Mucosal leishmaniasis: A forgotten disease, description and identification of species in 50 Colombian cases / Leishmaniasis mucosa: una enfermedad olvidada, descripción e identificación de especies en 50 casos colombianos

Abstract Introduction: Mucosal leishmaniasis has a progressive course and can cause deformity and even mutilation in the affected areas. It is endemic in the American continent and it is mainly caused by Leishmania (Viannia) braziliensis. Objective: To describe a series of mucosal leishmaniasis cases and the infectious Leishmania species. Materials and methods: We included 50 patients with a clinical diagnosis of mucosal leishmaniasis and parasitological confirmation, and we described their clinical and laboratory results. We performed species typing by PCR-RFLP using the miniexon sequence and hsp70 genes; confirmation was done by sequencing. Results: The median time of disease evolution was 2.9 years (range: 1 month to 16 years). The relevant clinical findings included mucosal infiltration (94%), cutaneous leishmaniasis scar (74%), total loss of the nasal septum (24%), nasal deformity (22%), and mucosal ulceration (38%). The symptoms reported included nasal obstruction (90%), epistaxis (72%), rhinorrhea (72%), dysphonia (28%), dysphagia (18%), and nasal pruritus (34%). The histopathological study revealed a pattern compatible with leishmaniasis in 86% of the biopsies, and amastigotes were identified in 14% of them. The Montenegro skin test was positive in 86% of patients, immunofluorescence in 84%, and culture in 8%. Leishmania (V.) braziliensis was identified in 88% of the samples, L. (V) panamensis in 8%, and L. (V.) guyanensis and L. (L.) amazonensis in 2% respectively. Conclusion: In this study, we found a severe nasal disease with destruction and deformity of the nasal septum in 25% of the cases, probably associated with late diagnosis. Leishmania (V.) braziliensis was the predominant species. We described a case of mucosal leishmaniasis in Colombia caused by L. (L.) amazonensis for the first time.

Resumen Introducción. La leishmaniasis mucosa tiene un curso progresivo y puede causar deformidad e incluso mutilación de las zonas afectadas. Es endémica en el continente americano y es causada principalmente por Leishmania (Viannia) brasiliensis. Objetivo. Describir una serie de casos de leishmaniasis mucosa y las especies de Leishmania infecciosas. Materiales y métodos. Se estudiaron 50 pacientes con diagnóstico clínico de leishmaniasis mucosa y confirmación parasitológica. Se describieron sus características clínicas y los resultados de laboratorio. La tipificación de especies se hizo mediante reacción en cadena de la polimerasa de los polimorfismos de la longitud de los fragmentos de restricción (Restriction Fragment Length Polymorphism Polymerase Chain Reaction, PCR-RFLP) en la secuencia del miniexon y el gen hsp70 y se confirmó por secuenciación. Resultados. La evolución de la enfermedad fue de un mes a dieciséis años (mediana de 2,8 años). Los hallazgos clínicos fueron los siguientes: infiltración mucosa (94 %), cicatriz de leishmaniasis cutánea (74 %), pérdida total del tabique nasal (24 %), deformidad nasal (22 %) y ulceración (38 %). Los síntomas reportados fueron: obstrucción nasal (90 %), epistaxis (72 %), rinorrea (72 %), disfonía (28 %), disfagia (18 %) y prurito nasal (34 %). La histopatología mostró un patrón compatible con leishmaniasis en 86 % de las biopsias y se identificaron amastigotes en 14 % de ellas. La prueba de Montenegro fue positiva en 86 % de los pacientes, la inmunofluorescencia en 84 %, y el cultivo en 8 %. Leishmania (V.) brasiliensis se identificó en 88 % de las muestras, L. (V) panamensis en 8 %, y L. (V.) guyanensis y L. (L.) amazonensis en 2 %, respectivamente. Conclusión. Se encontró enfermedad nasal grave con destrucción y deformidad del tabique nasal en una cuarta parte de los casos, probablemente debido a un diagnóstico tardío. Leishmania (V.) brasiliensis fue la especie predominante. Se describe por primera vez un caso de leishmaniasis mucosa causado por L. (L.) amazonensis en Colombia.

Leprosy and American cutaneous leishmaniasis coinfection

Abstract: Brazil is a country with a high prevalence of infectious diseases such as leprosy and leishmaniasis. However, coinfection of these diseases is still poorly understood. We report a case of a patient who presented with lepromatous leprosy and cutaneous-mucosal leishmaniasis at the same period. After clinical, laboratory, and histopathological diagnosis, the treatment was introduced and the patient showed important clinical improvement. He was followed in our outpatient clinic. Both pathologies play an important role in the immune system. Depending on the immune response profile of the host, diseases may present themselves in different ways. In this case, the patient showed a divergent immune response for each disease. We hypothesized that this response is specific for each pathogen.

BODY WEIGHT AS A DETERMINANT OF CLINICAL EVOLUTION IN HAMSTERS (Mesocricetus auratus) INFECTED WITH Leishmania (Viannia) panamensis / Peso como determinante da evolução clínica em hamsters (Mesocricetus auratus) infectados com Leishmania (Viannia) panamensis

SUMMARY The clinical outcome of infection with Leishmania species of the subgenus Viannia in hamster model (Mesocricetus auratus) has shown to be different depending on experimental protocol. Body weight has been a relevant determinant of the clinical outcome of the infection in hamsters with visceral leishmaniasis but its importance as a clinical parameter in hamsters with cutaneous leishmaniasis is not known. In this study, the clinical evolution of infection with L. (V) panamensis was evaluated in juvenile and adult male hamsters during 11 weeks by comparing clinical parameters such as attitude, temperature, respiratory rate, appearance of the stool, and body weight between infected and non-infected groups. Results showed that body weight decreased in adult hamsters after infection by L. (V) panamensis; this observation supports the use of body weight as an additional parameter to define the management or treatment of cutaneous leishmaniasis in infected adult hamsters used as an animal experimental model for leishmaniasis. .

RESUMO O resultado clínico da infecção por espécies de Leishmania do subgênero Viannia no modelo de hamster (Mesocricetus auratus) tem se mostrado diferente, dependendo do protocolo experimental. O peso corporal tem sido um importante determinante da evolução clínica da infecção em hamsters com leishmaniose visceral, mas sua importância como parâmetro clínico em hamsters com leishmaniose cutânea não é conhecido. Neste estudo, a evolução clínica da infecção com L. (V) panamensis foi avaliada em jovens e adultos hamsters machos durante 11 semanas, comparando os parâmetros clínicos tais como a atitude, a temperatura, a frequência respiratória, a aparência das fezes, e o peso corporal entre infectado e grupos não infectados. Os resultados mostraram que o peso corporal diminuiu em hamsters adultos após infecção por L. (V) panamensis. Esta observação suporta a utilização do peso corporal, como um parâmetro adicional para definir a administração ou o tratamento de leishmaniose cutânea em hamsters adultos infectados usados como modelo animal experimental para a leishmaniose. .

Leishmaniasis mucocut nea con presentacion atipica: setenta anos posprimoinfeccion / Mucocutaneous leishmaniasis with atypical presentation: seventy years after primary infection

Las leishmaniasis son un grupo de enfermedades tropicales causadas por par sitos protozoarios del g‚nero Leishmania. Hayal menos 20 especies de Leishmania, cada una puede causar una enfermedad espec¡fica relacionada a la especie ya la respuesta inmunol gica del hu‚sped. Se presenta el caso de un paciente var¢n de 87 a¤os, con el diagn¢stico de leishmaniasis mucocut nea, setenta a¤os despu‚s de la primoinfecci n, cuya presentaci¢n se inicia en la zona cut nea y compromete la mucosa nasal por extensi¢n. Tiene antecedente de hace 70 a¤os de lesi¢n ulcerativa que se resolvi¢ espont neamente en un viaje a  rea end‚mica de leishmaniasis en Per£, desde entonces nunca viaj¢ fuera de Lima. El paciente fue diagnosticado de leishmaniasis por histopatologia y PCR de las lesiones. Fue tratado con estibogluconato de sodio, 20 mglkgld, intramuscular, cada 12 horas, por 28 d¡as, con per¡odos de descanso de 7 d¡as. Present¢ curaci¢n cl¡nica completa de las lesiones infiltradas y ulcerativas.

Leishmaniasis is a tropical disease witli a wide clinical spectrum caused by protoioan parasites of the genus Leishmania. There are at least 20 species of Leishmania, each may cause a disease specific to the species and the host immunological response. We present the case of a 87 year old male patient, We found he had an ulcerative lesion on his left arm 70 years prior, that spontaneously heal, while he traveled to an endemic area for leishmaniasis in Peru. Since then he had never traveled outside his city. The patient was diagnosed of leishmaniasis by histopathology and PCR from the lesions. He was treated with systemic sodium stibogluconate (20 mg/kg/d) for 28 days with complete clinical healing of the ulcerative lesions.

Laryngeal Leishmaniasis

Introduction: Leishmaniasis is classified into three clinical presentations: visceral, coetaneous and mucocutaneous. The latter is usually secondary to hematogenous spread after months or years of skin infection and can manifest as infiltrative lesions, ulcerated or vegetating in nose, pharynx, larynx and mouth, associated or not with ganglionics infarction. Laryngeal involvement is part of the differential diagnosis of lesions in this topography as nonspecific chronic laryngitis, granulomatosis and even tumors of the upper aerodigestive tract presenting atypical evolution. Sometimes it is difficult for the correct diagnosis of Leishmaniasis, with description of cases in the literature were conducted improperly. Objective: The objective of this study is to report a case of laryngeal Leishmaniasis addressing the difficulty of diagnosis, complications and treatment applied. Case Report: A patient with pain throat, dysphagia, odynophagia, dysphonia and weight loss, with no improvement with symptomatic medication. At telelaringoscopy, infiltrative lesion showed nodular supraglottis. He underwent a tracheotomy for airway obstruction and biopsy with immunohistochemical study for a definitive diagnosis of laryngeal Leishmaniasis. The patient was referred to the infectious diseases that initiated treatment with N-methylglucamine antimoniate with satisfactory response to therapy. Final Comments: Faced with a clinical suspicion of granulomatous diseases, it is essential to follow protocol laboratory evaluation associated with histological injury, to get a precise definition etiological without prolonging the time of diagnosis. Medical treatment for mucosal Leishmaniasis, recommended by the World Health Organization, was adequate in the case of laryngeal disorders, with complete resolution of symptoms...

Detección de Leishmania braziliensis en lesión mucosa con 16 años de evolución: Registro de un caso / Detection of Leishmania braziliensis in a mucosal lesion with 16 years of evolution: A case report

Se registra, en un paciente masculino de 48 años, la detección de Leishmania (Viannia) braziliensis en muestra de lesión mucosa crónica con 16 años de evolución clínica. El caso presentado cursa con perforación del tabique nasal no evidenciándose lesión cutánea primaria sugestiva de leishmaniasis. Por su ocupación el paciente ha frecuentado, por largos períodos, bosques en áreas endémicas para leishmaniasis en el occidente de Venezuela. Continuas evaluaciones clínicas, inmunológicas e histopatológicas realizadas durante varios años fallaron en establecer un diagnóstico certero incrementando la severidad del caso. Exámenes recientes realizados en nuestro laboratorio revelan la presencia de amastigotes en muestras de la lesión nasal activa en extendidos coloreados con tinción de Giemsa. La identificación del parásito como L. braziliensis y la verificación de la infección por este parásito en el paciente, fue lograda por ensayos de PCR y Western Blot, respectivamente. Se concluye que el caso presentado sufre una leishmaniasis mucocutánea de vieja data con una baja respuesta inmunológica, a juzgar por la frecuente negatividad en pruebas de IDR y/o la detección de anticuerpos circulantes anti-Leishmania. Se discute sobre la imprecisión diagnóstica en el caso presentado y se advierte sobre el riesgo epidemiológico potencial de casos similares.

The detection of Leishmania (Viannia) braziliensis from a chronic mucosal lesion with 16 years of clinical evolution in a 48 years old male patient is reported. The patient showed destruction of the nasal septal cartilage with no evidence of primary leishmanial lesion. Due to his professional work he frequently visited areas of western Venezuela where leishmaniasis is endemic. Frequent clinical, immunologic and histopathologic evaluations carried out during several years failed to establish a right diagnosis, increasing the severity of the mucosal lesion. The finding of a sparse number of amastigotes in a sample from the mucosal lesion stained by Giemsa stain, suggested a mucosal infection by Leishmania. The identification of the parasite as L. braziliensis and the verification of the infection by this parasite in the reported case were carried out using a PCR assay and a Western Blot test, respectively. It is concluded that the patient was suffering a long-lasting, reluctant to heal and severe lesion with a low immunological response due to infection by L. braziliensis causing mucocutaneous leishmaniasis (MCL). The fail in the diagnosis of this particular case of MCL and the potential epidemiological risk in similar cases are discussed.

Atypical mucocutaneous involvement with Leishmania donovani.

Mucocutaneous leishmaniasis has rarely been reported from India. The usual causative organisms of this infection are Leishmania braziliensis and L. tropica. Another species, L. donovani, which usually causes visceral leishmaniasis, has recently been reported to cause mucocutaneous disease in a few patients from Sri Lanka. We report two patients who had undiagnosed chronic skin lesions for several years. Skin biopsies revealed Leishmania and the species was characterized as L. donovani in both patients. There was considerable improvement in the skin lesions following treatment with liposomal amphotericin B.

Mucocutaneous Leishmaniasis: clinical markers in presumptive diagnosis / Leishmaniose mucosa: marcadores clínicos no diagnóstico presuntivo

Mucocutaneous Leishmaniasis (ML) can lead to serious sequela; however, early diagnosis can prevent complications. AIM: To evaluate clinical markers for the early diagnosis of ML. MATERIALS AND METHODS: A series study of 21 cases of ML, which were evaluated through clinical interview, nasal endoscopy, biopsy and the Montenegro test. RESULTS: A skin scar and previous diagnosis of cutaneous leishmaniasis (CL) were reported in 8(38 percent) patients, and 13(62 percent) of them denied having had previous CL and had no scar. Nasal/oral symptom onset until the ML diagnosis varied from 5 months to 20 years, mean value of 6 years. In the Montenegro test, the average size of the papule was 14.5 mm, which did not correlate with disease duration (p=0.87). The nose was the most often involved site and the extension of the injured mucosa did not correlate with disease duration. The parasite was found in 2 (9.52 percent) biopsy specimens. CONCLUSIONS: ML diagnosis was late. Finding the parasite in the mucosa, cutaneous scar and/or previous diagnosis of CL were not clinical markers for ML. ML diagnosis must be based on the Montenegro test, chronic nasal and/or oral discharge and histological findings ruling out other granulomatous diseases.

A leishmaniose cutâneo-mucosa (LM) pode deixar sequelas graves. O diagnóstico precoce evita complicações. OBJETIVO: Avaliar marcadores clínicos para o diagnóstico precoce da LM. MATERIAL E MÉTODO: Estudo de série de 21 casos avaliados com diagnóstico confirmado de LM por meio de entrevista, endoscopia nasal, biópsia e teste cutâneo de Montenegro. RESULTADOS: A cicatriz cutânea ou história de leishmaniose cutânea foram observadas em 8 (38 por cento) pacientes e 13(62 por cento) negaram terem tido forma cutânea e não tinham cicatriz. O início dos sintomas nasais/orais até a definição do diagnóstico variou de 5 meses a 20 anos, média de 6 anos. No teste de Montenegro, o tamanho médio da pápula foi de 14,5mm e não se correlacionou com a duração da doença (p=0,87). O comprometimento nasal predominou e a extensão da lesão não se correlacionou com a duração da doença. Parasitas foram encontrados em 2(9,52 por cento) espécimes de lesões biopsiadas. CONCLUSÃO: O diagnóstico da LM foi tardio. O encontro do parasito na mucosa, a cicatriz típica e leishmaniose cutânea prévia não foram marcadores para o diagnóstico de LM. O diagnóstico de LM pode se basear no teste de Montenegro alterado associado a sintomas nasais e/ou orais e exclusão de outras doenças granulomatosas.

case of mucocutaneous leishmaniasis from Interior Sindh

A case of mucocutaneous leishmaniasis of a 10 year-old-boy from Chachro district of interior Sind is presented here who presented with a nonhealing mucocutaneous ulcer of 3 years duration

American tegumentary leishmaniasis: langerhans cells in montenegro skin test / Leishmaniose tegumentar americana: células de Langerhans na reação intradérmica de Montenegro

This work analyzed the histopathology and epidermal Langerhans cells (LC) of Montenegro skin test (MST) in patients with American tegumentary leishmaniasis (ATL) in order to in situ characterize and compare the immunological reaction of the two major clinical forms of ATL, localized cutaneous leishmaniasis (LCL) and mucocutaneous leishmaniasis (MCL). MST histopathology of both LCL and MCL showed superficial and deep perivascular inflammatory infiltrate composed mainly of lymphocytes and histiocytes. Epidermal LC population was higher in MST biopsies taken from LCL patients when compared to MCL group, at 48 and 72 hours after antigen inoculation. Increased number of epidermal LC displayed in MST biopsies of LCL patients represents specific cellular immunity against parasites. The decrease of LC in MST biopsies of MCL patients does not necessarily indicate a worse specific cellular immunity in this clinical form of leishmaniasis.

Este trabalho analisou e quantificou as células de Langerhans e as características histopatológicas da reação de Montenegro nos pacientes com leishmaniose tegumentar americana (LTA) para caracterizar seu comportamento imunológico nas duas formas clínicas mais comuns da LTA, a leishmaniose cutânea localizada (LCL) e a leishmaniose cutâneo-mucosa (LCM). O exame histopatológico apresentou infiltrado inflamatório perivascular superficial e profundo, com predomínio de histiócitos e linfócitos, sem diferença significante entre as duas formas da doença. O resultado da quantificação das CL apresentou aumento das CL na LCL e diminuição na LCM em 48 e 72 horas após a inoculação do antígeno (p < 0,001). O aumento das células de Langerhans epidérmicas na reação de Montenegro da LCL demonstra a presença de imunidade celular específica, enquanto a diminuição das mesmas células na LCM não necessariamente demonstra uma diminuição da imunidade celular específica.

Leishmaniose muco-cutânea: relato de caso clínico / Mucocutaneous leishmaniasis: a case report

Leishmaniose muco-cutânea é, dentre as variantes da doença tegumentar, uma infecção causada pelo protozoárioLeishmania (Viannia) braziliensis, acometendo pele e mucosas com o desenvolvimento de úlceras. Este trabalhotem por objetivo relatar o caso clínico de um paciente, apresentando lesão ulcerada em região de asa donariz e soalho nasal do lado direito. Em associação havia uma lesão avançada em glande peniana cominfecção secundária. Diante dos achados clínicos, teve-se como diagnóstico provável leishmaniose mucocutânea,o qual foi sugerido pelo exame histopatológico, após biópsia incisional da lesão. Terapêutica medicamentosa específica foi administrada, e o paciente encontra-se com remissão da sintomatologia e em observação.

Dendrócitos dérmicos fator XIIIa positivos na resposta tecidual cutânea da leishmaniose tegumentar americana / Factor XIIIa positive dermal dendrocytes in american tegumentary leishmaniasis cutaneous tissue response

Para verificar a participação dos dendrócitos dérmicos fator XIIIa positivos (DDFXIIIa+) na patogenia da leishmaniose tegumentar americana (LTA) fez-se a sua demonstração por técnica imuno-histoquímica em lesões de pele de 47 doentes e comparação de sua população com a de grupo controle normal. Verificou-se a interação dos DDFXIIIa+ com os parasitas por técnica imuno-histoquímica de dupla marcação com os anticorpos anti-fator XIIIa e anti-Leishmania. Os DDFXIIIa+ eram hipertróficos e numerosos nas lesões de LTA quando comparados a pele normal. Evidenciou-se parasitismo de DDFXIIIa+ em 11 de 22 casos. Os resultados sugerem a participação dos DDFXIIIa+ no mecanismos patogenéticos da LTA como célula - alvo, efetora e/ou apresentadora de antígenos / In order to verify factor XIIIa positive dermal dendrocyte (FXIIIa+DD) involvement in american tegumentary leishmaniasis pathogenesis, 47 patients skin lesions were subjected to immunohistochemistry technique, quantified and compared to a normal skin group sample. Interaction of FXIIIa+DD and parasites was disclosed by double-staining technique with anti-factor XIIIa and anti- Leishmania antibodies. FXIIIa+DD were hypertrofic and numerous in leishmaniasis skin lesions. FXIIIa+DD harboring Leishmania were observed in 11 of 22 biopsies. The results obtained suggest the participation of FXIIIa+DD in the pathogenesis of tegumentary leishmaniasis skin lesions as host cell, immune effector and/or antigen-presenting cell...

Leishmaniosis mucocutánea en perros naturalmente infectados en Salta, Argentina / Mucocutaneous leishmaniasis in naturally infected dogs in Salta, Argentina

The objective of the present study is to describe two cases of dogs with mucocutaneous lesions caused by Leishmania spp. Both dogs presented destruction of the nasal septum, hyperemia with soft palate edema and barking alteration due to laryngeal compromise. Biopsies were taken from the lesion border and Leishmania spp. amastigotes were seen in the imprints. The dogs presented positive serology when complex soluble antigen from Leishmania mexicana was used. One of the dogs was also suspected to be infected by Trypanosoma cruzi as suggested by its positive reaction with a purified specific antigen, Ag163B6-cruzipain. Most of the studies concerning leishmaniosis in dogs have described the cutaneous form of this disease in close association with human cases of Leishmania infection instead of the mucocutaneous form described herein. The presence of dogs with mucocutaneous leishmaniosis alerts on an increase of the prevalence of this form in humans, which can cause deforming lesions, alterations of the speech and even an inadequate nutrition due to difficulties in deglutition.

Persistence of Leishmania antigen in C57B1/6j inbred mice infected with Leishmania (Leishmania) amazonensis

Purpose. To develop an animal model for studying mucocutaneous leishmaniasis. Methods. The hind footpad of C57B1/6j inbred mice was experimentally infected with 10(7) Leishmania (Leishmania) amazonensis promastigote and the skin was studied through ligh and electron transmission microscopy and immunohistochemistry (PAP) techniques. Results. There were morphological evidences of cellular immune mechanisms and hypersensitivity reaction after eight weeks of infection and metastasis and well shaped parasites at ultrastructural level by fifty-one weeks post infection. Relapse of infection with mucosa lesions occurred around the 50th week after inoculation. Conclusion. The use of this animal model in long term follow up could be an useful experimental model for human mucocutaneous leishmaniasis.

Las asociaciones de pacientes y el control de la leishmaniasis en el Perú / Patients' associations and the control of leishmaniasis in Perú

La leishmaniasis mucocutánea americana es un grave problema de salud en el Perú, particularmente en la región montañosa de Cuzco, donde se produjeron 25 por ciento de todos los nuevos casos notificados en 1989. El número de casos ha aumentado notablemente desde principios del denenio de 1980, cuando hubo una emigración estacional en gran escala a las zonas endémicas, especialmente a la región forestal de Madre de Dios, debido al descubrimiento de nuevas minas de oro en esa zona y al deterioro económico en el Perú. Ante la falta de respuesta oficial del Gobierno peruano, centenares de enfermos de leishmaniasis en la zona de Cuzco formaron asociaciones de autoayuda con el objetivo de obtener los medicamentos necesarios para tratar su afección. El logro principal de este movimiento que surgió espontáneamente, apoyado por varias instituciones públicas y privadas, fue animar a los enfermos, particularmente a los pacientes con lesiones de las mucosas, a salir del aislamiento. Como resultado, se han reducido mucho la prevalencia e incidencia de la enfermedad en ese territorio

An evaluation of clinical, serologic, anatomopathologic and immunohistochemical findings for fifteen patients with mucosal leishmaniasis before and after treatment

O controle de tratamento da leishmaniose mucosa (LM) pode ser realizado pelo exame clinico e o acompanhamento dos titulos sorológicos da reaçäo de imunofluorescencia indireta (RIFI). Estudamos a correlaçäo entre a presença de antigeno no tecido através da reaçäo de imuno-histoquimica, os titulos da reaçäo de imunofluorescencia indireta e os achados anatomopatologicos, em quinze pacientes com LM, antes e após as lesöes estarem cicatrizadas pela avaliaçäo otorrinolaringologica, e avaliamos qual destes parametros pode ter utilidade no seguimento. Após a terapeutica houve negativaçäo do antigeno tecidual em quatro doentes (grupo A), sendo a reduçäo ou negativaçäo dos titulos da RIFI estatisticamente significante (p<0.05), o que näo ocorreu nos doentes, em que houve permanencia do antigeno posteriormente ao tratamento (grupo B)...

Visceralizaçäo da leishmaniose cutâneomucosa disseminada causada pela leishmania viannia braziliensis em paciente imunocompetente / Visceralization of disseminated leishmaniosis mucocutaneous caused by leishmania viannia braziliensis in immunocompetent patient

Em relaçäo à invasäo de órgäos internos por leishmânias que normalmente se manifestam no tegumento cutâneo, foram documentados dois casos da forma tegumentar de leishmaniose com presença do parasito na medula. As espécies identificadas foram Leishmania amazonensis e Leishmania Viannia braziliensis. Relata-se o caso de um paciente de 33 anos com febre ocasional, mais de cinquenta lesoes pápuloulcerosas disseminadas na pele, infiltraçao de septo nasal, cavum, laringe e também hepatomegalia. A pesquisa de parasitos das lesöes cutâneas em cultura, no exame histopatológico e na inoculaçäo em hamsters foi positiva com a identificaçäo por anticorpos monoclonais de Leishmania Viannia braziliensis na pele. No exame histopatológico do fígado foi encontrado infiltrado histiolinfoplasmocitário com raros parasitos. O leucograma apresentou leucopenia e velocidade de hemossedimentaçäo elevada. O teste de ELISA para o vírus da imunodeficiência humana foi negativo, e testes cutâneos para avaliar imunidade celular, positivos. Este relato reforça a possibilidade de visceralizaçao, em indivíduos imunocompetentes, quando se trata de cepa de leishmania Viannia braziliensis, considerada inicialmente com tropismo exclusivo para peles e mucosas. Casos semelhantes precisam ser documentados com a identificaçäo do parasito na víscera a fim de esclarecer a patogenia dessa espécie de leishmania

Cutaneous leishmaniosis coinfection in AIDS patients: Case report and literature review

A fatal case of mucosal leishmaniasis in a patient with AIDS is presented. Seventeen cases of L. brasiliensis coinfection in AIDS patients in Brazil have been presented at the meetings of The Brazilian Society of Infectious Diseases. As in the case presented here, 4 cases with mucosal involvement also had negative delayed type hypersensitivity reactions to leishmania antigens. This lack of immunologic responsiveness, the invasive nature of the infection, and the poor response to therapy indicate that the combination of these infections should be viewed as a new disease entity.