Oral manifestations in the American tegumentary leishmaniasis.

INTRODUCTION: American tegumentary leishmaniasis (ATL) can affect the skin or mucosa (mucocutaneous leishmaniasis - MCL) including the oral cavity. MCL oral lesions are often confused with other oral diseases, delaying diagnosis and specific treatment, and increasing the likelihood of sequelae. Thus, increasing the knowledge of the evolution of ATL oral lesions can facilitate its early diagnosis improving the prognosis of healing. OBJECTIVES: Evaluate the frequency of ATL oral lesion and describe its clinical, laboratory and therapeutic peculiarities. METHODS: A descriptive transversal study was carried out, using data from medical records of 206 patients with MCL examined at the outpatient clinics-IPEC-Fiocruz between 1989 and 2013. Proportions were calculated for the categorical variables and the association among them was assessed by the Pearson's chi-square test. Measures of central tendency and dispersion were used for the continuous variables and their differences were assessed by both parametric (t test) and non parametric (Mann-Whitney) tests. P-values <0.05 were considered as significant. RESULTS: The most affected site was the nose, followed by the mouth, pharynx and larynx. Seventy eight (37.9%) have oral lesions and the disease presented a lower median of the evolution time than in other mucous sites as well as an increased time to heal. The presence of oral lesion was associated with: the presence of lesions in the other three mucosal sites; a smaller median of the leishmanin skin test values; a longer healing time of the mucosal lesions; a higher recurrence frequency; and a smaller frequency of treatment finishing and healing. When the oral lesion was isolated, it was associated with an age 20 years lower than when the oral lesion was associated with other mucosal sites. CONCLUSION: Considering the worst therapy results associated with the presence of oral lesions, we suggest that lesions in this location represent a factor of worse prognosis for MCL.

American cutaneous leishmaniasis caused by Leishmania (Viannia) braziliensis resistant to meglumine antimoniate, but with good response to pentamidine: a case report.

This is a case report of a Brazilian soldier with cutaneous leishmaniasis. The lesion relapsed following two systemic treatments with meglumine antimoniate. The patient was treated with amphotericin B, which was interrupted due to poor tolerance. Following isolation of Leishmania sp., six intralesional infiltrations of meglumine antimoniate resulted in no response. Leishmania sp promastigotes were again isolated. The patient was submitted to intramuscular 4 mg/kg pentamidine. Parasites from the first and second biopsies were identified as Leishmania (Viannia) braziliensis; those isolated from the first biopsy were more sensitive to meglumine antimoniate in vitro than those isolated from the second biopsy. No relapse was observed.

American cutaneous leishmaniasis caused by Leishmania (Viannia) braziliensis resistant to meglumine antimoniate, but with good response to pentamidine: a case report / Leishmaniose cutânea americana causada pela Leishmania (Viannia) braziliensis resistente ao antimoniato de meglumina e com boa resposta terapêutica à pentamidina: relato de um caso

Relatamos um caso de um militar brasileiro com leishmaniose cutânea, cuja lesão reativou após dois tratamentos sistêmicos com antimoniato de meglumina. Foi tratado com anfotericina B, mas precisou interromper por intolerância à medicação. Após isolamento de Leishmania sp, seis infiltrações intralesionais de antimoniato de meglumina foram realizadas, sem resposta. Promastigotas de Leishmania sp. foram novamente isoladas. Foi submetido a tratamento intramuscular com pentamidina (4mg/kg). Parasitas da primeira e segunda biópsias foram identificados como Leishmania (Viannia) braziliensis; os da primeira biópsia eram mais sensíveis ao antimoniato de meglumina in vitro do que os da segunda biópsia. A lesão não reativou.

This is a case report of a Brazilian soldier with cutaneous leishmaniasis. The lesion relapsed following two systemic treatments with meglumine antimoniate. The patient was treated with amphotericin B, which was interrupted due to poor tolerance. Following isolation of Leishmania sp., six intralesional infiltrations of meglumine antimoniate resulted in no response. Leishmania sp promastigotes were again isolated. The patient was submitted to intramuscular 4mg/kg pentamidine. Parasites from the first and second biopsies were identified as Leishmania (Viannia) braziliensis; those isolated from the first biopsy were more sensitive to meglumine antimoniate in vitro than those isolated from the second biopsy. No relapse was observed.

Ensaio imunoenzimático com antígeno de leishmania (Viannia) braziliensis no diagnóstico e acompanhamento de pacientes com leishmaniose tegumentar americana / Enzyme immunoassay with leishmania (Viannia) braziliensis antigen in the diagnosis and monitoring of patients with cutaneous tegumentar leishmaniasis

Avaliou-se o ensaio imunoenzimático indireto (ELISA) com antígeno de Leishmania (V.) braziliensis para a investigação diagnóstica da leishmaniose tegumentar americana (LTA) em suas modalidades cutânea (LC) e cutâneomucosa (LCM) e avaliação da resposta terapêutica a partir de amostras de soro de pacientes atendidos no Instituto de Pesquisa Clínica Evandro Chagas (IPEC). O grupo I, LTA (n=153) foi formado com amostras de soros de pacientes com pelo menos um resultado positivo nos exames parasitológicos ou na reação em cadeia da polimerase (PCR), e o grupo II, controle (n=103), com amostras de indivíduos representativos da população do estudo, com suspeita inicial de LTA, mas com outro diagnóstico confirmado. As seguintes informações foram obtidas dos prontuários: avaliação clínica, dermatológica otorrinolaringológica; intradermorreação de Montenegro IDRM; pesquisa de Leishmania por exame direto e histopatológico, isolamento em meio de cultura, PCR e exames diretos com colorações especiais, inoculação em meios de cultura para fungos e micobactérias. As amostras foram obtidas nas fases de investigação diagnóstica e pós-tratamento em períodos definidos até dois anos. Comparou-se a sensibilidade do ELISA com a de cada um dos métodos parasitológicos, PCR e com a IDRM. Para avaliação da resposta terapêutica, amostras de 75 pacientes que se mantiveram com as lesões cicatrizadas durante o período do estudo constituíram o subgrupo cura terapêutica (ICT) e aquelas de 31 pacientes com recidivas constituíram o subgrupo recidiva pósterapêutica (IRT). A confiabilidade do teste avaliado pelo coeficiente de correlação intraclasse foi de 0,953 (IC 95 por cento)Encontrou-se sensibilidade de 94,7 por cento, especificidade de 95,1 por cento e valores preditivos, positivo e negativo de 96,6 por cento e 92,4 por cento respectivamente...

Indirect Enzyme Immunoassay (ELISA) was evaluated with Leishmania (V.) braziliensis antigen to the diagnostic workup of American Tegumentary Leishmaniasis (American Tegumentary Leishmaniasis - ATL) in their cutaneous (CL) and mucocutaneous (MCL) modalities, and about the therapeutic response from samples of serum from patients at the Instituto de Pesquisa Clínica Evandro Chagas (IPEC). Group I, ACL (n = 153) was formed with sera samples of patients with atleast one positive result in parasitological examinations or in polymerase chain reaction (PCR), and group II, control (n = 103), with samples of individuals representative of the study population, with initial suspicion of ACL, but with other confirmed diagnosis. The following information was obtained from medical records:clinical, dermatological, and otorrinolaringology evaluation; measure in mm of Montenegro intradermoreaction (IDRM); search for Leishmania by direct examination and histopathology, isolation in culture media, PCR and direct examination with special staining and inoculation in culture media for fungi and mycobacteria. Samples were obtained during the diagnostic workup and after treatment, in periods defined as up to two years. We compared the sensitivity of the ELISA with each of theindividual parasitological methods, the PCR, and the IDRM. To evaluate the therapeutic response, samples of 75 patients who remained with the lesions healed during the study period were the therapeutic healing subgroup (ICT) and those 31 patients with recurrences were the post-therapy relapse subgroup (IRT). The reliability of the test assessed by the intraclass correlation coefficient was 0.953 (95 percentCI). We found a sensitivity of 94.7 percent and 95.1 percent specificity, and positive and negative predictive values of 96.6 percent and 92.4 percent, respectively...

Is Leishmania (Viannia) braziliensis preferentially restricted to the cutaneous lesions of naturally infected dogs?

Nineteen dogs naturally infected with Leishmania (Viannia) braziliensis were studied in order to determine the presence of the parasite outside cutaneous lesions. Eleven (57.9%) animals showed single cutaneous or mucosal lesions and eight (42.1%) presented two or three lesions. Twenty-eight active lesions were biopsied. Isolation in culture and characterization by enzyme electrophoresis were possible in 100% of cases and amastigote forms were visualized upon histopathological examination in three samples (n=25, 12%). Isolation of the parasite in culture from peripheral blood and intact skin fragments obtained from the scapular region was negative in all animals, as was the histopathological analysis of skin from this region. Serological reactivity determined by an immunofluorescent antibody test and/or enzyme-linked immunosorbent assay was demonstrated in 15 animals. The results obtained suggest that L. braziliensis preferentially remains at the site of lesion, in contrast to the systemic distribution of parasites observed in dogs infected with L. (Leishmania) chagasi. A better understanding of this aspect may help direct diagnostic and control strategies applicable to areas characterized by the simultaneous occurrence of the cutaneous and visceral forms of leishmaniasis, as is the case for the Municipality of Rio de Janeiro, Brazil.

Aspectos epidemiológicos da leishmaniose tegumentar americana em cães, no Município de Paraty, Estado do Rio de Janeiro, Brasil / Epidemiological aspects of canine american tegumentary leishmaniasis in the Municipality of Paraty, State of Rio de Janeiro, Brazil

A leishmaniose tegumentar americana (LTA) é de ocorrência endêmica no Estado do Rio de Janeiro, sendo a maior incidência observada nos municípios do litoral sul. No período de 1993 a 1995, foram registrados, no Município de Paraty, extremo sul do Estado, 169 casos humanos, o que corresponde a 15 porcento das notificações no estado. Neste trabalho, realizou-se estudo em áreas endêmicas (Praia Grande, Taquari, Várzea do Machado e Graúna) de LTA, com cães residentes no Município de Paraty, entre março e dezembro de 1996. Foram visitadas 315 residências, compreendendo uma população de 1.282 habitantes, com 215 cães estudados. O trabalho inicial consistiu na coleta de sangue venoso, para realização das técnicas sorológicas: Reação de Imunofluorescência Indireta (RIFI) e Enzyme Linked Immunossorbent Assay (ELISA). O resultado da sorologia foi de 3,2 percent de positividade para a técnica de Rifi e 10,2 porcento para a de Elisa. A prova intradérmica canina foi realizada na mesma ocasião da coleta de sangue e sua positividade foi de 8,8 porcent. Dos 215 cães, cinco deles apresentaram lesões suspeitas, nos quais realizou-se biópsia e técnica de aspirado a vácuo

Phase 1 study of an inactivated vaccine against American tegumentary leishmaniasis in normal volunteers in Brazil

A phase 1 double-blind placebo-controlled study was performed to evaluate a vaccine against American tegumentary leishmaniasis in 61 healthy male volunteers. Side effects and the immune response to the vaccine were evaluated, with 1- and 2- dose schemes, with intervals of 7 or 21 days, each dose containing 1440 mg of protein N antigen of a single strain of Leishmania amazonensis (PH 8) diluted in merthiolated saline (1:10,000). Merthiolated saline and an inert substance were used as placebos. No significant clinical alterations were found following the respective injections in the vaccinated individuals as compared to the placebos, except for local pain, which was associated significantly with injection of the vaccine. The laboratory alterations we observed bore no association with the clinical findings and were unimportant. We observed no differences between the groups with regard to seroconversion or the Montenegro skin test. However, the group that received a single dose of the vaccine and the one that received two doses with a 21-day interval displayed cutaneous induration significantly larger than in the control group, with 100 per cent and 66 per cent conversion in the skin test, respectively. We concluded that the vaccine does not present any major side effect that would contraindicate its use in healthly individuals.