Polymerase chain reaction with lesion scrapping for the diagnosis of human American tegumentary leishmaniasis

The objective of this work was to compare the polymerase chain reaction (PCR) using lesion scrapping with other conventional techniques for the diagnosis of the American tegumentary leishmaniasis (ATL). For this, patients with cutaneous lesions suspected to be ATL were studied. The DNA was amplified with the MP1L/MP3H primers. From the 156 studied patients, 79 (50.6%) presented positive parasite direct search (PD), 81 (51.9%) had positive Montenegro skin test (MST), and 90 (57.7%) presented PD and/or MST positive. The PCR was positive in all of the positive-PD patients (100% sensitivity), in 91.1% of the positive PD and/or MST patients, and in 27.3% of the patients that presented negative PD and positive MST. The PCR positivity was similar to the PD (P = 0.2482) and inferior to the MST (P = 0.0455), and to the PD/MST association (P = 0.0133). The high PCR sensitivity, and positivity in those cases where the PD was negative, highlights the importance of this technique as an auxiliary tool for the diagnosis of ATL

Distribuição geográfica e características epidemiológicas da leishmaniose tegumentar americana em áreas de colonização antiga do Estado do Paraná, Sul do Brasil Geographic distribution and epidemiological features of American tegumentary leishmaniasis in old rural settlements in Paraná State, Southern Brazil

Analisa-se a epidemiologia da leishmaniose tegumentar americana em municípios das mesorregiões norte central, centro ocidental e noroeste do Estado do Paraná, Brasil. O diagnóstico dos casos de leishmaniose tegumentar americana foi realizado na Universidade Estadual de Maringá, de 1987 a 2004. Conforme o provável local de infecção, os casos foram divididos em autóctones (infectaram-se no domínio doméstico) ou alóctones (infectaram-se fora do domínio doméstico). Observou-se que em todos os anos do período houve atendimento de casos provenientes das mesorregiões supracitadas. Os municípios com maior número de casos notificados foram Maringá (458), Doutor Camargo (126), São Jorge do Ivaí (121), Terra Boa (114), Cianorte (98) e Colorado (95). De 1.938 casos, 66,9% eram do sexo masculino. Entre 667 casos autóctones, o número de mulheres afetadas pela doença foi semelhante ao de homens, com casos em menores de cinco anos de idade, fatos que não ocorreram entre os 794 casos alóctones. As condições necessárias à produção da leishmaniose tegumentar americana foram criadas no processo de construção do espaço rural das mesorregiões em pauta, particularmente no modelo de colonização e na crise da monocultura cafeeira.<br>This study analyzes the epidemiology of American tegumentary leishmaniasis in the municipalities of the Central North, Central West, and Northwest mesoregions of Paraná State, Brazil. Diagnosis of American tegumentary leishmaniasis cases was performed at the State University in Maringá from 1987 to 2004. According to the probable site of infection, cases were classified as autochthonous (infection inside the household domain) or allochthonous (outside the household domain). Municipalities with the most cases were Maringá (458), Doutor Camargo (126), São Jorge do Ivaí (121), Terra Boa (114), Cianorte (98), and Colorado (95). Of the total of 1,938 cases, 66.9% were male. Among the 667 autochthonous cases, similar numbers of men and women were infected, with cases in minors as young as five years of age, with the latter not occurring in the 794 allochthonous cases. Conditions favoring American tegumentary leishmaniasis were created in the processes involved in occupying the rural areas of these mesoregions, particularly in the agricultural settlement model and the crisis in coffee monoculture