In a retrospective study the data concerning 49 patients with cutaneous leishmaniasis were analysed. The group included 39 patients seen in Amsterdam in the period 1979-1988 in the Royal Institute for the Tropics and the University Medical Centre and 10 patients seen in the University Hospital of Leiden in the period 1970-1982. Mediterranean countries, especially Spain, were important sources of infection. In 26 patients, one skin lesion was found. All but one of the patients had (papulo)nodules, nodules with central scab formation and/or ulcerative skin lesions. In most cases the lesions were localized on the face and extremities, one patient had a mucosal lesion of the nose, three had sporotrichoid extension and six, lymphadenitis. For demonstration of the parasite, aspiration, smear, biopsy and culture were used with varying frequencies. The biopsy and culture methods contributed most to the diagnosis. The treatment in 22 patients consisted in parenteral administration of sodium stibogluconate while 13 received primary cryotherapy. In addition, four patients were subjected to cryotherapy because of a recurrence after, or side effects of the treatment with sodium stibogluconate. In three patients, spontaneous healing was awaited. Owing to incomplete follow-up, the ultimate condition was not known of all patients; the skin lesions treated with cryotherapy all healed. In case of nodular and ulcerative skin lesions in a person who has lived in the (sub)tropics, cutaneous leishmaniasis should be considered; the geographical anamnesis is of great importance in this respect.

Adult↗

PubMed1990

The pharmacokinetics of artemisinin after oral, intramuscular and rectal administration to volunteers.

The pharmacokinetics after oral, intramuscular and rectal administration of artemisinin, a new potent antimalarial drug, to healthy volunteers has been examined. The study was set-up as a four-way cross-over design with a wash-out period of one week between the test days. In ten volunteers artemisinin concentrations in serum were monitored using a reversed phase HPLC assay with UV detection after derivatization. After oral administration, artemisinin was rapidly but incompletely absorbed, the mean absorption time was 0.78 h and the bioavailability relative to the intramuscularly injected suspension in oil 32%. The mean residence time of the latter (10.6 h) was 3 times that of the oral formulation (3.4 h). This seems to enable a twice daily dosage regimen for the intramuscular oil injection, while the oral formulation necessitates a more frequent dosing interval. After intramuscular injection and rectal administration of an aqueous suspension, very low and variable artemisinin concentrations in serum were observed, probably indicating a poor and erratic absorption.

Administration, Oral↗

PubMed1989