et al. 2012

Sri Lankan J Infec Dis

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Visceral leishmaniasis is a vector-borne protozoan disease targeted for elimination from the Indian subcontinent by year 2020. Sri Lanka is a new focus of human leishmaniasis caused by a genetically distinct variant of Leishmania donovani, which is the species more widely known to cause visceral leishmaniasis (VL). The clinical entity that is most frequent in Sri Lanka is cutaneous leishmaniasis (CL), though a few cases of muco-cutaneous (MCL) and VL have also been reported in the recent past. In CL, papules, nodules, ulcerating nodules and ulcers occur mainly as single lesions on exposed body areas of affected individuals. A wide age range is affected including both sexes. The potential for visceralization in the cutaneous variant of L. donovani in Sri Lanka is not known. There is no evidence for a serological response in CL patients who have demonstrated negative for rK 39 antibodies in sera, (rk39 test being the recommended test for VL detection), while MCL and VL cases have been rK39 positive.Phlebotomus argentipes, the vector of L. donovani in other parts of the world is a widely prevalent insect in almost all parts of Sri Lanka. Studies are underway for vector identification. L.donovani is transmitted between this vector and the human host, the only known host for this species. However, domestic dogs have shown the presence of Leishmania parasites and also the presence of anti -L. donovani antibodies in their sera, providing primary evidence for the likely presence of an animal reservoir in Sri Lanka. Field-based risk factor studies have shown that there is peri-domestic as well as zoonotic/outdoor transmission cycles in different parts of the country.At present patients are detected mainly passively based on self referrals. Only a proportion of these patients proceed for pre-treatment laboratory confirmation due to the lack of freely available investigation facilities. Leishmaniasis was made a notifiable disease in Sri Lanka in 2008. Action plan for its control was drawn up with primary involvement of the Ministry of Health and other stake holders in 2008. Preventive and control activities are required to be put in place sooner rather than later. Enhanced case detection and active treatment are of prime value in controlling L.donovani infections. Availability of cost effective and field friendly diagnostic services in a decentralized manner, timely case management and vector control using appropriate protocols are necessary. To achieve this, a considerable amount of information is already available, and further research is needed to fill in the essential gaps.

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“…In HIV-infected patients, leishmaniasis slows immune restoration and is associated with a high tendency to experience relapse [8][9][10]. Cases of leishmaniasis mimicking malignant disorders or developing in patients who have received a diagnosis of cancer have been described [11][12][13][14][15]. This can either lead to misdiagnosis or cause a delay in the establishment of the correct diagnosis.…”

Section: A N S W E R T O T H E P H O T O Q U I Zmentioning

confidence: 99%

“…However, local tissue damage as a result of radiotherapy could explain the spread and the high local viral load of parasites. Few cases of leishmaniasis after radiotherapy have been reported [14,16].…”

Section: A N S W E R T O T H E P H O T O Q U I Zmentioning

confidence: 99%