BackgroundPentavalent antimonials have been the first line treatment for dermal leishmaniasis in Colombia for over 30 years. Miltefosine is administered as second line treatment since 2005. The susceptibility of circulating populations of Leishmania to these drugs is unknown despite clinical evidence supporting the emergence of resistance.Methodology/Principal Findings In vitro susceptibility was determined for intracellular amastigotes of 245 clinical strains of the most prevalent Leishmania Viannia species in Colombia to miltefosine (HePC) and/or meglumine antimoniate (SbV); 163, (80%) were evaluated for both drugs. Additionally, susceptibility to SbV was examined in two cohorts of 85 L. V. panamensis strains isolated between 1980–1989 and 2000–2009 in the municipality of Tumaco. Susceptibility to each drug differed among strains of the same species and between species. Whereas 68% of L. V. braziliensis strains presented in vitro resistance to HePC, 69% were sensitive to SbV. Resistance to HePC and SbV occurred respectively, in 20% y 21% of L. panamensis strains. Only 3% of L. V. guyanensis were resistant to HePC, and none to SbV. Drug susceptibility differed between geographic regions and time periods. Subpopulations having disparate susceptibility to SbV were discerned among L. V. panamensis strains isolated during 1980–1990 in Tumaco where resistant strains belonged to zymodeme 2.3, and sensitive strains to zymodeme 2.2.Conclusions/SignificanceLarge scale evaluation of clinical strains of Leishmania Viannia species demonstrated species, population, geographic, and epidemiologic differences in susceptibility to meglumine antimoniate and miltefosine, and provided baseline information for monitoring susceptibility to these drugs. Sensitive and resistant clinical strains within each species, and zymodeme as a proxy marker of antimony susceptibility for L. V. panamensis, will be useful in deciphering factors involved in susceptibility and the distribution of sensitive and resistant populations.

Actinic prurigo is a chronic photodermatosis with onset in childhood or before 20 years of age. It is most prevalent in Amerindians and Latin American mestizos, although it has been reported worldwide. Patients present with photodistributed, erythematous excoriated papules, cheilitis, and conjunctivitis. There is strong association with human leukocyte antigen DR4, especially the DRB1*0407 subtype. Treatment consists of photoprotection and the use of thalidomide.

Time between first symptoms and diagnosis is the key predictive factor of disability at time of leprosy diagnosis. Strengthening of active searching for infected people and promotion of early diagnosis are recommended.

Disseminated histoplasmosis in South America is associated with AIDS in 70-90 % of cases. It is visceral and cutaneous, compromising the oral, pharynx, and laryngeal mucous membranes. The involvement of the nasal mucosa is unusual. Two patients with perforation of the nasal septum as the only sign of their disease were clinically and histopathologically diagnosed as leishmaniasis. The revision of the biopsies and the culture of nasal discharge secretions showed that the pathogens seen were not amastigotes but Histoplasma capsulatum. Other mycotic lesions were not detected, nor there was history of cutaneous leishmaniasis. The leishmanin skin test, available only for the male patient, was negative. The PCR and immunofluorescence antibody titers for Leishmania were negative in both patients. They were HIV positive; in the male, his CD4+ T cell count was 60/mm(3) and in the female 133/mm(3). The nasal ulcer was the only manifestation of histoplasmosis and the first of AIDS in both patients. The male patient recovered with amphotericin B and itraconazole treatment. The female has improved with itraconazole. Both patients received antiretroviral treatment. Nasal mucous membrane ulcers should include histoplasmosis among the differential diagnosis. In conclusion, two patients had perforation of their nasal septum as the only manifestation of histoplasmosis, a diagnosis confirmed by nasal mucosa biopsy and by culture of H. capsulatum, findings which demonstrated that both patients had AIDS.

Introducción: En Colombia no existen instrumentos específicos validados para evaluar la calidad de vida con acné. Este estudio realizó validación lingüística al español y psicométrica de un instrumento para evaluar la calidad de vida con acné. Material y métodos: Validación psicométrica en pacientes con acné. La consistencia interna y la estabilidad en el tiempo se evaluaron con coeficientes a de Cronbach y correlación de Lin, mientras que la sensibilidad al cambio fue calculada con respuesta media estandarizada (SMR) y la evidencia relacionada con contenido con el método Delphi. Análisis factorial para evaluar evidencia relacionada con estructura interna. La evidencia de validez de constructo se evaluó con prueba de Kruskal Wallis o correlación de Spearman. Resultados: La consistencia interna es adecuada (a Cronbach 0.74-0.90); la estabilidad moderada (la correlación de Lin fue de 0.67-0.72). La sensibilidad al cambio satisfactoria (SMR 0.61-0.90) y los resultados de asociaciones con otras variables constituyen evidencia de validez de constructo. El análisis factorial confirmatorio permite concluir que la estructura de cuatro dominios no se mantiene en esta versión y el análisis factorial exploratorio de factores principales propone una estructura de tres factores. Conclusiones: La versión en español de la escala Acne-QoL se considera equivalente conceptual y semánticamente a la versión original, demuestra adecuadas propiedades psicométricas, pero puede beneficiarse de modificaciones.