Mucocutaneous leishmaniasis in the Federal District

Relatamos aqui 11 casos de leishmaniose tegumentar americana (LTA) em pacientes que residem no DF e que não saíram da sua área durante um tempo que variou de seis meses a dois anos antes do início da doença. Seis dos 11 pacientes, residem na cidade satélite de Planaltina. Todos têm a intradermorreação de Montenegro positiva. Dez deles têm presença de leishmânia nas lesões. Nas lesões de dois pacientes foram identificadas, pelo método de anticorpos monoclonais, Leishmania (V) braziliensis. Nove deles, foram tratados com antimonial pentavalente e dois com pentamidina. Houve duas ocorrências de recidiva, ambas, após o uso do antimonial. Constatada a presença de vetores e de pacientes infectados no Distrito Federal, acredita-se que possa estar ocorrendo infecção por leishmânia em Brasília e em suas áreas periurbanas.In the present study, we report 11 cases of mucocutaneous leishmaniasis (MCL) in patients living in the Federal District who had not left their area of residence for a period ranging from six months to two years before the onset of the disease. Six of the eleven patients live in the suburban town of Planaltina. All showed a positive Leishmanin intradermal reaction. Ten of them presentedt the parasite in their lesions. Leishmania (V) braziliensi was identified in the lesions of two patients by the monoclonal antibody method. Nine patients were treated with pentavalent antimoy and two with pentamidine. Relapse occurred in two cases after treatment with antimony. In view of the detection of vectors and infected patients in the Federal District, it is probable that Leishmania infection is occurring in Brasilia and its suburban areas

A comparative study between the efficacy of pentamidine isothionate given in three doses for one week and N-methil-glucamine in a dose of 20mgSbV/day for 20 days to treat cutaneous leishmaniasis

Setenta e nove pacientes com leishmaniose tegumentar americana, forma cutânea, foram divididos em dois grupos: o grupo experimental (I), formado por 38 pessoas que receberam isotionato de pentamidina, 4mg/kg/dia, três aplicações, IM, durante uma semana, e o grupo controle (II), formado por 41 doentes tratados com N-metilglucamina, 20mgSbV/kg/dia por 20 dias, EV. Foram identificados, por técnica de anticorpos monoclonais, 21 isolados com predominância de Leishmania (Viannia) braziliensis. Encontrou-se cura clínica em 71,05% do grupo experimental e 73,17% do grupo controle (p=0,47). Alterações de ECG foram mais freqüentes utilizando antimonial pentavalente, com significância (p<0,05). O tratamento com a pentamidina mostrou eficácia semelhante quando comparado ao antimonial e apresenta vantagens como duração reduzida de tratamento e baixa toxicidade cardiológica.Seventy-nine patients with cutaneous leishmaniasis were included in this study. The experimental group (n = 38) was treated with pentamidine isothionate in a dose of 4mg/kg/day on alternate days, for one week. The control group (n = 41) was treated with N-methylglucamine in a dose of 20mgSbV/kg/day for 20 days. Twenty-one isolates were identified using monoclonal antibody technique. We characterized Leishmania (Viannia) braziliensis, most frequently. There was a cure rate of 71.05% of the patients in the experimental group and 73.17% in the control group (p = 0.47).We found a statistical significance regarding frequency of ECG alterations between the experimental and control group (p<0.05). In our study pentamidine was as effective as antimonial for the treatment of american cutaneous leishmaniasis. It proved to be a safer drug considering heart toxicity. Moreover, it requires less time to complete the treatment

Comparative study between oral miltefosine and parenteral N-metil glucamine antimoniate for the treatment of experimental leishmaniasis caused Leishmania (Leishmania) amazonensis

Vinte e cinco camundongos infectados com Leishmania amazonensis foram tratados com antimoniato de N-metil glucamina e miltefosina oral. Critérios: medidas das patas, pesquisa de amastigotas e culturas após-tratamento. Miltefosina: 2,43mm e glucamina 3,46mm (p=0,05). Miltefosina: esfregaços e culturas negativos. Glucamina: 2 esfregaços positivos e culturas positivas (p<0,05). Concluímos que miltefosina foi semelhante à glucamina.Twenty-five mice were infected with Leishmania amazonensis and treated with glucamine and oral miltefosine. The criteria used were pad measurements and investigations of amastigotes and cultures after treatment. Measurements: miltefosine 2.43 mm and glucamine 3.46 mm (p: 0.05). Miltefosine smears and cultures were negative. Glucamine produced two positive smears and the cultures were positive (p < 0.05). Miltefosine was similar to or better than glucamine

Clinical, epidemiological and therapeuthic study of 402 patients with American cutaneous leishmaniasis seen at University Hospital of Brasilia, DF, Brazil

FUNDAMENTOS – A leishmaniose tegumentar americana é doença em expansão no Brasil. A região Centro- Oeste é hoje a terceira em incidência e a primeira em crescimento da doença. OBJETIVOS – Avaliar pacientes com leishmaniose tegumentar americana atendidos no Hospital Universitário de Brasília, quanto a aspectos clinicoepidemiológicos e resposta ao tratamento com antimonial pentavalente. MÉTODOS – Estudo do tipo série de casos de 402 pacientes, segundo sexo, idade, ocupação, procedência, formas clínicas, métodos de diagnóstico, tratamento com antimonial pentavalente e efeitos colaterais, no período de 1/1/1994 a 28/2/2003. O acompanhamento foi de um ano pós-tratamento. RESULTADOS – Predomínio de homens, lavradores, de 20 a 39 anos, com a forma cutânea. A eficácia do antimonial foi maior em pacientes com forma cutânea tratados até seis meses depois do início dos sintomas, e em pacientes do sexo feminino (diferenças estatisticamente significativas na análise multivariada). O mesmo ocorreu para pacientes com forma mucocutânea, mas sem diferença estatística significante. Alterações eletrocardiográficas foram mais freqüentes no grupo tratado com 20mg SbV/kg/dia por 30 dias em relação ao tratado por 20 dias. Eosinofilia ocorreu em 17,5% dos casos. CONCLUSÕES – Tratamento precoce, sexo feminino e a forma cutânea apresentaram índices mais elevados de cura. Alterações do eletrocardiograma aumentaram com o tempo de tratamento com antimoniais. A eosinofilia como efeito colateral ao uso do antimonial merece maior investigação. _______________________________________________________________________________________ ABSTRACTBACKGROUND - American cutaneous leishmaniasis is a disease with high prevalence and incidence in Brazil. The Brazilian Central-Western Region currently holds the third largest incidence and the first growth rate of this disease in the country. OBJECTIVES - To evaluate clinical, epidemiological and treatment features of patients with American cutaneous leishmaniasis seen at the University Hospital of Brasília. METHOD - A case series study with 402 patients was carried out, spanning the period between January 1st, 1994 and February 28th, 2003. The following variables were studied: sex, age, occupation, state of origin, clinical features, diagnostic techniques, treatment with pentavalent antimony and side effects. Follow-up was one year after the end of treatment. RESULTS – The predominant group of patients was composed by male rural laborers who presented mainly the cutaneous form of the illness. The greatest efficacy of the antimony was observed in patients presenting the cutaneous form treated up to six months after the onset of symptoms, and in females in general (both differences were statistically significant in multivariate analysis). The early treatment of the mucocutaneous form also presented better results, although not statistically significant. Electrocardiographical alterations were more frequent in the group of patients receiving a 20mg SbV/Kg/day for a 30-day schedule than those with the same dosage for 20 days. Eosinophilia was found in 17.5%. CONCLUSIONS – Early treatment, female gender and cutaneous form presented higher levels of cure. Electrocardiographic changes rose as time of treatment was increased. The remarkable report of eosinophilia as a side effect of meglumine antimoniate deserves further investigation

Clinical, epidemiological and therapeuthic study of 402 patients with American cutaneous leishmaniasis seen at University Hospital of Brasilia, DF, Brazil

FUNDAMENTOS – A leishmaniose tegumentar americana é doença em expansão no Brasil. A região Centro- Oeste é hoje a terceira em incidência e a primeira em crescimento da doença. OBJETIVOS – Avaliar pacientes com leishmaniose tegumentar americana atendidos no Hospital Universitário de Brasília, quanto a aspectos clinicoepidemiológicos e resposta ao tratamento com antimonial pentavalente. MÉTODOS – Estudo do tipo série de casos de 402 pacientes, segundo sexo, idade, ocupação, procedência, formas clínicas, métodos de diagnóstico, tratamento com antimonial pentavalente e efeitos colaterais, no período de 1/1/1994 a 28/2/2003. O acompanhamento foi de um ano pós-tratamento. RESULTADOS – Predomínio de homens, lavradores, de 20 a 39 anos, com a forma cutânea. A eficácia do antimonial foi maior em pacientes com forma cutânea tratados até seis meses depois do início dos sintomas, e em pacientes do sexo feminino (diferenças estatisticamente significativas na análise multivariada). O mesmo ocorreu para pacientes com forma mucocutânea, mas sem diferença estatística significante. Alterações eletrocardiográficas foram mais freqüentes no grupo tratado com 20mg SbV/kg/dia por 30 dias em relação ao tratado por 20 dias. Eosinofilia ocorreu em 17,5% dos casos. CONCLUSÕES – Tratamento precoce, sexo feminino e a forma cutânea apresentaram índices mais elevados de cura. Alterações do eletrocardiograma aumentaram com o tempo de tratamento com antimoniais. A eosinofilia como efeito colateral ao uso do antimonial merece maior investigação. _______________________________________________________________________________________ ABSTRACTBACKGROUND - American cutaneous leishmaniasis is a disease with high prevalence and incidence in Brazil. The Brazilian Central-Western Region currently holds the third largest incidence and the first growth rate of this disease in the country. OBJECTIVES - To evaluate clinical, epidemiological and treatment features of patients with American cutaneous leishmaniasis seen at the University Hospital of Brasília. METHOD - A case series study with 402 patients was carried out, spanning the period between January 1st, 1994 and February 28th, 2003. The following variables were studied: sex, age, occupation, state of origin, clinical features, diagnostic techniques, treatment with pentavalent antimony and side effects. Follow-up was one year after the end of treatment. RESULTS – The predominant group of patients was composed by male rural laborers who presented mainly the cutaneous form of the illness. The greatest efficacy of the antimony was observed in patients presenting the cutaneous form treated up to six months after the onset of symptoms, and in females in general (both differences were statistically significant in multivariate analysis). The early treatment of the mucocutaneous form also presented better results, although not statistically significant. Electrocardiographical alterations were more frequent in the group of patients receiving a 20mg SbV/Kg/day for a 30-day schedule than those with the same dosage for 20 days. Eosinophilia was found in 17.5%. CONCLUSIONS – Early treatment, female gender and cutaneous form presented higher levels of cure. Electrocardiographic changes rose as time of treatment was increased. The remarkable report of eosinophilia as a side effect of meglumine antimoniate deserves further investigation

Leishmania mexicana amazonensis isolated from a patient with fatal mucosal leishmaniasis

Faculdade de Medicina (FMD

Comparative study of parasitological techniques for demonstration of amastigotes and primary isolation of promastigotes in American Cutaneous leishmaniasis

FUNDAMENTOS: O PCR tem alta sensibilidade no diagnóstico da LTA, mas é caro e distante da prática. A cultura e o esfregaço são práticos, mas pouco sensíveis. OBJETIVO: O objetivo deste trabalho foi comparar os dois últimos métodos, buscando maior sensibilidade e menor custo. MÉTODOS:Foram comparados três meios de cultura no isolamento de leishmânia: Difco agar sangue + Schneider + soro bovino fetal (20%); Difco agar sangue + Schneider + urina humana (2%); Schneider + urina humana (2%). Foram comparadas, também, duas técnicas de pesquisa de amastigotas: esfregaço realizado com biópsia, ou raspado através de palito (matchstick). RESULTADOS: Os índices de positividade e contaminação (29 a 33% e 8 a 11%, respectivamente, p>0.05) foram semelhantes na comparação dos cultivos. Os esfregaços com biópsia, ou palito também não tiveram diferenças significativas (14 e 19%, respectivamente, p> 0,05). A Leishmania (Viannia) braziliensis predominou. CONCLUSÃO: No Brasil, a urina pode substituir o soro fetal bovino. Há vantagem na relação custo/benefício. A urina não tem custo enquanto 500ml de soro bovino fetal custa 185 dólares.BACKGROUND: PCR is a highly sensitive procedure for the diagnosis of LTA, but it is expensive and not readily available. Culture and smearing are practical, but they lack sensitivity. OBJECTIVE: The objective of this work is to compare the latter two methods in order to achieve a higher sensitivity at a lower cost. METHOD: Three culture media were compared in the process of isolating leishmaniasis: blood Agar Difco + Schneider + 20% fetal calf serum; Difco + Schneider + human sterile urine (2%); Schneider with sterile human urine (2%). Moreover, two techniques were compared for the demonstration of amastigotes: biopsy performed with smears, or matchstick scrapping RESULTS: The positivity and contamination indices (29-to-33% and 8-to-11%, respectively, p>0.05) were similar when comparing the cultures. The smears carried out by biopsy or the matchstick scrapping procedure had no significant differences (14 and 19%, respectively, p>0.05). Leishmania (Viannia) braziliensis predominated. CONCLUSION: In Brazil, urine may substitute fetal calf serum. The cost-to-benefit ratio is advantageous. Urine has no cost, while the market value of 500 ml of fetal calf serum is $US 185

Sensitivity of Lymph Node Aspiration in Localized Cutaneous Leishmaniasis Due to Leishmania (Viannia) braziliensis

Twenty nine patients with localized cutaneous leishmaniasis had lymph node and skin ulcer aspirations for culture of Leishmania with the modified Marzochi´s vacuum aspiratory technique. Sensitivity of lymph node aspiration was 58.6% and 34.5% for skin ulcer aspiration (P=0.06). Combined sensitivity of the two methods was 79.3%. There was no agreement between methods (Kappa Index = -0.084; CI95% -0,45; 0,28) showing the potential complementary roles in diagnostic approach

Sensitivity of a vacuum aspiratory culture technique for diagnosis of localized cutaneous leishmaniasis in an endemic area of leishmania (Viannia) braziliensis transmission

Sixty eight patients with localized cutaneous leishmaniasis from an area with Leishmania (Viannia) braziliensis transmission had cultures performed with a modified Marzochi´s vacuum aspiratory puncture technique to establish sensitivity and contamination rate with this new method. Overall sensitivity of three aspirates was 47.1%; (CI95% 39.4; 59.4) significantly greater than the sensitivity of a single one aspirate. Fungal contamination was observed in 6/204 (2.9%) inoculated culture tubes. We recommend that this useful technique should be adopted as routine for primary isolation of L. (V.) braziliensis from localized cutaneous ulcers

American cutaneous leishmaniasis triggered by electrocoagulation

Cutaneous leishmaniasis is usually transmitted by infected phlebotomine sand fly bites that initiate local cutaneous lesions. Few reports in the literature describe other modes of transmission. We report a case of a previously healthy 59-year-old woman who underwent electrocoagulation to remove seborrheic keratosis confirmed by dermatoscopy. Three months later, a skin fragment tested positive for Leishmania culture; the parasite was identified as L. (V.) braziliensis. Trauma may generate inflammatory cascades that favor Leishmania growth and lesion formation in previously infected patients. American cutaneous leishmaniasis is a dynamic disease with unclear pathophysiology because of continually changing environments, demographics, and human behaviors