ABSTRACT
BACKGROUND Cutaneous leishmaniasis (CL) generally presents with a single or several localised cutaneous ulcers without involvement of mucous membranes. Ulcerated lesions are susceptible to secondary contamination that may slow the healing process. OBJECTIVE This study verified the influence of non-parasitic wound infection on wound closure (epithelialisation) and total healing. METHODS Twenty-five patients with a confirmed diagnosis of CL and ulcerated lesions underwent biopsy of ulcer borders. One direct microbial parameter (germ identification in cultures) and four indirect clinical parameters (secretion, pain, burning sensation, pruritus) were analysed. FINDINGS Biopsies of ten lesions showed secondary infection by one or two microorganisms (Staphylococcus aureus, Pseudomonas aeruginosa, Enterococcus faecalis, Streptococcus pyogenes and Candida parapsilosis). "Secretion" and "burning sensation" influenced epithelialisation time but not total healing time. Positive detection of germs in the ulcer border and "pain" and "pruritus" revealed no influence on wound closure. CONCLUSIONS Our borderline proof of clinical CL ulcer infection inhibiting CL wound healing supports the need to follow antimicrobial stewardship in CL ulcer management, which was recently proposed for all chronic wounds.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Wound Healing , Leishmaniasis, Cutaneous/microbiology , Kaplan-Meier Estimate , Coinfection/microbiology , Prospective StudiesABSTRACT
Localised cutaneous leishmaniasis (LCL) is the most common form of cutaneous leishmaniasis characterised by single or multiple painless chronic ulcers, which commonly presents with secondary bacterial infection. Previous culture-based studies have found staphylococci, streptococci, and opportunistic pathogenic bacteria in LCL lesions, but there have been no comparisons to normal skin. In addition, this approach has strong bias for determining bacterial composition. The present study tested the hypothesis that bacterial communities in LCL lesions differ from those found on healthy skin (HS). Using a high throughput amplicon sequencing approach, which allows for better populational evaluation due to greater depth coverage and the Quantitative Insights Into Microbial Ecology pipeline, we compared the microbiological signature of LCL lesions with that of contralateral HS from the same individuals.Streptococcus, Staphylococcus,Fusobacterium and other strict or facultative anaerobic bacteria composed the LCL microbiome. Aerobic and facultative anaerobic bacteria found in HS, including environmental bacteria, were significantly decreased in LCL lesions (p < 0.01). This paper presents the first comprehensive microbiome identification from LCL lesions with next generation sequence methodology and shows a marked reduction of bacterial diversity in the lesions.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Young Adult , Gram-Negative Bacteria/isolation & purification , Gram-Positive Bacteria/isolation & purification , Leishmaniasis, Cutaneous/microbiology , Skin/microbiology , Gram-Negative Bacteria/classification , Gram-Positive Bacteria/classification , Skin/parasitologyABSTRACT
Foi estudada a flora bacteriana em úlceras leishmanióticas, destacando-se o encontro das espécies aeróbicas Staphylococus aureus e Pseudomonas aeruginosa. O estudo da sensibilidade destas espécies a antibióticos mostrou sensibilidade à vancomicina, à amicacina e ao cloranfenicol em 100 por cento dos isolados testados de Staphylococus aureus e à amicacina, à gentamicina e à tobramicina em 100 por cento dos isolados testados de Pseudomonas aeruginosa. Estas espécies foram, em geral, resistentes às penicilinas e à tetraciclina.
The bacterial flora from leishmanial ulcers was studied. The aerobic species Staphylococcus aureus and Pseudomonas aeruginosa were found most frequently. Evaluation of the sensitivity of these species to antibiotics showed that 100 percent of these isolates of Staphylococcus aureus were sensitive to vancomycin, amikacin and chloramphenicol, while 100 percent of the isolates of Pseudomonas aeruginosa were sensitive to amikacin, gentamicin and tobramycin. These species were generally resistant to penicillins and tetracycline.
Subject(s)
Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Young Adult , Anti-Bacterial Agents/pharmacology , Gram-Negative Bacteria/drug effects , Gram-Positive Bacteria/drug effects , Leishmaniasis, Cutaneous/microbiology , Gram-Negative Bacteria/isolation & purification , Gram-Positive Bacteria/isolation & purification , Microbial Sensitivity Tests , Young AdultABSTRACT
Um estudo prospectivo, sobre a sensibilidade antimicrobiana da flora bacteriana em úlceras cutâneas leishmanióticas, foi realizado em pacientes portadores de leishmaniose tegumentar, em Corte de Pedra, Bahia. Foram estudados 84 pacientes, principalmente adolescentes e adultos dedicados à lavoura, apresentando lesão cutânea única. Staphylococcus aureus predominou (83 por cento) nas culturas, sendo sensível à maioria dos antibióticos testados. Flora bacteriana mista esteve presente na úlcera em 37 (44,1 por cento) pacientes. Entre as bactérias Gram-negativas isoladas, foram mais freqüentes Enterobacter sp (13,1 por cento), Proteus sp (8,3 por cento), Pseudomonas aeruginosa (7,1 por cento) e Klebsiella sp (7,1 por cento), sendo sensíveis principalmente à ciprofloxacina, aminoglicosídeos, cefalosporinas de terceira geracão e carbapenêmicos.
Subject(s)
Child, Preschool , Child , Adolescent , Adult , Middle Aged , Humans , Male , Female , Anti-Bacterial Agents/pharmacology , Gram-Negative Bacteria/drug effects , Gram-Positive Bacteria/drug effects , Leishmaniasis, Cutaneous/microbiology , Skin Ulcer/microbiology , Gram-Negative Bacteria/isolation & purification , Gram-Positive Bacteria/isolation & purification , Microbial Sensitivity Tests , Prospective StudiesABSTRACT
In a prospective study to evaluate the influence of secondary bacterial infection on the evaluation of cutaneous leishmaniasis, in Corte de Pedra (Bahia), we isolated Corynebacterium diphtheriae in 7 (8.3) out of 84 patients with ulcers studied. Due to the small number of patients with the presence of the bacteria in the ulcer, we could not conclude whether Corynebacterium diphtheriae behaves only as a colonizer nor its influence on the healing of the leishmaniotic ulcer.
Subject(s)
Humans , Child, Preschool , Child , Adolescent , Adult , Corynebacterium diphtheriae , Leishmaniasis, Cutaneous/microbiology , Skin Ulcer/microbiology , Prospective StudiesABSTRACT
In order to study the prevalence of secondary bacterial infection in ulcerated lesions and its relationship to the healing process, 84 leishmaniotic patients were evaluated. Diagnosis of the secondary infection was made by bacterial aerobic culture of peripheral tissue specimen of the ulcer. All patients received antimonial therapy during 20 days and washed their ulcers with common soap. Cases were composed mainly of adolescent and adult farmer patients with single lesions. The evaluated ulcers were encountered on legs and feet in 47.6%. Secondary bacterial infection was found in 45/83 (54.2%), and was more frequent in lesions located below the knee. Staphylococcus aureus predominated (89%). The ulcers' healing process, evaluated in 79 patients one month after finishing treatment, was not influenced by the secondary bacterial infection.
Foram avaliados 84 pacientes leishmanióticos com o objetivo de verificar a prevalência de infecção bacteriana secundária das úlceras cutâneas e de estudar sua relação com a cicatrização das lesões. A infecção secundária foi diagnosticada mediante cultura bacteriana aeróbica de amostra de tecido da lesão. Todos os pacientes receberam tratamento antimonial durante 20 dias e fizeram lavagem da úlcera com água e sabão comum. A casuística foi composta principalmente de adolescentes e de adultos dedicados à lavoura, apresentando lesão única. Em 47,6%, as úlceras estudadas estavam localizadas nas pernas e nos pés. Verificou-se infecção secundária em 45/83 (54,2%), sendo mais freqüente nas lesões localizadas abaixo dos joelhos. O Staphylococcus aureus predominou (88,9%). A reepitelização completa das úlceras, avaliada em 79 pacientes um mês após o fim do tratamento, não foi influenciada pela infecção secundária.
Subject(s)
Adolescent , Adult , Aged , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Staphylococcal Infections/complications , Staphylococcal Infections/epidemiology , Leishmaniasis, Cutaneous/complications , Brazil , Staphylococcal Infections/microbiology , Leishmaniasis, Cutaneous/microbiology , PrevalenceSubject(s)
Animals , DDT , Dieldrin , Female , Humans , India , Insect Vectors/microbiology , Insecticide Resistance/physiology , Insecticides , Leishmaniasis, Cutaneous/microbiology , Lethal Dose 50 , Malathion , Nitriles , Phlebotomus/microbiology , Phlebotomus Fever/microbiology , Pyrethrins , Time FactorsABSTRACT
Estudio prospectivo, de corte transversal donde fueron incluídos 102 pacientes con diagnóstico clínico y serológico de Leishmania Cutánea (LC) y Mucocutánea (LMC), que concurrieron al Laboratorio Central de Salud Pública, durante los años 1996 y 97, para la determinación del título de anticuerpos IgG anti-leismania se utilizó la Inmunoflourescencia Indirecta (IFI) y la Intradermoreacción de Montenegro (IDRM)