Leishmaniasis cutánea en Colombia: una mirada epidemiológica / Cutaneous leishmaniasis in Colombia: an epidemiological overview

La leishmaniasis resulta una enfermedad infectocontagiosa causada por un protozoo del género Leishmania. Esta constituye un problema de salud importante para diversas regiones de América Latina. El aislamiento social impuesta a raíz de la pandemia de COVID-19 favoreció que disminuyera la incidencia de esta entidad, pero las actividades sociales de la normalidad se retomaron paulatinamente, imponiéndose que se retomen las medidas de seguimiento y control correspondientes.

Leishmaniasis is an infectious disease caused by a protozoan of the genus Leishmania. Leishma-niasis constitutes a significant health problem for various regions of Latin America. The social isolation imposed because of the COVID-19 pandemic favored a decrease in the incidence of this entity. However, regular social activities were gradually resumed, imposing the correspon-ding monitoring and control measures.

Perfil epidemiológico dos casos de leishmaniose tegumentar americana no Brasil / Epidemiological profile of american tegumentary leishmaniasis cases in Brazil / Perfil epidemiológico de los casos de leishmaniosis tegumentaria americana fuera del Brasil

Objetivo: Identificar o perfil epidemiológico da Leishmaniose Tegumentar Americana no Brasil no período de 2009 a 2018. Métodos: Trata-se de um estudo descritivo, exploratório, com abordagem quantitativa. Nesta pesquisa foram utilizadas informações de casos de Leishmaniose Tegumentar Americana notificados no Sistema de Informação de Agravos de Notificação, através da base de dados do Departamento de Informações do Sistema Único de Saúde, em todas as regiões do Brasil, no período de 2009 a 2018, sendo computados 209.129 casos. Resultados: Foram analisados 209.129 de casos no período de 2009 a 2018. Sendo o ano de 2012 com maior número de casos, e 2016 com o menor. O sexo masculino, a faixa etária de 20 a 59 e indivíduos de baixa escolaridade apresentaram maior índice de casos. Regiões de destaque em maiores números de casos, tem-se o Norte e Nordeste. Relacionado a variável raça/cor, observou-se destaque na cor parda. Conclusão: O estudo contribui para construção de novos dados, auxiliando os gestores da saúde e os profissionais no desenvolvimento de medidas para controle da enfermidade. (AU)

Objective: To identify the epidemiological profile of American Tegumentary Leishmaniasis in Brazil from 2009 to 2018. Methods: This is a descriptive, exploratory study with a quantitative approach. In this research, information of American Tegumentary Leishmaniasis cases reported in the Sistema de Informação de Agravos de Notificação was used, through the database of the Departamento de Informações do Sistema Único de Saúde, in all regions of Brazil, in the period from 2009 to 2018, with 209,129 cases being computed. Results: 209,129 cases were analyzed from 2009 to 2018. Being the year 2012 with the highest number of cases, and 2016 with the lowest. The male gender, the age group 20 to 59, and individuals with low education presented a higher rate of cases. The regions with the highest number of cases were the North and Northeast. Regarding the variable race/color, it was observed that the brown-skinned population was highlighted. Conclusion: The study contributes to the construction of new data, helping health managers and professionals to develop measures to control the disease. (AU)

Objetivo: Identificar el perfil epidemiológico de la leishmaniasis tegumentaria americana (LTA) en Brasil entre 2009 y 2018. Métodos: Estudio descriptivo, exploratorio con abordaje cuantitativo. En esta investigación se utilizó información sobre casos de leishmaniasis tegumentaria americana reportados en el Sistema de Información de Enfermedades de Notificación, a través de la base de datos del Sistema de Información del Sistema Único de Salud, en todas las regiones de Brasil, en el período de 2009 a 2018, a donde se contabilizaron 209.129 casos. Resultados: Se analizaron 209.129 casos en el período de 2009 a 2018. 2012 fue el año con mayor número de casos y 2016 con el menor. El sexo masculino, el grupo de edad de 20 a 59 años y las personas con bajo nivel educativo presentaron un mayor índice de casos. Las regiones destacadas en mayor número de casos son el Norte y el Nordeste. En relación con la variable raza/color, se destacó el color marrón. Conclusión: El estudio contribuye a la construcción de nuevos datos, ayudando a los gestores y profesionales sanitarios en el desarrollo de medidas para el control de la enfermedad. (AU)

Hombre de 18 años con síndrome verrugoso tropical: ¿leishmaniasis o esporotricosis? / An 18-year-old man with tropical verrucous syndrome: Leishmaniasis or sporotrichosis?

Resumen | El síndrome verrugoso tropical comprende condiciones cutáneas infecciosas, crónicas y granulomatosas que cursan con placas, nódulos o úlceras verrugosas, de ahí su nombre. Este síndrome incluye la cromoblastomicosis, la esporotricosis, la paracoccidioidomicosis, la lobomicosis, la leishmaniasis y la tuberculosis cutánea verrugosa, todas ellas enfermedades de amplia distribución en áreas tropicales y subtropicales. Sus diagnósticos pueden ser difíciles y confundirse entre sí, lo cual es más frecuente entre la esporotricosis y la leishmaniasis. Para distinguirlas se recurre a criterios clínicos y epidemiológicos, y a métodos diagnósticos como intradermorreacción, examen directo, biopsia, cultivo, inmunofluorescencia y PCR, algunos de los cuales no son de uso común. El diagnóstico preciso conduce al tratamiento adecuado. Se presenta el caso de un hombre de 18 años con extensas placas verrugosas en una rodilla, inicialmente interpretadas como leishmaniasis verrugosa por la clínica, la epidemiología y la biopsia. Se le trató con Glucantime® durante 20 días, pero no presentó mejoría, por lo que se tomó una nueva biopsia que también se interpretó como leishmaniasis cutánea. La revisión de ambas biopsias evidenció inflamación con granulomas abscedados y presencia de cuerpos asteroides esporotricósicos, que condujeron al diagnóstico de esporotricosis, el cual se confirmó luego con el cultivo del hongo. Las lesiones remitieron con la administración de itraconazol. La clínica y la epidemiología de la leishmaniasis y las de la esporotricosis pueden ser semejantes, por lo que la biopsia y los estudios de laboratorio son esenciales para establecer el diagnóstico. El cuerpo asteroide esporotricósico es patognomónico de esta entidad. Se revisaron los conceptos esenciales de estas condiciones y los criterios para diferenciarlas.

Abstract | The tropical verrucous syndrome includes infectious, chronic, and granulomatous skin conditions appearing with plaques, nodules, or ulcers with a warty surface which gives name to the syndrome. It includes forms of chromoblastomycosis, sporotrichosis, paracoccidioidomycosis, lobomycosis, leishmaniasis, and tuberculosis verrucosa cutis with ample distribution in tropical and subtropical areas. The diagnoses may be difficult and confused among them, especially between sporotrichosis and leishmaniasis. Clinical, epidemiologic, intradermal reactions, direct smears, skin biopsies, cultures, immunofluorescence, and PCR are used to differentiate them, although several of these methods are not commonly used. We present an 18-year-old man with extensive verrucous plaques in one knee interpreted by clinic, epidemiology, and biopsy as verrucous cutaneous leishmaniasis. He was treated with Glucantime® for 20 days without improvement. A new biopsy was made that was also interpreted as cutaneous leishmaniasis. The revision of both biopsies showed inflammation with abscessed granulomas and asteroid sporotrichotic bodies at the center of the granulomas that led to the diagnosis of sporotrichosis later confirmed by the fungus culture. The patient responded to the treatment with itraconazole. As clinical and epidemiological findings of leishmaniasis and sporotrichosis can be similar, skin biopsy and other paraclinical studies are necessary to establish a proper diagnosis. The asteroid sporotrichotic body is pathognomonic of this mycosis. We review here the essential concepts of leishmaniasis and sporotrichosis and the criteria to differentiate them.

Anfotericina B Liposomal, Tratamiento Pediátrico en Leishmaniasis Cutánea con Falla Terapéutica

Resumen La leishmaniasis cutánea en Bolivia, es menos frecuente en niños. Su presencia probablemente responde a la domesticación del vector en áreas de asentamientos humanos. La anfotericina B, está indicada para el tratamiento de la leishmaniasis en adultos, sin respuesta a los antimoniales pentavalentes o sin una cura clínica de las úlceras. Esta serie de casos, tiene por objetivo compartir experiencias del empleo de anfotericina B liposomal en pacientes pediátricos con leishmaniasis cutánea y falla terapéutica a los antimoniales. Seis pacientes con estas características ingresados al servicio de Infectología del Hospital Pediátrico Manuel Asencio Villarroel, recibieron Anfotericina B liposomal 2 a 3 mg/Kg peso día, en un periodo promedio de 18 días. Se observó remisión progresiva de las úlceras durante el tratamiento y cicatrización completa a los tres meses post tratamiento. Ninguno presentó efectos adversos y las pruebas bioquímicas renales y hepáticas, se encontraban dentro de valores normales.

Abstract The cutaneous leishmaniasis in Bolivia is less frequent in children. Its presence probably responds to the domestication of the vector in areas of human settlements. Amphotericin B is indicated for the treatment of leishmaniasis in adults, without response to pentavalent antimonials or without a clinical cure for ulcers. The objective of this series of cases is to share experiences of the use of liposomal amphotericin B in paediatric patients with cutaneous leishmaniasis and therapeutic failure of antimonials. Six patients with these characteristics admitted to the Infectology service of the Manuel Asencio Villarroel paediatric hospital, received liposomal Amphotericin B, 2 to 3 mg / kg weight day, in a mean period of 18 days. Progressive remission of the ulcers was observed during treatment and complete healing at three months of post-treatment. None had adverse effects, and the kidney and liver biochemical tests were within normal values.

Clinical and epidemiological aspects of American cutaneous leishmaniasis with genital involvement

Abstract Genital lesions are an unusual presentation of American cutaneous leishmaniasis. Conditions such as disseminated cutaneous leishmaniasis and HIV infection may be associated with genital involvement. The authors present five cases of American cutaneous leishmaniasis with genital lesions and discuss the clinical and epidemiological aspects observed in this case series.

Identification of Leishmania species by high-resolution DNA dissociation in cases of American cutaneous leishmaniasis

Abstract Background American cutaneous leishmaniasis is an infectious dermatosis caused by protozoa of the genus Leishmania, which comprises a broad spectrum of clinical manifestations depending on the parasite species involved in the infections and the immunogenetic response of the host. The use of techniques for amplification of the parasites DNA based on polymerase chain reaction polymerase chain reaction and the recent application of combined techniques, such as high-resolution DNA dissociation, have been described as a viable alternative for the detection and identification of Leishmania spp. in biological samples. Objectives To identify the Leishmania species using the polymerase chain reaction high-resolution DNA dissociation technique in skin biopsies of hospital-treated patients, and compare with results obtained by other molecular identification techniques. Methods A retrospective study assessing patients with suspected American cutaneous leishmaniasis seen at a hospital in São Paulo/Brazil was conducted. The paraffin blocks of 22 patients were analyzed by polymerase chain reaction high-resolution DNA dissociation to confirm the diagnosis and identify the species. Results Of the 22 patients with suspected American cutaneous leishmaniasis, the parasite was identified in 14, comprising five cases (35.6%) of infection by L. amazonensis, four (28.5%) by L. braziliensis, two (14.4%) by L. amazonensis + L. infantum chagasi, two (14.4%) by L. guyanensis, and one (7.1%) by Leishmania infantum chagasi. In one of the samples, in which the presence of amastigotes was confirmed on histopathological examination, the polymerase chain reaction high-resolution DNA dissociation technique failed to detect the DNA of the parasite. Study limitations The retrospective nature of the study and small number of patients. Conclusions The method detected and identified Leishmania species in paraffin-embedded skin biopsies with a sensitivity of 96.4% and could be routinely used in the public health system.

Manipulación de lesiones en pacientes con leishmaniasis cutánea: serie de casos en un hospital peruano / Manipulation of cutaneous leishmaniasis lesions: case series in a peruvian hospital

RESUMEN En áreas endémicas de leishmaniasis cutánea es común que los pacientes manipulen sus lesiones con tratamientos tradicionales como primera opción terapéutica. Con el objetivo de describir la frecuencia y los cambios de la manipulación de lesiones de leishmaniasis cutánea de pacientes en el Hospital Cayetano Heredia, se realizó un estudio tipo serie de casos. Se incluyeron 124 pacientes con leishmaniasis cutánea. El 54% (67/124) manipuló sus lesiones; el 92,5% (62/67) lo hizo con productos químicos, y el 43,3% (29/67), con plantas. Los cambios locales más frecuentemente reportados por los pacientes fueron aumento de tamaño de la lesión en el 35,8% (24/67) e incremento de inflamación en el 28,4% (19/67). La manipulación disminuyó la positividad del diagnóstico parasitológico en aquellos pacientes con lesiones ulcerativas.

ABSTRACT In cutaneous leishmaniasis endemic areas it is a common practice for patients to manipulate their lesions with traditional treatments as a first therapeutic option. A case series study was conducted in order to describe the frequency and the variations of the patient manipulation of cutaneous leishmaniasis lesions at the Cayetano Heredia Hospital. The study included 124 patients with cutaneous leishmaniasis. From the patient population it was found that 54% (67/124) manipulated their lesions. Of this, 92.5% (62/67) did so with chemicals, and 43.3% (29/67) with plants. The most frequent local changes reported by patients were increased lesion size in 35.8% (24/67) and increased inflammation in 28.4% (19/67). Manipulation by patients decreased the positivity of the parasitological diagnosis in those patients with ulcerative lesions.

Qualidade de vida relacionada à saúde de pessoas com Leishmaniose Tegumentar Americana / Health-related quality of life of people with American Tegumentary Leishmaniasis

Objetivou-se avaliar a qualidade de vida relacionada à saúde de pessoas acometidas pela Leishmaniose Tegumentar Americana, segundo aspectos sociodemográficos e clínicos. Estudo transversal, realizado na Paraíba, Brasil, em 2019. Participaram 22 pessoas com idade acima de 18 anos, em tratamento hospitalar para leishmaniose cutânea. Utilizou-se um questionário com variáveis sociodemográficas e clínicas e o instrumento Medical Outcomes Survey Short-Forma-36, sendo analisados por medidas descritivas e testes estatísticos não paramétricos. O estudo foi aprovado por um Comitê de Ética em Pesquisa. Evidenciou-se maioria dos participantes do sexo masculino, entre 20 e 88 anos, com relação conjugal, agricultores e com cães no domicílio. Apresentaram lesão ulcerativa nos membros. Todos os domínios de qualidade de vida medidos pelo instrumento apresentaram scores baixos. Os achados desta investigação denotam a necessidade de ações de promoção da saúde e prevenção da infecção pela Leishmaniose Tegumentar Americana.

The aim of this study was to analyze the health-related quality of life in people infected with American Tegumentary Leishmaniasis, according to sociodemographic and clinical data. Cross-sectional study, conducted in Paraíba, Brazil, in 2019. Twenty-two patients over the age of 18 years old in hospital treatment for cutaneous leishmaniasis participated. A questionnaire with sociodemographic and clinical variables and the Medical Outcomes Survey Short Form - 36 (SF-36) were used and analyzed by descriptive measures and non-parametric statistical tests. The study was approved by a Research Ethics Committee. Most of the participants were male, between the ages of 20 and 88 years old, farmers, in a marital relationship, and owned dogs. They showed ulcerative lesions on their limbs. All quality of life domains measured by the instrument presented low scores. The findings of this investigation show the need for actions to promote health and prevent infection by American Tegumentary Leishmaniasis.

Leishmaniose Tegumentar Americana: uma análise histopatológica e molecular em lesões de dermatites no estado de Pernambuco, Brasil / American Cutaneous Leishmaniasis: a histopathological and molecular analysis of dermatitis lesions in the State of Pernambuco, Brazil

Objetivo: Realizar uma análise histopatológica e molecular em biópsia de pele entre as lesões de dermatites de pacientes com suspeita de Leishmaniose Tegumentar Americana (LTA) no hospital de referência do estado de Pernambuco entre o período de 2016 e 2017. Métodos: Trata-se de um estudo descritivo observacional, no qual todos os pacientes com lesões clinicamente sugestivas para LTA incluídos no estudo foram submetidos à coleta de biópsia de pele das lesões, as quais foram analisadas pela técnica histopatológica e PCR (Reação em Cadeia de Polimerase). Resultados: Foram analisadas 24 amostras de biópsia de pele de pacientes com suspeita clínica de LTA, por testes histopatológicos e confirmação pela PCR. As amostras foram caracterizadas pela busca do DNA de Leishmania braziliensis através da PCR. Das 24 amostras estudadas, em nenhuma foi encontrado DNA de L. braziliensis. Apenas em um caso foi detectada presença de amastigotas de Leishmania pela técnica histopatológica. Outros achados microscópicos observados foram: dermatite granulomatosa (33,33%), úlcera crônica (20,83%), carcinoma basocelular (16,66%), Leishmaniose, dermatite plasmocitária e inflamação granulomatosa (8,33%) e Hanseníase (4,16%). Conclusão: O diagnóstico histopatológico detectou um caso de LTA, porém, a PCR não encontrou DNA do parasito. A análise histopatológica mostrou que as lesões dermatotrópicas dos pacientes são oriundas principalmente de úlceras, tumores de pele e hanseníase.

Objective: Accomplish a histopathological and molecular analysis in skin biopsy between the dermatitis lesions of patients with suspected American Cutaneous Leishmaniasis (ATL) at the Hospital of Reference of the State of Pernambuco between the period of 2016 and 2017. Methods: This is a descriptive, observational study in which all patients with clinically suggestive lesions for ATL included in the study were submitted to skin biopsy of the lesions and analyzed by the histopathological technique and PCR (Polymerase Chain Reaction). Results: Were analyzed 24 skin biopsy samples from patients with clinical suspicion of ATL, by histopathological tests and confirmation by PCR. Samples were characterized by the search of Leishmania braziliensis DNA through PCR. Of the 24 samples studied, no DNA of L. braziliensis was found. Only in one case was detected presence of Leishmania amastigotes by histopathological technique. Other microscopic findings were granulomatous dermatitis (33.33%), chronic ulcer (20.83%), basal cell carcinoma (16.66%), Leishmaniasis, plasmacytoma dermatitis and granulomatous inflammation (8.33%) and leprosy, 16%). Conclusion: The histopathological diagnosis detected a case of ATL, however, the PCR did not find DNA of the parasite. The histopathological analysis showed that the dermatotropic lesions of the patients come mainly from ulcers, skin tumors and leprosy.

American tegumentary leishmaniasis: severe side effects of pentavalent antimonial in a patient with chronic renal failure

Abstract: Pentavalent antimonials are the first-line drug treatment for American tegumentary leishmaniasis. We report on a patient with chronic renal failure on hemodialysis who presented with cutaneous lesions of leishmaniasis for four months. The patient was treated with intravenous meglumine under strict nephrological surveillance, but cardiotoxicity, acute pancreatitis, pancytopenia, and cardiogenic shock developed rapidly. Deficient renal clearance of meglumine antimoniate can result in severe toxicity, as observed in this case. These side effects are related to cumulative plasma levels of the drug. Therefore, second-line drugs like amphotericin B are a better choice for patients on dialysis.

Disseminated leishmaniasis: clinical, pathogenic, and therapeutic aspects

Abstract: Disseminated leishmaniasis is a severe and emerging form of American tegumentary leishmaniasis. Disseminated leishmaniasis is defined by the presence of more than 10 polymorphic cutaneous lesions, distributed over more than two noncontiguous parts of the body. Nasal mucosal involvement is observed in almost half of cases. Disseminated leishmaniasis patients present with a decreased production of Th1 cytokines in the peripheral blood due to the attraction of leishmania- activated T cells to the multiple cutaneous lesions. Disseminated leishmaniasis development is poorly understood and is related to a complex network involving environmental, host immune response, and parasite factors, in which L. braziliensis polymorphism plays an important role. Disseminated leishmaniasis is a challenging disease to cure, presenting a high failure rate of 75% to pentavalent antimony therapy. Despite its importance and severity, this form of American tegumentary leishmaniasis has been poorly studied and documented, deserving greater attention from professionals working in endemic areas.

Perfil da leishmaniose cutânea americana na Amazônia Sul-Ocidental brasileira: uma abordagem multivariada / American cutaneous leishmaniasis profile in a Brazilian Southwestern Amazonia: a multivariate approach / Perfil de la leishmaniasis cutanea americana en la Amazonia Sul-occidental brasileña: un enfoque multivariado

Justificativa e Objetivos: A Leishmaniose Cutânea Americana (LCA) é uma doença de cadeia de transmissão complexa sujeita a diversos determinantes, em uma mesma região. Este estudo teve como objetivo analisar o comportamento e determinar o perfil epidemiológico da LCA em uma região da Amazônia Sul-ocidental utilizando técnicas de análises multivariadas. Métodos: Utilizou-se as informações do Sistema de Informação de Agravos de Notificação (Sinan), 2001 a 2010,para o estado do Acre e técnicas de análises de agrupamento hierárquico e de componentes principais. Resultados: Foram analisados um total de 10.984 casos de LCA e discriminados três grupos. O primeiro grupo se destacou por apresentar maior porcentagem de indivíduos do sexo feminino, com predominância da forma clínica mucosa, idade até 20 anos, que residiam e trabalhavam em áreas rurais e florestais; o segundo grupo foi discriminado por agrupar indivíduos do sexo masculino, com forma clínica cutânea, idade superior a 40 anos de idade, que residiam e trabalhavam em áreas urbanas; o terceiro grupo foi constituído por indivíduos do sexo masculino, forma clínica cutânea, idades entre 20 e 40 anos, que residiam e trabalhavam em áreas rurais. Conclusão: Há evidências que para cada tipo de transmissão de LCA florestal, urbano e rural, exista um perfil epidemiológico correspondente e as técnicas de análises multivariadas foram eficientes em destacar o comportamento da LCArelacionando-os ao perfil dos indivíduos acometidos.(AU)

Background and Objectives: The American Cutaneous Leishmaniasis (ACL) is a disease of complex chain of transmission subject to various determinants, in the same region. Theaim was to analyze the ACL behavior and identify the epidemiological profile in a Brazilian Southwestern Amazonia region, using multivariate analysis techniques. Methods: The hierarchic cluster and principal components analysis were performed using the Brazilian System for Disease Notification (Sinan), from 2001 until 2010, recorded in the state of Acre. Results: 10,984 cases were analysed and discriminated three groups of ACL. In the first group, the epidemiological profile presented a higher percentage, in relation to the other two groups, of women with predominance of ACL mucosa form, aging less than 20 years, living and working in rural and forest environment; In the second group, the epidemiological profile consisted of male patients, with ACL in the cutaneous form, age of 40 years or older, living and working in urban areas. In the third group, there was predominance of male patients, ACL cutaneous form, ages between 20 and 40 years, living and working in rural areas. Conclusion: There are evidences that for each type of transmission, namely forest, urban and rural, there is a corresponding epidemiological profile and techniques of multivariate analyzes were effective to evidence the ACL behaviour relating them to the profile of the affected individuals.(AU)

Justificación y objetivos: LeishmaniasisCutanea Americana (LCA)es una enfermedad de ciclo de contaminación compleja afectada por diversos factores, en una misma zona. Este estudio tuvo como objetivo el análisis del comportamiento y el perfil de salud en la zona de Amazonia Sul-occidental empleando técnicas de análisis multivariantes. Métodos: se ha empleado las informciones del Sistema de Informação de Agravos de Notificação (SINAN), 2001 a 2010, para la Provincia de Acre y técnicas de análisis por conglomerados y análisis de componente principal. Resultados: han sido analisados un total de 10.984 casos de LCA y diferenciados en tres grupos. El primer grupo se ha destacado por presentar un mas grande percentual de personas del sexo femenino, con predominancia de forma clinica mucosa, edad hacia los 20 años, que vivian y trabajavan en diversas zonas, rurales y florestales; el según grupo fue diferenciado por incorporar personas del sexo masculino, con forma clínica cutanea, edad arriba de 40 años, que vivian y trabajaban en zonas urbanas; el tercer grupo se ha constituído por personas del sexo masculino, forma clínica cutanea, edades entre los 20 y 40 años, que vivian y trabajaban en zonas rurales. Conclusión: hay evidencias que para cada tipo de contaminación de LCAflorestales, urbanas y rurales, existía un perfil epidemiológico compatible y las técnicas de análisis multivariantes han sido eficientes en distinguir la actuación de la LCA relacionándose al perfil de las personas infectadas.(AU)

Leishmaniasis cutánea y embarazo / Cutaneous leishmaniasis and pregnancy

Se estudió a una mujer de 19 años, con embarazo de cuatro meses, que presentaba cuatro úlceras cutáneas de tres meses de evolución, diagnosticadas por biopsia como leishmaniasis cutánea. El frotis directo y la leishmanina fueron negativos. Dado que todos los medicamentos usuales para la leishmaniasis cutánea están contraindicados en el embarazo, la paciente no recibió tratamiento, aunque curó espontáneamente durante el embarazo. Se cree que la leishmaniasis cutánea no tiene peligro para la mujer embarazada y que no hay transmisión de la madre al feto en el humano, aunque se ha detectado en animales en condiciones experimentales. La paciente tuvo un parto sin complicaciones y la condición de salud tanto de ella como de su hijo era normal a los dos años de seguimiento.

We studied a 19-year-old woman, with a 4-month pregnancy who presented with four cutaneous leg ulcers of three months of evolution diagnosed by biopsy as cutaneous leishmaniasis. Direct smear and the leishmanin skin test were negative. Since all the usual medications for cutaneous leishmaniasis are contraindicated in pregnancy, she did not receive any treatment but cured spontaneously of her lesions during pregnancy. It is believed that cutaneous leishmaniasis does not carry danger for pregnant women and that there is no maternal-fetal transmission in humans, though it occurs in experimental animals. The patient gave birth without complications and both she and her son remained normal after two years of follow-up.

Treatment of cutaneous leishmaniasis with thermotherapy in Brazil: an efficacy and safety study

Abstract: BACKGROUND: Pentavalent antimonials remain as the standard drugs in the treatment of cutaneous leishmaniosis. The high cost, difficult administration, long treatment time, toxicity and increasing morbidity are factors that limit the use of these drugs. OBJECTIVES: To describe the response to radiofrequency thermotherapy in the treatment of localized cutaneous leishmaniasis in Brazil, and to evaluate its safety and tolerability. METHODS: We conducted a non-comparative open trial with a total of 15 patients confirmed to have cutaneous leishmaniasis on parasitological examination. A single radiofrequency thermotherapy session at 50ºC for 30 seconds was applied to the lesion and its edges. In patients with more than one lesion, only the largest one was treated initially. If after 30 days there was no evidence of healing, the smaller lesion was also treated with thermotherapy. Clinical cure was defined as visible healing for three months after treatment. The patients were followed-up for six months and there was no follow-up loss. RESULTS: Of all 23 lesions, only two evolved to complete healing without the need of treatment. Of 21 lesions, 18 (85.7%) achieved full healing. The main observed side effects were itching, burning sensation, pain and blisters. STUDY LIMITATIONS: Sample with a small number of patients and short follow-up. CONCLUSION: Thermotherapy can be considered a therapeutic alternative in localized cutaneous leishmaniasis, especially in cases of single cutaneous lesions and with formal contraindications to conventional treatment with pentavalent antimonials.

Curvas de fusión de regiones genómicas específicas: una herramienta prometedora para el diagnóstico y tipificación de las especies causantes de la leishmaniasis cutánea en Colombia / High-resolution melting analysis based on specific genomic regions: A promising tool for the diagnosis and typing of species causing cutaneous leishmaniasis in Colombia

Resumen Introducción. La leishmaniasis cutánea es una enfermedad causada por parásitos del género Leishmania que tiene gran incidencia en Colombia. El diagnóstico y la identificación de la especie infecciosa son factores críticos en el momento de escoger e iniciar el tratamiento. Actualmente, los métodos de diagnóstico y tipificación requieren procedimientos complejos, por lo que es necesario validar nuevos marcadores moleculares y métodos que simplifiquen el proceso. Objetivo. Desarrollar una herramienta basada en la reacción en cadena de la polimerasa (PCR) con curvas de fusión (High Resolution Melting; PCR-HRM) para el diagnóstico y tipificación de las tres especies de Leishmania de importancia epidemiológica en casos de leishmaniasis cutánea en Colombia. Materiales y métodos. Los genomas de Leishmania panamensis, L. braziliensis y L. guyanensis se compararon mediante métodos bioinformáticos. Las regiones específicas de especie identificadas se validaron mediante PCR. Para los marcadores seleccionados se diseñó una PCR-HRM y se estimaron algunos parámetros de validez y seguridad usando aislamientos de pacientes colombianos caracterizados previamente mediante PCR y análisis de polimorfismos en la longitud de los fragmentos de restricción (Restriction Fragment Length Polymorphism - RFLP; PCR-RFLP) del gen hsp70. Resultados. El análisis genómico comparativo mostró 24 regiones específicas de especie. Sin embargo, la validación mediante PCR solo identificó un marcador específico para cada especie de Leishmania. Los otros marcadores mostraron amplificación cruzada. El límite de detección para los tres marcadores seleccionados fue de un parásito, mientras que la sensibilidad, la especificidad, el valor predictivo positivo y el negativo fueron de 91,4, 100, 100 y 75 %, respectivamente. Conclusiones. Las tres regiones seleccionadas pueden emplearse como marcadores moleculares en el diagnóstico y tipificación de las especies causantes de la leishmaniasis cutánea en Colombia.

Abstract Introduction: Cutaneous leishmaniasis, caused by parasites of the genus Leishmania, is a disease with high incidence in Colombia. The diagnosis and identification of the infectious species are critical factors when selecting and initiating treatment. Currently, the methods for diagnosing and typing cutaneous leishmaniasis require complicated procedures and there is a need for the validation of new molecular markers and methods to simplify the process. Objective: To develop a tool based in PCR melting curves (PCR-HRM) for the diagnosis and typing of the three Leishmania species of epidemiological importance for cutaneous leishmaniasis in Colombia. Materials and methods: The genomes of Leishmania panamensis, L. braziliensis and L. guyanensis were compared with bioinformatic methods. The species-specific regions were then validated using PCR. For the selected markers, a PCR-HRM was designed, and validity and security parameters were estimated using isolates from Colombian patients previously characterized by PCR-RFLP of the hsp70 gene. Results: The comparative genomic analysis yielded 24 species-specific regions. However, the PCR validation identified only one marker that was specific to each Leishmania species. The other markers showed cross amplification. The detection limit for the three selected markers was one parasite. The sensitivity, specificity, predictive positive and negative values were 91.4%, 100%, 100% and 75%, respectively. Conclusions: The three selected regions can be used as molecular markers in the diagnosis and typing of the causative species of cutaneous leishmaniasis in Colombia.

Dermatoscopic signs in cutaneous leishmaniasis

Abstract: Dermoscopy is a non-invasive technique widely used to aid in the characterization and diagnosis of pigmented skin lesions. Recently, it has also been employed for the evaluation of non-pigmented skin tumours, and inflammatory and infectious cutaneous diseases. Although the diagnosis of cutaneous leishmaniasis is confirmed by the demonstration of amastigotes in infected skin or by the growth of promastigotes in culture medium, dermoscopy could be useful as a further diagnostic test. We report a patient with a nodular lesion located on the right cheek for almost two years. The lesion was clinically suggestive of cutaneous leishmaniasis. Dermoscopy showed yellow tears, erythema and vascular structures. The diagnosis was confirmed by the demonstration of amastigotes in a skin scraping sample.

Aspectos ecoepidemiológicos, detección natural e identificación molecular de Leishmania spp. en Lutzomyia reburra, Lutzomyia barrettoi majuscula y Lutzomyia trapidoi / Eco-epidemiological aspects, natural detection and molecular identification of Leishmania spp. in Lutzomyia reburra, Lutzomyia barrettoi majuscula and Lutzomyia trapidoi

Resumen Introducción. La provincia de Pichincha, Ecuador, es un área endémica de leishmaniasis cutánea, en donde se han determinado como vectores los flebotomíneos antropofílicos con infección natural por Leishmania spp. Sin embargo, no se ha evaluado el papel en la transmisión de las especies zoofílicas. Objetivo. Evaluar la infección natural por Leishmania en dos especies de flebotomíneos zoofílicos, Lutzomyia reburra y Lu. barrettoi majuscula, y en una antropofílica, Lu. trapidoi, así como la endofagia y la sinantropía de estas especies en el noroccidente de Pichincha. Materiales y métodos. Los flebotomíneos se recolectaron en trampas de luz CDC colocadas en diferentes hábitats y altitudes en sitios que son focos de leishmaniasis cutánea. La infección con Leishmania spp. se detectó en el ADN genómico de hembras de las especies de flebotomíneos de interés. Se amplificó el gen espaciador interno de la transcripción del ARN ribosómico, unidad I (ITS1), y los genes de las topoisomerasas mitocondrial II (mtTOPOII) y nuclear II (TopoII). Se determinaron los porcentajes de positividad para Leishmania a escala espaciotemporal, la proporción de endofagia y el índice de sinantropía. Resultados. Se determinó la presencia de infección natural por Le. amazonensis en Lu. reburra (9,5 %) y Lu. b. majuscula (23,8 %); en Lu. trapidoi se detectaron Le. amazonensis, Le. brazilienis y Le. naiffilainsoni. Los flebotomíneos eran asinantrópicos y con baja endofagia. Conclusión. Se registró por primera vez la presencia de infección natural en Lu. reburra y Lu. barrettoi majuscula por Le. amazonensis, y se demostró la importancia de los flebotomíneos zoofílicos en el mantenimiento del ciclo de transmisión de Leishmania spp. en focos endémicos.

Abstract Introduction: The province of Pichincha in Ecuador is an endemic area of cutaneous leishmaniasis, where anthropophilic sand flies with natural infection by Leishmania, have been reported as vectors. However, the role in transmission of zoophilic species has not been evaluated. Objective: To evaluate natural infection by Leishmania in two zoophilic phlebotomine sand fly species, Lutzomyia reburra and Lu. barrettoi majuscula, and one anthropophilic species, Lu. trapidoi, as well as the endophagy and synanthropism of these species in the northwest of Pichincha. Materials and methods: Phlebotomines were collected using CDC light traps in different habitats and altitudes with presence of cutaneous leishmaniasis. Leishmania infection was detected using genomic DNA from females of the collected sand flies. We amplified the internal transcribed spacer gene of ribosomal RNA I (ITS1), the mitochondrial topoisomerase II gene (mtTOPOII), and the nuclear topoisomerase II gene (TopoII). Percentages of positivity for Leishmania, at spatio-temporal scale, proportion of endophagy and synanthropism index were calculated. Results: Natural infection was determined for Le. amazonensis in Lu. reburra (9.5%) and Lu. b. majuscula (23.8%), while in Lu. trapidoi we detected Le. amazonensis, Le. brazilienis and Le. naiffilainsoni. Phlebotomines were asynanthropic and with low endophagy. Conclusion: Natural infection with Le. amazonensis was recorded for the first time in Lu. reburra and Lu. b. majuscula, demonstrating the importance of zoophilic phlebotomines in the maintenance of the Leishmania transmission cycle in endemic foci.

Aspectos socioepidemiológicos y culturales de la leishmaniasis cutánea: concepciones, actitudes y prácticas en las poblaciones de Tierralta y Valencia, (Córdoba, Colombia) / Socio-epidemiological and cultural aspects of cutaneous leishmaniasis: conceptions, attitudes and practices in the populations of Tierralta and Valencia (Cordoba, Colombia)

RESUMEN Este artículo se centra en las concepciones, actitudes y prácticas de los pobladores de cuatro veredas en Tierralta y Valencia (Córdoba, Colombia), que han padecido o conocen la leishmaniasis cutánea. Se implementó una metodología mixta que combinó un diseño cualitativo con entrevistas y grupos focales (n=45), y un diseño epidemiológico en el que se aplicó la prueba de Montenegro (n=251), se relevaron casos sospechosos de leishmaniasis cutánea en humanos (n=5) y se realizaron encuestas epidemiológicas (n=409). Entre los resultados se encontró que hay un desconocimiento del vector y, aunque identificaron la Lutzomyia (Alú), no la correlacionaron con la leishmaniasis cutánea. Por otra parte, los tratamientos tradicionales caseros son los más usados, lo que provoca el aumento del subregistro de casos. Respecto al personal de salud, se encontraron fallas en el diagnóstico y el tratamiento, lo que refuerza la adherencia a tratamientos caseros. Este escenario nos insta a reflexionar acerca de los retos del sistema de salud respecto a las intervenciones del personal de salud en las comunidades asentadas en zonas endémicas.

ABSTRACT This article focuses on the conceptions, attitudes and practices of the inhabitants from four villages (veredas) in Tierralta and Valencia (Cordoba, Colombia), who have suffered from or are aware of the existence of cutaneous leishmaniasis. A mixed methodology was implemented based in a qualitative design using interviews and focus groups (n=45) and an epidemiological design which included applying the Montenegro test (n=251), uncovering suspected cases of cutaneous leishmaniasis in humans, (n=5) and applying epidemiological surveys (n=409). Among the results, a lack of knowledge regarding the vector was found; although respondents could identify the Lutzomyia (known as “alú”), they did not correlate it with cutaneous leishmaniasis. In addition, traditional home treatments were more frequently used, increasing the underrecording of cases. With respect to healthcare personnel, flaws in diagnosis and treatment were found, which reinforces adherence to home treatments. This scenario calls for a reflection upon the challenges of the health care system in relation to the interventions of health personnel in communities situated in endemic areas.

Periungual tegumentary leishmaniasis: a diagnostic challenge

Abstract: Periungual and paronychia-like skin lesions can mimic various diseases, setting up a diagnostic challenge that invariably requires correlation with complementary tests. We report a case of an ulcerated tumor of the nailfold diagnosed as leishmaniasis. Although paronychia-like cutaneous leishmaniasis is a rare variant, its epidemiological relevance in Brazil should prompt dermatologists to include it as a plausible diagnosis thus leading to correct work up and treatment.

White starburst-like pattern as a dermoscopic clue in Old World cutaneous leishmaniasis

Abstract: A 70-year-old woman was referred to our dermatological unit by her general practitioner last summer, with a history of a two-month ulcerated purplish lesion on her left arm that spread centrifugally and that unsuccessfully treated with topical corticosteroids. The dermoscopic evaluation revealed an erythematous macula with central ulceration that showed the characteristic called "white starburst-like pattern" and some vascular structures (dotted vessels, polymorphous⁄ atypical vessels). The diagnosis of cutaneous leishmaniasis was made after histopathologic analysis and polymerase chain reaction essay.