Treatment of Old World cutaneous leishmaniasis with dapsone, itraconazole, cryotherapy, and imiquimod, alone and in combination

Background  Cutaneous leishmaniasis (CL) is a major public health problem. The currently available therapies are expensive, not freely available, toxic, and not always curative. A simple, effective, noninvasive therapeutic approach is required for the treatment of CL.
Aims  To determine the clinical patterns of CL and to report our experience in the management of CL.
Methods  One hundred and ten patients with CL seen between January 2005 and December 2007 were included in this study. The diagnosis was based on clinical features, parasitologic diagnosis, histopathology, and culture. Each patient was treated according to disease severity with either topical (cryotherapy or imiquimod) or systemic (itraconazole or dapsone) monotherapy, or a combination of these modalities.
Results  CL was more common in adult expatriate men, with the upper limbs as the most commonly affected site. Noduloulcerative CL was the most common presentation (84.6%). Atypical CL was found in 18 patients. Skin biopsy was the most common diagnostic technique (66.6%). Monotherapy showed an overall success rate of 56.41%, whereas combination therapy was successful in 69.56% of cases. Cryotherapy alone was successful in 68.18% of cases. Imiquimod alone was ineffective.
Conclusion  A stepwise approach represents a rational and practical way of confirming CL. A combination of itraconazole/dapsone and topically applied imiquimod is safe, simple, and effective for the treatment of CL. More studies are needed to establish the role of such an approach. Cryotherapy is also safe, simple and effective for the treatment of CL.     

Zoonotic sporotrichosis of lymphocutaneous type in a man acquired from a domesticated feline source: report of a first case in southern Karnataka, India

Background  Sporotrichosis is commonly encountered due to traumatic implantation of thorns or decayed vegetation with the dimorphic fungi, Sporothrix schenckii . Zoonotic spread of Sporotrichosis is rare and we describe here the first case of feline transmission of lymphocutaneous sporotrichiosis encountered in India.
Methods  An excision biopsy of nodulo-ulcerative lesion from the patients right elbow and forearm were collected for histopathology and portion of the specimen processed for mycological work up. Animal pathogenicity test performed in Swiss albino mice with intraperitoneal & foot pad inoculation. In addition an investigation of the ulcerative skin lesion from the domesticated cat was carried out.
Results  Histopathology examination of tissue sample from the patient and feline lesion revealed granulomatous reaction and a few slender elongated yeast cells consistent with Sporotrichosis. The diagnosis was confirmed by culturing Sporothrix schenkii and demonstration of thermal dimorphism. Pathogenicity testing in mice lead to orchitis in 12–15 days and the organism was re-isolated in pure culture. The patient was treated with oral saturated potassium iodide solution with complete resolution of the lesions.
Conclusion  Close contact with infected domesticated feline can be a potential source of transmission for Sporotrichosis as evidenced in this report.     

Idiopathic isolated optic nerve head swelling a presentation of two cases

Optic nerve head swelling is caused by either ocular or systemic diseases of inflammatory, infective, infiltrative, compressive, or ischemic origin. Uncommonly, an isolated optic nerve head swelling without the above underlying mechanisms might also occur. Two patients presented with unilateral, isolated optic nerve head swelling. A detailed oculoneurological examination and a series of investigations failed to indicate any pathology. No probable cause for optic nerve head swelling in these patients was determined by the authors. the authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or privider of services discussed in this article. The authors also do not discuss the use of off-label products, which include unlabeled, unapproved, or investigative products or devices.