Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Six weeks after his return from a two-week vacation in Croatia a 52 year-old janitor from Graz complained of loss of appetite, fever, headache, and a 9-kg weight loss. The spleen was enlarged to 16cm as measured by sonography. Laboratory tests revealed pancytopenia, a prolonged prothrombin time and elevation of serum LDH concentration. While repeated bone marrow biopsy showed no signs of leishmaniasis, high antibody titers against leishmania antigen led to the diagnosis of kala-azar. The indirect immunofluorescent antibody test (1:128) and a haemagglutination-inhibition test (1:512) showed diagnostic elevations of titers. Therapy with pentostam led to prompt defervescence and resulted in a full recovery of the patient. After six weeks a marked decrease of antibody titers in the haemagglutination-inhibition test (1:16) could be observed. Leishmaniasis has to be considered in patients with fever of unknown origin who return from Mediterranean countries. Despite a negative bone marrow biopsy a diagnosis is possible on the basis of serological tests. This is important because effective therapy is available as illustrated by this patient and because of the fact that the disease runs a lethal course if the diagnosis is missed.
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PMID:[Kala-azar acquired in Croatia]. 133 39

In an open trial, longer courses of pentavalent antimonials (Sbv) at sub-optimal doses (10 mg/kg body weight), in association with recombinant human interferon-gamma (IFN-gamma) (100 micrograms/m2 of body surface area) were administered, by daily intramuscular injections, to 13 patients with diagnoses of cutaneous or mucocutaneous leishmaniasis unresponsive to Sbv. Four patients presented with large skin ulcers, and 9 had mucosal involvement as the main manifestation, the latter affecting the nose (3 cases), nose and septum (2 cases), nose and oral cavity (1 case), and nose, pharynx and larynx (3 cases). Except for one case with severe involvement of the upper respiratory tract, the lesions were fully resolved by the end of therapy (mean duration 40 +/- 12 [SD] d, range 30-60 d) in the 11 patients who completed therapy. The main side effects were headache and fever (7 cases), together with leucopenia and eosinophilia (4 cases). It is concluded that combined administration of low doses of Sbv plus IFN-gamma may provide a novel therapeutic approach for the treatment of antimony-resistant cutaneous or mucocutaneous leishmaniasis. The possible mechanisms by which IFN-gamma contributes to resolution of the disease are discussed.
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PMID:Clinical healing of antimony-resistant cutaneous or mucocutaneous leishmaniasis following the combined administration of interferon-gamma and pentavalent antimonial compounds. 815 19

Interferon-gamma (IFN-gamma) is produced by activated T cells and probably by NK cells. Its production can be induced by mitogens, antigens and other molecules. IFN-gamma interacts with cells by binding to specific membrane receptors. IFN-gamma--1b is an Escherichia coli--derived recombinant DNA product, which has biological activity identical to natural human IFN-gamma. This IFN type is a more potent immunomodulator than IFN-alpha and IFN-beta. Long term treatment with a therapeutic dosage of IFN-gamma--1b produces a significant reduction in the incidence of serious infections in patients with chronic granulomatous disease. This cytokine can be also useful in the treatment of patients with visceral leishmaniasis, Epstein-Barr virus infections, lepromatous leprosy and other infectious diseases. Phase I and II studies have demonstrated it to be capable of producing antitumor effects, especially in metastatic renal cell carcinoma and some hematologic malignancies. Clinical trials have suggested efficacy of IFN-gamma in the treatment of severe atopic dermatitis and rheumatoid arthritis. The most common adverse reactions are fever, headaches and erythema at the injection site.
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PMID:[Biological properties and clinical applications of interferon gamma (IFN-gamma)]. 820 10

Ninety-two patients in Colombia with cutaneous leishmaniasis were randomly assigned to groups to be treated with meglumine antimonate (infected control subjects; 10 mg of antimony/kg intramuscularly, twice a day for 20 days), pentamidine (2 mg/kg every other day intramuscularly, for a total of seven injections), or itraconazole (200 mg orally, twice a day for 28 days) or to receive no treatment (negative control subjects). In the group treated with meglumine antimonate, 21 of 23 patients healed by the first follow-up visit, 1.5 months after the end of therapy, and did not relapse (91% cure rate). In the pentamidine-treated group, 23 of 24 patients healed and did not relapse (96%). Four of the 23 pentamidine-treated patients who ultimately were cured had terminated therapy prematurely (after receiving 4-6 injections) because of hypotension (2 patients), hypoglycemia (1 patient), or headache and myalgias (1 patient). In a subsequent group of 19 patients who were administered 2 mg of pentamidine/kg every other day for a total of only four injections, 14 healed without relapse (74% cure rate). The itraconazole-treated group was similar to the no-treatment control group in terms of the number of patients for whom therapy failed (75% and 64%, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Evaluation of pentamidine for the treatment of cutaneous leishmaniasis in Colombia. 838 11

Twenty male patients with zoonotic cutaneous leishmaniasis were included in this study. Each patient received 1200 mg of allopurinol/day in divided doses for a duration of one month. 80% of patients had an excellent response (cure), however, sometimes leaving mild pigmented or faintly coloured skin i.e. a more or less acceptable scar, but with no recurrence for one year follow-up. The drug was well tolerated. However, it showed headache in 20%, myalgia in 10% and transient increase of liver enzymes in 20%. All these side effects disappeared at the end of treatment. The parasites have particular enzymatic reactions that have relevance for chemotherapy. Certain purine analogous are metabolised by the parasites to nucleotides and aminated to the analogous of adinine nucleotides. These halt protein synthesis and cause break down of RNA. Allopurinol is recommended in treatment of cutaneous leishmaniasis, as it is effective, cheap, orally administered, available and with less side effects.
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PMID:Allopurinol in the treatment of zoonotic cutaneous leishmaniasis. 891 34

We treated six patients with mucosal leishmaniasis who failed to respond to glucantime (20 mg/kg/day) with ambisome (2-5 grams total dose). The daily dose was 2-3 mg/kg/day given for a minimum of 20 days. After 26-38 months of follow up, five patients were clinically cured. One relapsed after six months. No side effects of therapy were observed apart from headache after infection. Ambisome is a therapeutic option for patients with mucosal leishmaniasis unresponsive to antimonials.
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PMID:[Treatment of the mucosal form of leishmaniasis without response to glucantime, with liposomal amphotericin B]. 914 35

The efficacy and toxicity of sodium stibogluconate (SSG) at a dosage of 20 mg/(kg.d) for either 20 days (for cutaneous disease) or 28 days (for visceral, mucosal, or viscerotropic disease) in the treatment of leishmaniasis is reported. Ninety-six U.S. Department of Defense health care beneficiaries with parasitologically confirmed leishmaniasis were prospectively followed for 1 year. One patient was infected with human immunodeficiency virus; otherwise, comorbidity was absent. Clinical cure occurred in 91% of 83 cases of cutaneous disease and 93% of 13 cases of visceral/viscerotropic disease. Adverse effects were common and necessitated interruption of treatment in 28% of cases, but they were generally reversible. These included arthralgias and myalgias (58%), pancreatitis (97%), transaminitis (67%), headache (22%), hematologic suppression (44%), and rash (9%). No subsequent mucosal leishmaniasis was identified, and there were no deaths attributable to SSG or leishmaniasis.
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PMID:Safety and efficacy of intravenous sodium stibogluconate in the treatment of leishmaniasis: recent U.S. military experience. 986 60

Efficacy and safety of meglumine antimoniate and sodium stibogluconate BP 88R were compared in cutaneous leishmaniasis treatment in Corte de Pedra, Bahia, an endemic area of leishmaniasis due to Leishmania (Viannia) braziliensis. An open trial was developed with one hundred twenty seven patients who were diagnosed based on clinical criteria and Montenegro's skin test. Fifty eight patients were treated with meglumine antimoniate and 69 received sodium stibogluconate. Both groups received 20 mg/Sbv/kg/day for 20 days. Patients were followed every ten days during treatment and every month thereafter for three months. Sixty two percent patients cured with meglumine antimoniate and 55% cured with sodium stibogluconate (p = 0.42). Headache was more frequent during the first half of treatment in patients receiving sodium stibogluconate (p = 0.026). During the second half, patients treated with sodium stibogluconate showed a greater frequency of myalgia/arthralgia (p = 0.004) and abdominal pain/anorexia (p = 0.004). Three patients treated with sodium stibogluconate had severe side effects.
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PMID:[A comparative study between sodium stibogluconate BP 88R and meglumine antimoniate in the treatment of cutaneous leishmaniasis. I. The efficacy and safety]. 1049 67

Sitamaquine (WR6026) is an 8-aminoquinoline in development for the oral treatment of visceral leishmaniasis (VL). This was an open-label, dose-increasing study to determine the dose-response and safety profile for sitamaquine in Kenyan patients with VL caused by Leishmania donovani. Patients (mean age 15.9 [range = 5-47] years) received sitamaquine daily for 28 days at one of four doses: 1.75 (n = 12), 2.0 (n = 61), 2.5 (n = 12), or 3.0 (n = 12) mg/kg/day. The primary efficacy outcome was cure (absence of parasites on splenic aspirate) in the intent-to-treat population at day 180. Cure was achieved in 79 (83%) of 95 patients overall, and in 11 (92%) of 12, 49 (80%) of 61, 9 (82%) of 11, and 10 (91%) of 11 patients at sitamaquine doses of 1.75, 2.0, 2.5, or 3.0 mg/kg/day, respectively. The most frequent adverse events during active treatment were abdominal pain (12 [12%] of 97) and headache (11 [11%] of 97), and one patient in each of the 2.5 mg/kg/day and 3.0 mg/kg/day dose groups had a severe renal adverse event. The effects of sitamaquine on the kidney need further investigation. Sitamaquine was efficacious and generally well tolerated in Kenyan patients with VL.
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PMID:A phase II dose-increasing study of sitamaquine for the treatment of visceral leishmaniasis in Kenya. 1628 96

Overseas deployments place military personnel at risk for tropical diseases not typically observed on the U.S. mainland. This case describes the first reported case of brucellosis returning from Operation Enduring Freedom and Operation Iraqi Freedom. A 31-year-old infantry soldier complained of a 6-week history of headaches, relapsing fever, and constitutional symptoms since returning from Iraq. This soldier was determined to have the only reported case of brucellosis, but was one of many soldiers at risk from eating unpasteurized cheese on the local economy. Although malaria and leishmaniasis continue to be the most common deployment-related illnesses, brucellosis must also be considered in the differential of any redeployed soldier with headache, fever, and body aches. Public health as well as command elements must reinforce their role in preventing exposure to this pathogen.
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PMID:Illness in a redeployed soldier. 1752 Nov 7


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