ABSTRACT
Sixty eight patients with localized cutaneous leishmaniasis from an area with Leishmania (Viannia) braziliensis transmission had cultures performed with a modified Marzochi's vacuum aspiratory puncture technique to establish sensitivity and contamination rate with this new method. Overall sensitivity of three aspirates was 47.1 percent; (CI95 percent 39.4; 59.4) significantly greater than the sensitivity of a single one aspirate. Fungal contamination was observed in 6/204 (2.9 percent) inoculated culture tubes. We recommend that this useful technique should be adopted as routine for primary isolation of L. (V.) braziliensis from localized cutaneous ulcers
Subject(s)
Adult , Humans , Male , Female , Leishmania braziliensis/isolation & purification , Leishmaniasis, Cutaneous/diagnosis , Antibodies, Monoclonal , Biopsy, Needle , Brazil , Culture Media , Leishmaniasis, Cutaneous/parasitology , Retrospective Studies , Rural Population , Sensitivity and SpecificityABSTRACT
Twenty nine patients with localized cutaneous leishmaniasis had lymph node and skin ulcer aspirations for culture of Leishmania with the modified Marzochi's vacuum aspiratory technique. Sensitivity of lymph node aspiration was 58.6 percent and 34.5 percent for skin ulcer aspiration (P=0.06). Combined sensitivity of the two methods was 79.3 percent. There was no agreement between methods (Kappa Index = -0.084; CI95 percent -0,45; 0,28) showing the potential complementary roles in diagnostic approach
Subject(s)
Adult , Humans , Male , Female , Biopsy, Needle , Leishmania braziliensis/isolation & purification , Leishmaniasis, Cutaneous/diagnosis , Lymphatic Diseases/etiology , Culture Media , Leishmaniasis, Cutaneous/parasitology , Lymph Nodes/pathology , Lymphatic Diseases/pathology , Sensitivity and SpecificityABSTRACT
Often in tropical practice there is not time or conditions to do a proper autopsy on a patient who has died. A needle biopsy technique is described for limited closed autopsy examination to clariffy organ histology. In this way the clinician may resolve puzzling fatal disease.
Subject(s)
Humans , Biopsy, Needle/methods , Autopsy , Autopsy/instrumentation , Biopsy, Needle/instrumentationABSTRACT
During the period October 1992 to July 1995 we measured the osmolarity and pH of ampoules of meglumine antimoniate (glucantime) from lot 9206L-004 (manufactured by Rhodia Farma Ltd, of Säo Paulo, SP, Brazil) maintained in three temperature conditions namely 4 degrees C, 37 degrees C and ambiental. Although we observed statistically significant differences in osmolarity between samples, the limited number of measurements and the variation of this property in ampoules maintained at the same temperature were obstacles to obtain definitive conclusions. Such a variation was not found with pH. Assuming these parameters could reflect structural changes in the pentavalent antimony molecule, clearly further better controlled experiments are indicated.
Subject(s)
Antiprotozoal Agents/chemistry , Organometallic Compounds/chemistry , Meglumine/chemistry , Drug Storage , Hydrogen-Ion Concentration , Osmolar ConcentrationSubject(s)
Humans , Animals , Adult , Male , Middle Aged , Wound Healing , Leishmania braziliensis , Leishmaniasis, Mucocutaneous/pathology , Skin/pathology , Mucous Membrane/pathologyABSTRACT
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).
Subject(s)
Humans , Animals , Cricetinae , Leishmania braziliensis , Leishmaniasis, Mucocutaneous/diagnosis , Leishmaniasis, Mucocutaneous/drug therapy , Antiprotozoal Agents/therapeutic use , Brazil , Chi-Square Distribution , Follow-Up Studies , Recurrence , Remission Induction , Retrospective Studies , Time FactorsABSTRACT
Some predictions are made as to how work on leishmaniaisis and its control will develop in Brazil in the future.
Subject(s)
Humans , Leishmaniasis/epidemiology , Congress , Leishmaniasis/prevention & controlABSTRACT
Brazilian mucosal leishmaniasis is briefly reviewed, emphasis being given to recent advances clinical management. Patients continue to occupy much hospital bed space and in some cases are notoriously difficult to treat. Indefinite follow up is recommended. Many aspects of the aetiology remain mysterious although Leishmania (Viannia) braziliensis is the most common organism isolated. Perspectives for a more effective treatment, oral and cheap, are still remote
Subject(s)
Humans , Animals , Leishmania braziliensis , Leishmaniasis, Mucocutaneous/diagnosis , Antiprotozoal Agents/adverse effects , Antiprotozoal Agents/therapeutic use , Brazil , Diagnosis, Differential , Leishmania braziliensis/isolation & purification , Leishmaniasis, Mucocutaneous/parasitology , Leishmaniasis, Mucocutaneous/drug therapy , Prognosis , RecurrenceABSTRACT
Relatamos o caso clínico, tratamento e evoluçäo de uma criança com a síndrome da esplenomegalia hiperreativa da malária tratada fora da área endêmica para a malária. A criança apresentava importante esplenomegalia, era procedente de área endêmica para malária, os níveis de imunoglobulinas e de anticorpos antimaláricos estavam elevados e observou-se linfocitose sinusial hepática. A criança näo voltaria mais para a área endêmica de malária, pelo que foi tratada com apenas um curso de quinino apresentando resposta clínica favorável. Esta resposta a um único curso de terapia curativa antimalárica sugere a importância da reinfecçäo com o parasita da malária no desenvolvimento e na maturaçäo desta sídrome
Subject(s)
Child , Humans , Female , Malaria, Falciparum/drug therapy , Quinine/administration & dosage , Splenomegaly/drug therapy , Administration, Oral , Brazil , Disease Reservoirs , Malaria, Falciparum/complications , Malaria, Falciparum/diagnosis , Remission Induction , Splenomegaly/diagnosis , Splenomegaly/etiology , Time FactorsABSTRACT
No transcurso de um periodo de 5 anos foram estudados 3 isolados de um paciente com leishmaniose mucosa recidivante causada pela Leishmania (Viannia) braziliensis e 7 clones de um desses isolados. Este estudo foi feito pela analise dos serodemas e zimodemas. Os resultados indicaram a ocorrencia de variacoes fenotipicas clonais. Oito marcadores isoenzimaticos demonstraram diferencas nos padroes eletroforeticos em Acetato de Celulose (AC), bem como em camada fina de amido. Da mesma forma foram constatadas diferencas em um painel de anticorpos monoclonais especificos e subespecificos. Nossas observacoes indicam ainda que a leishmania (Viannia) braziliensis esta composta por subpopulacoes de parasitas com caracteristicas bioquimicas e antigenicas peculiares.
Subject(s)
Cricetinae , Animals , Humans , Leishmaniasis, Mucocutaneous/immunology , Antibodies, Monoclonal , Antigenic Variation , Biomarkers , Clone Cells/immunology , Electrophoresis, Cellulose Acetate , Fluorescent Antibody Technique , Leishmaniasis, Mucocutaneous/geneticsABSTRACT
As principais razöes para a escolha da pentamidina no presente ensaio terapêutico foram a alta taxa de recidiva de casos de forma mucosa de leishmaniose tegumentar com o tratamento pelos antimoniais pentavalentes e o fato deste medicamento ter sido usado com sucesso na forma cutânea da doença. Seis pacientes com forma mucosa de leishmaniose tegumentar diagnosticados clinicamente por exame dermato-otorrinolaringológico, reaçäo intradérmica de Montenegro, cultura inoculaçäo em hamster e esfregaço de material obtido das lesöes, exame histopatológico e pesquisa de anticorpos circulantes, foram tratados com pentamidina na dose de 200 mg em dias alternados, com dose total entre 2,3 a 5,9g, de acordo com a clínica. Houve cura clínica e parasitológica de cinco casos, com acompanhamento variando de 12 a 24 meses após o tratamento. No único caso de falha, tratava-se de um paciente que também näo respondeu ao tratamento com Glucantime. Entre os efeitos colaterais estäo um caso de diabetes mellitus, alteraçöes transitórias de glicemia em dois casos e abscesso glúteo em um, concluindo-se ser boa a resposta terapêutica à pentamidina dos casos da forma mucosa de leishmaniose tegumentar
Subject(s)
Adult , Middle Aged , Humans , Male , Female , Leishmaniasis/drug therapy , Pentamidine/therapeutic use , Antibodies/analysis , Leishmania braziliensis/immunology , Leishmaniasis/pathology , Pentamidine/administration & dosage , Pentamidine/adverse effectsABSTRACT
De acordo com o cadastro de 1416 pacientes portadores de leishmaniose tegumentar americana (L.T.A) referentes ao período de janeiro de 1976 a maio de 1987, os autores realizaram um levantamento da procedência dos casos dessa parasitose atendidos nas áreas endêmicas de Três Braços e Corte de Pedra no estado da Bahia. Os pacientes procediam de 24 dos 89 municípios que compöem a regiäo cacaueira da Bahia, destacando-se os municípios de Valença, Wenceslau Guimaräes e Teolândia como os de maior prevalência, somando juntos 923 casos (65,1%, com 520 destes residindo em umas poucas localidades contínuas entre si, formando uma área endêmica, com transmissäo ocorrendo provavelmente no peri, intradomicílio e nas lavouras de cacau e cravo localizadas nas encostas da floresta atlântica. Nota-se que a partir de 1983, houve um aumento do número de casos em toda a regiäo, havendo evidências da leishmaniose tegumentar americana comportar-se como uma doença ocupacional em toda a regiäo estudada
Subject(s)
Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Humans , Male , Female , Leishmaniasis , Brazil , Cacao , Delivery of Health Care , Occupational Diseases , Leishmaniasis/epidemiology , Rural WorkersABSTRACT
A cura da forma cucosa de leishmaniose com antimonial pentavalente em esquema interrompido é apenas 56% parecendo-nos que o esquema aplicado sem interrupçäo seria mais eficaz. Achados de Chulay et al. parmitiram ao autor concluir que cardiotoxicidade dos antimoniais pentavalentes é diretamente proporcional à dosagem diária e tempo de uso, ocorrendo morte súbita com dose diária de 60mg SbV/Kg. Tratamos em torno de 300 casos com doses que variaram de 10 a 28mg SbV/Kg/dia com ambos tipos de esquema. Houve um caso de morte súbita e um caso de insuficiência renal aguda sem óbito. Nosso paciente tinha 77 anos e era portador de arritmia cardiáca. Tratado com dose de 20mg SbV/Kg?dia, morreu subitamente no 24§ dia. Admite-se que em pacientes idosos e com alteraçöes eletrocardiográficas prévias o uso de drogas menos cardiotóxicas (pentamidina e anfotericina B) deve ser considerado. O emprego de antimoniais nestes casos requer controle eletrocardiográfico cuidadoso
