ABSTRACT
PURPOSE: To describe American cutaneous leishmaniasis of the eyelids and highlight the main clinical and diagnostic features of lesions, which are rare in this location. DESIGN: Retrospective, noncomparative case series METHODS: Leishmanin skin test, touch preparations, histopathologic analysis, and culture in appropriate media were used for clinical confirmation and parasitologic diagnosis. Positive cultures were identified by the iso-enzymes technique. All patients were treated with pentavalent antimony applied intramuscularly. RESULTS: Leishmanin skin test was positive in all five patients. Touch preparations, histopathologic analysis, and culture were performed in four patients. Touch preparations were positive (presence of Leishman's bodies) in two patients; histopathologic analysis showed a granulomatous infiltrate in four patients and parasite was present in two patients; culture was positive in three patients, and in two the parasite was identified as Leishmania (Viannia) braziliensis. Therapy was effective for all patients. CONCLUSIONS: Cutaneous leishmaniasis of the eyelids is uncommon in the Americas. The disease may present diagnostic difficulties when appearing in nonendemic areas. The clues for diagnosis are the clinical aspect of lesions, the epidemiologic data, and a positive Leishmanin skin test. Demonstration of parasite is not always possible. Pentavalent antimonial compounds are the therapy of choice. Formerly, transmission of leishmaniasis occurred only when humans penetrated forested areas and became an incidental host. Now, eyelid lesions are part of the changing pattern in the transmission of the disease. With the increase in ecotourism, these lesions may begin to be seen in air travelers returning to other parts of the world.
Subject(s)
Eye Infections, Parasitic/diagnosis , Eyelid Diseases/diagnosis , Eyelids/pathology , Leishmania braziliensis/isolation & purification , Leishmaniasis, Cutaneous/diagnosis , Aged , Animals , Antimony/therapeutic use , Antiprotozoal Agents/therapeutic use , Brazil , Child , Child, Preschool , Chlorides/therapeutic use , Eye Infections, Parasitic/drug therapy , Eye Infections, Parasitic/parasitology , Eyelid Diseases/drug therapy , Eyelid Diseases/parasitology , Eyelids/parasitology , Female , Humans , Leishmaniasis, Cutaneous/drug therapy , Leishmaniasis, Cutaneous/parasitology , Male , Retrospective StudiesABSTRACT
A two stage field trial comparing the effects of Lambdacyhalothrin (ICON) and DDT when used as residual sprays on the inside surfaces of houses, was conducted in the Machadinho and Jaru areas of Rodonia, Brazil, in 1987 and 1988. In 1987 houses along two 16 km contiguous stretches of a main and a side road were sprayed and the effects on malaria vectors monitored for the succeeding year. In the second stage approximately 55,000 houses in both districts were sprayed with ICON and the effect on malaria incidence measured by passive case detection. Of the eleven species of Anopheles caught in indoor and peridomiciliary collections A. darlingi was the commonest and is recognised as the most important vector in Brazil. ICON at either of two concentrations in bioassays killed more mosquitoes than DDT at each test from seven to twelve months after spraying. A rise in the number of A. darlingi collected eight months after spraying with DDT was not so marked in the ICON areas. Side effects of the insecticide were limited. The number of reported Plasmodium falciparum cases in the second phase declined 76% in Machadinho after spraying with ICON to 2851 cases. In Jaru there was a 28% reduction. The observed efficacy of the insecticide, its ready acceptance by the local populace, and its cost effectiveness make it a more useful insecticide for anti-malaria campaigns than DDT.
