Delmas K. Kitchen

TREATMENT OF PINTA WITH ANTIBIOTICS

Pinta, or mal del pinto, is a nonvenereal treponematosis known by many colloquial names. It is an ancient primitive tropical disease, essentially in the Western Hemisphere, which probably existed among the Aztecs a t the time of the Spanish Conquest. Iriate’ believes that a t least 400,000 cases are present in Colombia. The Mexican Public Health Department Census? in 1929-1931, revealed a prevalence of more than 250,000 cases in Mexico, with a predominance in the southern and southwestern areas, and it is estimated that the prevalence has increased to more than one-half million patients with the disease. The incidence rate for all of Mexico2 is 1.61 per cent, with each state varying widely in the total numbers present. The disease also occurs in Cuba, Haiti, Dominican Republic, Ecuador, Argentina, Venezuela, Peru, and Central America. To date, attempts to treat the disease have been confined largely to penicillin, or the older type of heavy-metal therapy. The results with the latter have been documented over the period of years during which heavy metals were used for the treatment of treponematoses. Aside from heavy metals and penicillin, only a few reports”’ l2 have appeared in the literature in which other antibiotics have been used. Some of these, as in the case of our own studies, had to do principally with the determination of the treponemal disappearance time from skin fluids of patients, following treatment with antibiotics such as chloromycetin, aureomycin, and terramycin. Reference to this part of our work is made later in this article. The present report deals with the evaluation of the clinical and serologic results in a series of 665 Mexican Indian peasants with pinta. They were treated with microcrystalline procaine penicillin G gelled in oil and aluminum monostearate (PAM).* The study was started on September 8, 1948. It will be noted that pinta is essentially a disease of childhood, since it is contracted by casual contact early in life. Although there is no evidence for the existence of congenital pinta, over 41 per cent of all patients in our series were in the age group of from five to 15 years. Clinical manifestations, so far as we know, are confined entirely to the skin. There is no proven evidence that there ever occurs visceral or central nervous system involvement. The lesions are so varied and intermingled that classification into sharply delineated stages, as in the case of the other treponemal diseases, is almost impossible. The cases were classified into early and late stages, and the following is a brief clinical description of our patients in each.

THE EFFECT OF HIGH CONCENTRATIONS OF PENICILLIN ON LEISHMANIA TROPICA, IN VIVO AND IN VITRO.

THE relatively low doses of penicillin commonly used in therapy are generally conceded to have no effect on Leishmania tropica either in vivo (Snow, 1944 ; ]>ostrovsky et al, 1946) or in vitro (Halawani and El Kordy, 1946). Adler and Pulvertaft {Adler et al., 194S) found that leishmania in culture was inhibited by crude preparations of penicillin, but that purified penicillin had no effect. Although secondary bacterial infection of leishmanial lesions may be controlled by such treatment, the primary leishmanial lesion lias been observed to remain unaffected (Sen Gupta and Chakravarty, li)45 ; Constantini, 1947 ; Pisacane, 1948 ; Lefranc, 1949a, b ; Mechin and Si Hassen, 1949).