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January 1989, Volume 39, Issue 1

Case Reports

MEBENDAZOLE IN CUTANEOUS LEISHMANIASIS

Noon S.Al-Waili  ( Private Clinic, House 34,Street 42,Section 729, Al-Mashtel, New Baghdad, Baghdad, Iraq. )
Subhi S. Dawood Al-Waili  ( Private Clinic, House 34,Street 42,Section 729, Al-Mashtel, New Baghdad, Baghdad, Iraq. )

Cutaneous leishmaniasis is endemic in the Mediterranean area, the Middle East and Central Asia. It represents major health problems. In Iraq, the disease is prevalent and known as Baghdad boil1. The lesions are self-healing but their duration is long and often unpredictable. They are uncomfortable and morbidity is expected particularly with multiple lesions. Each lesion heals with scar that is proportional to the size and site of the lesion. The scar and disfiguring site are inevitable even with or without available drugs which are often unsatisfactory and some of them have side effects. Mebendazole, a broad spectrum anthel­minthic drug, has been found to be effective in the treatment of protozoal infection including Giardia lam blia, Chilomastix mesnill and Trichomonis homonis2,3 and Schistosoma haematobium and S. mansoni4,5. Therefore, an attempt was made to investigate the possible effect of mebendazole in the treatment of another protozoan, Leishmania tropica, which infected three adult patients.

CASE REPORTS

Three adult patients, residents of Baghdad City, attended the clinic with 1-2 months history of typical oriental sore lesions. Physical examina­tion showed that the lesions were raised, crusted and fungating at granulomatous stages. One patient had three lesions on the lateral aspect of extensor surface of the right forearm, and one patient had two lesions on the right and left forearm. The other patient had one lesion on the left forearm and two lesions on the right leg. These cutaneous lesions were non-tender and the subcutaneous tissue was indurated. Scrapings were made at the edge of the lesions and smears were prepared and stained with Giemsa. Amastigotes (Leishman-Donovan bodies) were found in the smears. Laboratory investigations including haem­atological indices, hepatic and renal functions were normal. VDRL was negative. The patients had no previous anti-leishmanial treatment. After informed consent 1 g/day of mebendazole was given in three doses. The patients were jnstructed to attend the clinic twice weekly and to record any side effects including headache, dizziness, vertigo, nausea, vomiting, palpitation, skin rash and pyrexia. Laboratory investigations were repeated at two weeks interval. At two weeks, there was an obvious decrease in the size of lesions with less exudate. The lesions were dry and resolved completely at four weeks with very minimal residual scaring and pigmentation. The slit skin smear failed to reveal leishmanian organism. No side effect was recorded and the drug did not induce any changes in the laboratory investiga­tions. Six months follow-up was uneventful and the pigmentation resolved in few months.

DISCUSSION

Mebendazole in a dose of 1 g/day appeared to heal cutaneous leishmaniasis. It was well tolera­ted and had no side effects. No hepatic, haemato­logical or renal adverse effects were encountered. The lesions healed completely within 4 weeks without evident and disfiguring scaring. The mode of action is not known. However, meben­dazole can kill tissue parasites in high doses6. It might stimulate host immunity against leish­manian organisms as has been suggested with other parasitic infections7. It has been known that mebendazole blocks carbohydrate uptake by nématodes and decreases ATP which is essential for survival. The mainstay of therapy for both cutaneous and mucocutaneous leishmaniasis consisted of pentavalent antimonials8. Neverthe­less, oriental sore in Iraq responded poorly to them9. Other drugs including cotrimexazole, rilampicin, allopurinol, metronidizole, levamizole and more recently ketaconazole10 have many side effects. Therefore Mebendazole might re­present the non-toxic, inexpensive oral medicine for treating leishmaniasis.

REFERENCES

1. Guirges, S. Y. Natural and experimental rein­ fection of man with oriental sore. Ann. Trop. Med. Parasit., 1971;65: 197.
2. Al-Waili, N. Mebendazole in trichomonis hominis. Clin. Exp. Pharmacol. Physiol., 1987; 14: 679.
3. Al-Wail, N., Al-Waili, B. and Saloom, K. Meben­dazole for treatment of giardial infections. Trans. R. Soc. Trop. Med. Hyg., 1988; (in Press).
4. Al-Waili, N. Mebendazole in the treatment of Schistosoma haematobium. Trans. R. Soc. Trop. Med. Hyg., 1987; 81; 781.
5. Al-Waili, N. Therapeutic effects of mebendazole in the treatment of Schistosoma mansoni and S. haematobium. Trans. R. Soc. Trop. Med. Hyg., 1988; (in Press).
6. Campbell, W. C., McCracken, R. 0. and Blair, L.S. Therapy of hydatid disease. JAMA., 1974; 230: 825.
7. Kamath, V., Bhopale, M., Bhide, M. Immunolo­gical evidence of chemotherapeutic action of mebendazole against Ancylestceylanicum (loose, 1911) in hamaster (Mesocricetus auratus). J. Helminthol., 1985;59: 195.
8. Anonymous, Drugs for parasitic infections. Med. Letter, 1978; 2:17.
9. Rahim, G. F. and Tatar, I. H. Oriental sore in Iraq. Bull. Endem. Dis., 1966; 8:29.
10. Kubba, R., Al-Gindan, Y., El-Hassan, A. and Omer, A. Ketaconozole in cutaneous leishmani­asis result of a pilot study. Saud. Med. J., 1986; 7: 596.

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