Abstract. In the Amazon Basin of Peru, more than 50% of patients with uncomplicated Plasmodium falciparum malaria fail to respond to treatment with chloroquine or sulfadoxine-pyrimethamine. To assist the National Malaria Control Program in identifying an alternative first-line therapy for this region, we conducted a trial of the safety and efficacy of mefloquine (MQ) compared with mefloquine-artesunate (MQ-AS) combination therapy. Patients with uncomplicated P. falciparum infections between the ages of 5 and 50 years were randomly assigned to be treated with either MQ (15 mg/kg in a single oral dose) or MQ (15 mg/kg) plus AS (4 mg/kg/day for three days). A total of 98 patients were enrolled and followed for 28 days. None of the 47 patients who received MQ alone or the 51 patients who received MQ-AS combination therapy had recurrences of parasitemia during the 28-day follow-up period. Asexual parasite densities decreased significantly more rapidly and the proportion of patients with gametocytes was significantly lower on days 3−21 in the MQ-AS group than in patients treated with MQ alone. All patients tolerated the medication well. Based on the results of this study and with the objective of slowing the development of resistance, the Peruvian Ministry of Health has decided to revise its malaria treatment policy and recommend combination therapy with MQ-AS as the new first-line treatment of uncomplicated P. falciparum malaria in the Amazon region.

Eight adult patients with Buruli ulcer were seen in a recent 10-year period.

Forty patients with urinary tract infections were randomly assigned to receive a ten-day course of oral therapy with either norfloxacin 400 mg twice daily or cotrimoxazole (trimethoprim-sulfamethoxazole) 160/800 mg twice daily. There were 34 cases (19 in the norfloxacin and 15 in the cotrimoxazole group) of evaluable infections due to Escherichia coli (85% of cases), Klebsiella pneumoniae, Enterobacter spp., Proteus vulgaris and Alcaligenes faecalis. All organisms were sensitive to the assigned study drug. Twenty-two strains of Escherichia coli and five other isolates had a norfloxacin MIC50 of 0.03 mg/l and MIC90 of 1.0 mg/l. All patients were cured of the initial infection. Three diabetic patients in the norfloxacin group and another healthy patient in the cotrimoxazole group experienced asymptomatic recurrences due to organisms of the same species which, in the absence of causes of bacterial persistence, were considered to be reinfections. Mild reversible adverse effects of no clinical significance were observed in nine patients in each treatment group. Norfloxacin seems to be as effective and safe as cotrimoxazole in the conventional treatment of uncomplicated urinary tract infection.

To assist the Peruvian Ministry of Health in modifying the malaria treatment policy for their north Pacific coastal region, we conducted an in vivo efficacy trial of sulfadoxine-pyrimethamine (SP) and SP plus artesunate (SP-AS) for the treatment for uncomplicated Plasmodium falciparum infections. A total of 197 patients were randomized to therapy with either SP (25 mg/kg of the sulfadoxine component in a single dose on day 0) or a combination of SP plus AS (4 mg/kg on days 0, 1, and 2) and were followed for 28 days for symptoms and recurrence of parasitemia. No statistically significant differences between the two groups were observed on enrollment with respect to age, sex, history of malaria, or geometric mean parasite density. A total of 185 subjects completed the 28-day follow-up. Of the 91 subjects treated with SP alone, two had recurrences of parasitemia on day 7 and one on day 21. Of the 94 subjects treated with SP-AS, one had a recurrence of parasitemia on day 21. Fever and asexual parasite density decreased significantly more rapidly and the proportion of patients with gametocytemia on days 3-28 was significantly lower in subjects treated with combination therapy than in those who received SP alone. No severe adverse drug reactions were observed; however, self-limited rash and pruritus were significantly more common and an exacerbation of nausea, vomiting, and abdominal pain were observed significantly more frequently among patients who had received SP-AS. These results have contributed to a National Malaria Control Program decision to change to SP-AS combination therapy as the first-line treatment for uncomplicated P. falciparum malaria in northern coastal Peru in November 2001, making Peru the first country in the Americas to recommend this combination therapy.

RESUMENLas manifestaciones clínicas de la leishmaniosis son variables y están relacionadas con la especie infectante, su relación con el medioambiente y con la respuesta inmune del hospedero. Se presenta un caso de leishmaniosis andina cutánea tardía con una manifestación extensa. El caso se confirmó a través de estudios microbiológicos e inmunológicos, la identificación se realizó mediante secuenciamiento del gen del citocromo b, determinándose la especie como Leishmania (Leishmania) amazonensis. La paciente recibió tratamiento con estibogluconato sódico y al término de la terapia, mostró mejoría clínica de las lesiones. Se recomienda considerar a la leishmaniosis en el diagnóstico diferencial cuando se atienda ulceras crónicas dermatológicas atípicas. Palabras clave: Leishmaniasis cutánea; Leishmania; Citocromos b (fuente DeCS BIREME). CUTANEOUS LEISHMANIOSIS: UNUSUAL CLINICAL MANIFESTATION ABSTRACTClinical manifestations of leishmaniasis are diverse and related to the infecting species, its relationship with the environment and the host immune response. A case of late Andean cutaneous leishmaniasis with extensive manifestation is presented. The case was confirmed through microbiological and immunological studies; identification was performed by cytochrome b gene sequencing and the species was determined as Leishmania (Leishmania) amazonensis. The patient was treated with sodium stibogluconate and at the end of therapy the patient showed clinical improvement of the lesions. It is recommended to consider leishmaniasis in differential diagnosis when treating atypical dermatological chronic ulcers.