ABSTRACT
American tegumentary leishmaniasis (ATL) can occur in different forms, classically categorised as cutaneous leishmaniasis, mucosal leishmaniasis, diffuse cutaneous leishmaniasis and disseminated leishmaniasis. We analysed the presence of atypical manifestations (vegetative, verrucous, crusted and lupoid) among a cohort of patients presenting to the Health Post of Corte de Pedra, Bahia, Brazil. Among 1396 patients diagnosed with ATL in 2005-2006, 35 patients (2.5%) presented with atypical manifestations of the disease. Of these patients, 14 were pregnant women, 2 were co-infected with HIV and 19 had no co-morbidity or other apparent risk factors for the development of atypical ATL. The latter 19 patients were the focus of this study. They were predominantly adult males, frequently presenting with facial lesions [P<0.001; odds ratio (OR)=17.5, 95% CI 6.1-52.4] and had higher rates of treatment failure with antimonial therapy (P<0.001; OR=327, 95% CI 45-6668) compared with patients with classic ATL attending in the same period. Thirteen cases healed with amphotericin B, introduced after failure of three or more courses of antimony, suggesting that amphotericin B should be considered as the drug of choice for all patients diagnosed with atypical ATL.
Subject(s)
Leishmania braziliensis , Leishmaniasis, Cutaneous/pathology , Adolescent , Adult , Amphotericin B/therapeutic use , Animals , Antiprotozoal Agents/therapeutic use , Brazil/epidemiology , Facial Dermatoses/parasitology , Facial Dermatoses/pathology , Female , Humans , Leishmania braziliensis/drug effects , Leishmania braziliensis/immunology , Leishmaniasis, Cutaneous/drug therapy , Leishmaniasis, Cutaneous/immunology , Male , Meglumine/therapeutic use , Meglumine Antimoniate , Middle Aged , Organometallic Compounds/therapeutic use , Pregnancy , Pregnancy Complications, Parasitic/pathology , Prognosis , Risk Assessment , Risk Factors , Treatment Outcome , Young AdultABSTRACT
This paper records the plants used in the treatment of cutaneous leishmaniasis due to Leishmania (Viannia) braziliensis (L(V)b) among the rural population of a cocoa-producing coastal area of Bahia state, Brazil. An enquiry conducted among a hundred patients identified 49 plants species used to treat skin ulceration caused by this Leishmania species. The principal plants used are caju-branco (Anacardium occidentale, Anacardiaceae), used by 65% of the population, folha-fogo (Clidemia hirta,Melastomataceae) 39%, alfavaca-grossa (Plectranthus amboinicus, Lamiaceae) 33%, mastruz (Chenopodium ambrosioides, Chenopodiaceae) 31%, erva-de-santa-maria (Solanum americanum, Solanaceae) (25%) and transagem (Plantago major, Plantaginaceae) 2%.
Subject(s)
Disease Reservoirs , Leishmania braziliensis , Leishmaniasis, Cutaneous/drug therapy , Plants, Medicinal , Animals , Brazil , Female , Humans , Male , Middle Aged , Ointments , Plant Extracts/therapeutic use , Plant Leaves , Plant Roots , Powders , Rural PopulationABSTRACT
A novel measurement technique based on phase-stepping microinterferometry is proposed for the refractive-index profiling of planar waveguides fabricated by ion exchange in glass. The sample preparation simplicity and easy instrumental implementation, together with high accuracy and improved resolution, are argued.
ABSTRACT
The occurence of acute cutaneous leishmaniasis among inhabitants of 10 farms within 10 Km of the hamlet of Corte de Pedra, Bahia, Brazil was studied prospectively from 1984-l989. A mean population of 1,056 inhabitants living in 146 hourses were visited every 6 months and the numberof sKin ulcers recorded. A leishmanin skin test survey was done people with suggestive skin scars or active disease in l984. The incidence of skin ulcers due to Leishmania (Viannia) brasiliensis (Vlb) reached 83/1,000 inhabitants but declined sharply in the subsequent 2 years. Retrospective data shows that leishamiasis is a sporadic endemic disease. Although the reasons for this epidemic are unclear some possible aetiological factors are discussed
Subject(s)
Humans , Animals , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Disease Outbreaks , Leishmaniasis, Cutaneous/epidemiology , Antigens, Protozoan/administration & dosage , Brazil/epidemiology , Leishmaniasis, Cutaneous/diagnosis , Prospective StudiesABSTRACT
The occurrence of acute cutaneous leishmaniasis among inhabitants of 10 farms within 10 Km of the hamlet of Corte de Pedra, Bahia, Brazil was studied prospectively from 1984-1989. A mean population of 1,056 inhabitants living in 146 houses were visited every 6 months and the number of skin ulcers recorded. A leishmanin skin test survey was done people with suggestive skin scars or active disease in 1984. The incidence of skin ulcers due to Leishmania (Viannia) braziliensis (Lvb) reached 83/1,000 inhabitants but declined sharply in the subsequent 2 years. Retrospective data shows that leishmaniasis is a sporadic endemic disease. Although the reasons for this epidemic are unclear some possible aetiological factors are discussed.
Subject(s)
Disease Outbreaks , Leishmaniasis, Cutaneous/epidemiology , Adolescent , Adult , Aged , Animals , Antigens, Protozoan/administration & dosage , Brazil/epidemiology , Child , Child, Preschool , Humans , Infant , Leishmaniasis, Cutaneous/diagnosis , Middle Aged , Prospective StudiesABSTRACT
In field clinics in the communities of Três Braços and Corte de Pedra, Bahia, we have attended 1.416 patients with tegumentary leishmaniasis in fourteen years, the predominant species in transmission is Leishmania Viannia brasi liensis (LVB). Because of the danger of metastasis with this infection treatment was routinely recommended with Glucan-time. However sixteen patients refused injection therapy and six women were pregnant when seen and not treated. All patients were followed up in our clinic. All these patients closed their skin ulcers although one subsequently relapsed. Patients were followed up for variable periods (four to twelve years), after the diagnosis. In nine patients (40.9%) of the cohort, the time to healing after initiation of the lesion was calculated as six months of evolution. At twelve months, nineteen patients (86.3%) had complete healing of their lesions. In three patients an active lesion was present for longer than one year. The determinants of this variable natural evolution of human LVB lesion remains completely unknown. It is difficult for us to understand and compare the effects of therapeutic agents in mucocutaneous leishmaniasis.
