Estudo evolutivo da leishmaniose mucosa (7 a 17 anos de seguimento) causada por Leishmania (Viannia) braziliensis em Três Braços, Bahia / Follow-up of 7-17 years of patients with mucosal leishmaniases caused by Leishmania (Viannia) braziliensis in Três Braços, Bahia

RESUMO

Seventy seven (68 per cent) patients with mucosal leishmaniasis recorded during the period 1976-1986 in the region of Três Braços, Bahia were traced and re-evaluated clinically, diagnostically and therapeutically. Sixty-five patients were alive. The families of 12 dead patients were interviewed about probable cause of death. The 65 patients had a fresh clinical examination supplemented when necessary by a skilled ENT examination. All had a titre of circulating immunofluorescent antibodies estimated at the time. Eight patients with active mucosal lesions had triturated biopsies which were cultivated in NNN medium and inoculated in hamsters to attempt to recover Leishmania. The isolates were identified by monoclonal antibodies as Leishmania (Viannia) braziliensis. Fifty-six (86 per cent) patients were judged clinically cured. Nine (13 per cent) had active lesions. Of the 12 patients who died 5 (41 per cent) had no signs of activity at death. Mucosal leishmaniasis was thought to be the direct cause of death in 3 patients. The field treatment programme at Três Braços has managed to clinically cure 61 patients (79 per cent) during 17 years. Follow-up periods were a mean of 10 years (range 7-17).