Leishmaniasis is a disease that ranges in severity from skin lesions to serious disfigurement and fatal systemic infection. WHO has classified the disease as emerging and uncontrolled and estimates that the infection results in two million new cases a year. There are 12 million people currently infected worldwide, and leishmaniasis threatens 350 million people in 88 countries. Current treatment is based on chemotherapy, which relies on a handful of drugs with serious limitations such as high cost, toxicity, difficult route of administration and lack of efficacy in endemic areas. Vaccination remains the best hope for control of all forms of the disease, and the development of a safe, effective and affordable antileishmanial vaccine is a critical global public-health priority. Extensive evidence from studies in animal models indicates that solid protection can be achieved by immunization with defined subunit vaccines or live-attenuated strains of Leishmania. However, to date, no such vaccine is available despite substantial efforts by many laboratories. The major impediment in vaccine design is the translation of data from animal models to human disease, and the transition from the laboratory to the field. Furthermore, a thorough understanding of protective immune responses and generation and maintenance of the immunological memory, the most important and least-studied aspect of antiparasitic vaccine development, during Leishmania infection is needed. This review focuses on recent findings in antileishmania vaccine field and highlights current difficulties facing vaccine development and implementation.

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The available treatment options for visceral leishmaniasis (VL) have problems relating to efficacy, adverse effects and cost, making treatment a complex issue. We review the evidence relating to the different methods of treatment in relation to - efficacy and toxicity of the drugs in different areas of the world; ability to monitor side effects, length of treatment; ability of patients to pay for and stay safe during treatment, ability of the healthcare services to give intramuscular, intravenous or oral therapy; the sex and child-bearing potential of the patient and the immune status of the patient. The high mortality of untreated/ poorly treated VL infection makes the decisions paramount, but a unified and coordinated response by each area is likely to be more effective and informative to future policies than an ad hoc response. For patients in resource-rich countries, liposomal amphotericin B appears to be the optimal treatment. In South Asia, miltefosine is being used; the combination of single dose liposomal amphotericin B and short course miltefosine looks encouraging but has the problem of potential reproductive toxicities in females. In Africa, the evidence to switch from SSG is not yet compelling. The need to monitor and plan for evolving drug failure, secondary to leishmania parasite resistance, is paramount. With a few drugs the options may be limited; however, we await key ongoing trials in both Africa and India to explore the effects of combination treatment. If safe and reliable combinations are revealed by the ongoing studies, it is far from clear as to whether this will avoid leishmania parasite resistance. The development of new drugs to add to the armamentarium is paramount. Lessons can be learnt from the management of diseases such as tuberculosis and malaria in terms of planning the switch to combination treatment. As important as establishing the best choice for specific antileishmanial agent is ensuring treatment centers, which can best manage the problems encountered during treatment, specifically malnutrition, bleeding, intercurrent infections, drug side effects and detecting and treating underlying immunosuppression.

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Leishmania parasites have been widely used in experimental models to understand generation, maintenance and failure of immune responses underlying resistance and susceptibility to infection. The clinical outcomes of Leishmania infection depend on the infecting species and the immune status of the host. Noticeably most people exposed Leishmania never develop overt disease. Understanding the immunological events that result in failure or successful control of the parasites is fundamental to both design and evaluation of vaccines and therapies against the leishmaniases. Recent studies visualizing immune response to Leishmania major in the skin have given new insights into the different immune cells acting as hosts the parasite during different stage of infection. Control of Leishmania infection and disease progression has been associated with generation of T-helper (Th) 1 and Th2 responses respectively. Though still valid in several aspects, the Th1/Th2 paradigm is an oversimplification in need of revision. Th2 polarization has never explained severity of human leishmanial disease and a number of other T-cell subsets, including regulatory T- and Th17- cells, have important roles in susceptibility and resistance of both experimental and human leishmanial disease. This review gives an updated overview of immunological response considered to be of importance in protection, susceptibility, disease progression and cure of leishmaniasis, with a special emphasis on human diseases.

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Aims : The study aims to determine the: 1. frequency of inappropriate catheterization in medical wards and the reasons for doing it. 2. various risk factors associated with inappropriate catheterization, catheter associated urinary tract infections (CAUTI) and bacterial colonization on Foley's catheters (BCFC). Settings and Design: Hospital-based prospective study. Materials and Methods: One hundred and twenty five patients admitted consecutively in the medical wards of a tertiary care hospital, who underwent catheterization with a Foley's catheter, at admission, have been included in the study. Patient profiles were evaluated using the following parameters: age, sex, diagnosis, functional status, mental status, indication, duration and place of catheterization, development of BCFC and CAUTI. Statistical tests used: Chi-square test. Results: Thirty-six out of 125 (28.8%) patients included were inappropriately catheterized. BCFC developed in 52.8% and 22.4% were diagnosed with a CAUTI. The most frequent indication for inappropriate catheterization was urinary incontinence without significant skin breakdown (27.8%). The risk factors for inappropriate catheterization were female sex (RR=1.29, 95% CI=0.99, 1.69, P<0.05) and catheterization in the emergency (RR=0.74, 95% CI=0.61, 0.90, P<0.05). The risk factors for developing a BCFC were age>60 years (RR=0.65, 95% CI=0.48, 0.89, P<0.05), non-ambulatory functional status (RR=0.57, 95% CI=0.39, 0.84, P<0.01), catheterization in the emergency (RR=2.01, 95% CI=1.17, 3.46, P<0.01) and duration of catheterization>3 days (RR=0.62, 95% CI=0.43, 0.89, P<0.01). The risk factors for acquiring a CAUTI were age>60 years (RR=0.47, 95% CI=0.25, 0.90, P<0.05), impaired mental status (RR=0.37, 95% CI=0.18, 0.77, P<0.01) and duration of catheterization>3 days (RR=0.24, 95% CI=0.10, 0.58, P<0.01). Conclusions : Inappropriate catheterization is highly prevalent in medical wards, especially in patients with urinary incontinence. The patients catheterized in the medical emergency and female patients in particular are at high risk. Careful attention to these factors can reduce the frequency of inappropriate catheterization and unnecessary morbidity.

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Context : A school child educated about the benefits of sanitation and good hygiene behavior is a conduit for carrying those messages far beyond the school walls, bringing lasting improvement to community hygienic practices. Aims : To study the status of school environment and sanitation in rural India. Settings and Design: Government schools in rural Karnataka, cross sectional study. Materials and Methods: Twenty schools were randomly selected for the study. Informed consent was taken from the Heads of the schools. A pre tested close ended questionnaire was used to get the information. The minimum standards for sanitation of the school and its environment in India were used as the guiding principles to evaluate the appropriateness/ adequacy of the various attributes. Statistical analysis used: Percentages and proportions. Results : Out of 20 schools selected, one fourth of the schools were located/ sited at inappropriate places. Only half of the schools had appropriate/ adequate structure. Eighteen (90%) of the schools were overcrowded. Ventilation and day light was adequate for 12(60%) and 14(70%) of the schools respectively. Cleanliness of school compound/classrooms was adequate in 80% of the schools. There were no separate rooms for serving the midday meals in any of the schools under study. Eighteen (90%) of the schools were having drinking water points. Liquid and solid waste disposal was insanitary in six (30%) and eight (40%) of the schools respectively. Only half of the schools had adequate latrines for boys and 60% for girls. Only two (10%) of the schools had adequate hand washing points with soap. Conclusions : Environment and sanitation facilities at many of the schools are not fully satisfactory.

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The treatment options of leishmaniasis are limited and far from satisfactory. For more than 60 years, treatment of leishmaniasis has centered around pentavalent antimonials (Sb ^v ). Widespread misuse has led to the emergence of Sb ^v resistance in the hyperendemic areas of North Bihar. Other antileishmanials could also face the same fate, especially in the anthroponotic cycle. The HIV/ visceral leishmaniasis (VL) coinfected patients are another potential source for the emergence of drug resistance. At present no molecular markers of resistance are available and the only reliable method for monitoring resistance of isolates is the technically demanding in vitro amastigote-macrophage model. As the armametrium of drugs for leishmaniasis is limited, it is important that effective monitoring of drug use and response should be done to prevent the spread of resistance. Regimens of simultaneous or sequential combinations should be seriously considered to limit the emergence of resistance.

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Liposomal amphotericin B has been used with increasing frequency to treat visceral leishmaniasis (VL). It is the treatment of choice for immunocompetent patients in the Mediterranean region and the preferred drug for HIV/VL co-infection. Although there is a regional variation in the susceptibility of the parasite a total dose of 20 mg/kg is effective in immunocompetent patients. Randomized clinical trials of liposomal amphotericin B in the treatment and secondary prophylaxis of HIV-VL coinfected patients is urgently needed to optimize treatment in this subset. With the availability of Liposomal amphotericin B at a preferential pricing in the endemic areas, short course combination therapy can become a viable alternative.

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Vector control remains a key component of many anti-leishmaniasis programs and probably will remain so until an effective vaccine becomes available. Technologies similar to those used for control of adult mosquitoes, specifically interior residual sprays and insecticide-treated nets, are currently at the forefront as disease control measures. This article provides a review of literature on the biology and control of sand fly vectors of leishmaniasis in the context of changing disease risks and the realities of modern vector control. The Literature Retrieval System of the Armed Forces Pest Management Board, Washington, DC, was the primary search engine used to review the literature.

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Background: Ibuprofen and acetaminophen are common chemical agents that have anti-inflammatory, antipyretic, and analgesic activity. Aims: To detect any potential antibacterial effects of ibuprofen and acetaminophen on pathogenic bacteria. Materials and methods: Ibuprofen and acetaminophen were tested for antibacterial activity against seven isolates of bacteria including gram positive bacteria (Staphylococci aureus and Bacillus subtilis) and gram negative bacteria (E. coli, Enterobacter aerogenes, Enterobacter cloacae, Salmonella typhi and Paracoccus yeei). Spectrophotometer assay was applied to determine the antibacterial activities of ibuprofen and acetaminophen. Three controls were included in this study: Ampicilline sodium (20 μg/ml); cefotaxime sodium (20 μg/ml) and chemical free medium. Results: Staphylococcus aureus and Paracoccus yeei were susceptible to lower concentrations of ibuprofen and acetaminophen (MIC=1.25 mg/ml), while two strains of Enterobacter exhibited resistance to these agents. Conclusions: Ibuprofen and acetaminophen showed a potential antibacterial effect on isolated strains of bacteria. They had the same ability to inhibit bacterial growth.

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There are many challenges facing the successful control and eradication of cutaneous and visceral leishmaniasis. Leishmaniasis is still endemic in many poverty stricken and war torn areas. Through the use of an extensive literature review, this article examined the global disease burden of cutaneous and visceral leishmaniasis. Surveillance and control measures for leishmaniasis being used by the World Health Organization were also discussed in this article. Finally, potential new treatments and possible vaccines for leishmaniasis were reviewed in this article.

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Introduction : This paper is a part of the helminthological studies carried out on school-going children of the Kashmir Valley and deals with the status of intestinal helminths in the children of Gurez Valley and to assess epidemiological factors associated with the extent of endemic disease so that control measures are adopted. Material and Methods : Stool samples were collected from 352 children from Gurez Valley. The samples were processed using Kato-Katz thick smear technique, and microscopically examined for intestinal parasites. Results : Of the 352 children surveyed, 75.28% had one or more types of intestinal helminthes. Prevalence of Ascaris lumbricoides was highest (71.18%), followed by Trichuris trichiura (26.42%), Enterobius vermicularis (13.92) and Taenia saginata (5.39%). Conditions most frequently associated with infection included the water source, defecation site, personal hygiene, and the extent of maternal education. Conclusion : The study shows a relatively high prevalence of intestinal helminths and suggests an imperative for the implementation of control measures.

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Mucocutaneous is an infection caused by a single celled parasite transmitted by sand fly bites. There are about 20 species of Leishmania that may cause mucocutaneous leishmaniasis. Some Leishmania species are closely linked to humans and are therefore found in cities (L. tropica) whereas some others are more traditionally associated with animal species and therefore considered zoonoses (L. major). The evidence for optimal treatment of mucocutaneous leishmaniasis is patchy. Although the cutaneous form of the disease is often self-limiting, it does result in significant scarring and can spread to more invasive, mucocutaneous disease. Therefore, treatment may be considered to prevent these complications. Drugs for systemic and topical treatment are presented and discussed with regard to their application, use and adverse effects.

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We report the case of a 31-year-old male presenting with complaints of mild pain in the right ear for three months and hypoacusis for 10 days. On otoscopic examination, a thin, papery, white material was extracted from his ear and sent for fungal identification. This material revealed presence of Malassezia spp - with characteristic "spaghetti and meat ball appearance". The patient was treated with 2% acetic acid, hydrocortisone and Clotrimazole powder for one week and he resolved completely.

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Background : In India, indigenous cases of cutaneous leishmaniasis (CL) are mainly confined to the northwestern region. But now, more and more case reports are coming in from other parts of India. In January 2009, a 26-year-old lady residing in a forest area in Thiruvananthapuram district of Kerala State presented with bluish red nodules on her upper extremities, of six months duration, which was clinically more in favor of cutaneous leishmaniasis. She had never gone out of the district of Thiruvananthapuram in her life. Aim : To investigate whether the patient hails from a new endemic focus of cutaneous leishmaniasis. Setting and Design : An epidemiological investigation in the form of a survey was carried out in March 2009 by a multidisciplinary team among 63 persons residing in the Mele Aamala and Aayiramkala forest tribal settlements in Kuttichal Panchayat of Thiruvananthapuram district. Material and Methods : History taking and clinical examination of 38 persons in the area with special consideration to skin lesions was undertaken. Microbiological and histopathological examination of the skin lesions was done. Breeding places of sand fly and possible reservoirs of Leishmania were also simultaneously investigated. Statistical analysis used : The data obtained was tabulated as frequency and percentage. Chi-square test was done to find out the statistical significance of differences in distributions. Results : Out of the 38 persons examined, active lesions were found in 12 persons and six had healed lesions. Tissue samples were obtained from seven out of the 12 suspected cases. Four of them showed Leishman Donovan (LD) bodies in tissue smears. Out of the cultures taken from three patients, one showed promastigote forms in Novy McNeal Nicolle (NNN) medium. Histopathological study was done in five patients and two patients had LD bodies, one had epithelioid cell granuloma and the other two had mixed infiltrate with predominantly macrophages. All the three investigations were carried out in three patients and out of them one showed positivity in all the three investigations and the rest two were positive in tissue smear and histopathological examination. Sandflies collected from the area gave an indirect evidence of its role in the disease transmission in the area. Conclusion : The clinical, microbiological and histopathological evaluation of the skin lesions was consistent with cutaneous leishmaniasis. But none of the patients gave history of travel outside the district before the onset of the disease and no one had newly moved into this area within the last two years. So this may be considered as probably a new focus of cutaneous leishmaniasis

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A 31-year-old human immunodeficiency virus-positive male who presented to the Dermatology Outpatient Department with complaints of red, raised lesions on the face of 2 weeks duration was, on examination, found to have multiple papulonodular lesions on the face with associated cervical and axillary lymphadenopathy. There was history of local injury on the face 6 months prior to the development of symptoms. Skin biopsy revealed multiple round to oval spores with surrounding halo intracellularly, confirming the diagnosis of cutaneous histoplasmosis. No systemic involvement was detected on further investigations. The patient responded to oral antifungals in a short duration, confirming the local nature of the presentation. This is probably the first time in the literature that a primary cutaneous manifestation of histoplasmosis is being described in an immunocompromised individual.

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Aims: This study aims to assess the feeding inhibition and repellency effect of three brands of mosquito coils in experimental huts (East African design). Evaluated products were all pyrethroid-based mosquito coils - Kiboko^; , Total^; and Risasi^; . Mosfly (0.1% D-allethrin) was a positive control. Indoor resting behavior, feeding inhibition and induced exophily were measured as responses of burnt coil smoke in huts. Materials and methods: Resting mosquitoes were collected inside the huts, in window traps and verandah traps using mechanical aspirators. Identified to species level and sex. Results: A total of 1460 mosquitoes were collected, 58.9% (n=860) were Anopheles gambiae s.l while 41.1% (n=600) Culex quinquefasciatus. Indoor resting mosquitoes in all treated huts were significantly reduced than in negative control (DF=4, F=18.6, P < 0.001). Species found to rest indoors were not statistical different between the positive control (Mosfly coil) and other three treated huts (DF=3, F=1.068, P=0.408). Cx.quinquefasciatus had significantly higher induced exophily in all treatments comparing to An.gambiae s.l (DF=1, F=5.34, P=0.050). Comparison between species (An.gambiae s.l and Cx. quinquefasciatus) for the feeding inhibition among treated huts was not statistically significant (DF=1, F=0.062, P=0.810). Conclusion: Introduction of several personal protection measures will be ideal to supplement the existing gap in reducing the man vector contacts hence lowering the disease transmission.

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This report presents histopathological evidence of mycotic infection of the gingival epithelium followed by inverted verrucous giant cell epitheliomata of the gingiva. Sections from biopsy tissue revealed intercellular spaces of the parabasal squamous epithelium parasitized by Periodic Acid Schiff stain positive branching septate hyphae and conidia of morphological appearance of Trichophyton. Epithelial cells presented epitheliomatous proliferation with formation of giant cells showing phagocytosed fragments of mold.

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Aim: The host-response to hematophagus insects is still an important parameter in understanding disease transmission patterns. We investigated the feeding and mortality rates of three mosquito species, namely Culex quinquefasciatus, Aedes aegypti and Anopheles arabiensis against three different hosts. Materials and Methods: Unfed three to five-day-old female mosquitoes were released in a tunnel box that had a rabbit or guinea pig or mice as a host. The feeding succession patterns of mosquitoes in different hosts were An. arabiensis, Cx. quinquefasciatus and A. aegypti. Results: Mosquito mortality rate was 54.9% for mosquitoes introduced in mice as a host, 34.3% in the Guinea pig and 10.8% for those that introduced in the rabbit. Conclusion: The presence of defensive and tolerable hosts in environment emphasizes the relevance of studying epidemiological impact of these behaviors in relation to diseases transmission.

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Mucormycosis is rare in clinical practice. Most infections are acquired by inhalation; other portals of entry are traumatic implantation and ingestion in immunocompromised host. Mucormycosis is life threatening infection in immunocompromised host with variable moratlity ranging from 15 -81% depending upon site of infection. General treatment principles include early diagnosis, correction of underlying immunosuppression and metabolic disturbances, adequate surgical debridement along with amphotericin therapy. We describe surgical site mucormycosis extended to involve large bowel in elderly diabetic patient.

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Background: Methylxanthine has many antimicrobial effects on different types of organisms. Synergism actions between methylxanthine and cadmium or mercury on dermatophytes were tested. Aims: To determine the synergistic property between methylxanthine and cadmium or mercury on the growth of dermatophytes. Materials and Methods: Two isolated strains of dermatophytes (Trichophyton mentagrophytes and Epidermophyton floccosum) that clinical isolated were treated with the mixtures of methylxanthine either with cadmium or with mercury by using colony diameter method. Percentage inhibition was also calculated based on perpendicular colony diameters of grown fungi. Results: Cadmium had high ability to increase inhibitory action of methylxanthine agents on dermatophytes. Epidermophyton floccosum revealed more susceptibility to tested mixture than those of Trichophyton mentagrophytes. Mercury exhibited variable effects on dermatophytes after mixing with methylxanthine. Conclusions : Effective concentrations of methylxanthine on dermatophytes decreased in the presence of cadmium and mercury. Variable susceptibility of two species of dermatophytes to prepared mixture was noted.

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