Rural campaign to diagnose and treat mucocutaneous leishmaniasis in Bolivia.

Mucocutaneous leishmaniasis (MCL) is endemic in the tropical Amazonian lowlands of Bolivia, an area that regularly receives influxes of migratory populations. In these new agricultural development areas, a campaign to diagnose and treat the disease was carried out between 1989 and 1992, in order to provide direct access to MCL treatment in the endemic areas at a standard equivalent to that offered in the urban centres in Bolivia. The campaign led to the creation of decentralized local centres for diagnosis and treatment of the disease. A campaign to inform the population about leishmaniasis was also undertaken and courses were run to educate medical and paramedical personnel. As a result of the campaign, 3285 cases of leishmaniasis were diagnosed, including 2152 cutaneous and 326 mucosal forms. Also, a total of 1888 cases were treated, 1677 of which cutaneous and 211, mucosal.

Immunohistochemical analysis of the mucosal lesion in mucocutaneous leishmaniasis.

Using antibodies against surface antigens of inflammatory cells and against extra-cellular matrix components, immunocytochemical studies permit the investigation of the in situ cellular immune response and the associated fibrosis, in mucosal lesions. 57 paraffin embedded skin biopsies of mucocutaneous leishmaniasis originating from Bolivia, and due to Leishmania (Viannia) braziliensis, were studied. Memory T cells predominate within a non-organized granulomatous reaction, in which were observed proliferating macrophages. At the top of the lesion, epithelial cells expressed HLA-DR. Some characteristics of this lesion, particularly its chronic destructive pattern, presently lack any clear explanation.

[Convulsions associated with the administration of excessive dose of ceftazidime in patients with renal failure]. / Crises convulsives associées à l'administration de doses excessives de ceftazidime chez des patients en insuffisance rénale.

Central neurological diseases caused by beta-lactamins are usually associated with excessive dosages in patients with renal failure. Two case reports of convulsive encephalopathy in patients treated with ceftazidime, show the absolute necessity of adapted posology, in case of renal dysfunction. In one case, we could follow plasma levels of ceftazidime during hemodialysis, and calculated the pharmacokinetic parameters. We conclude that extra renal epuration is an efficient technique in case of acute ceftazidime intoxication.

Reproducibility of non-invasive measurement and of short-term variability of blood pressure and heart rate in healthy volunteers.

1. Spectral analyses of blood pressure and heart rate oscillations are increasingly used to assess the influences of diseases and drugs on the autonomic nervous system. Such influences can only be interpreted in view of the spontaneous variability of these oscillations. We therefore studied the reproducibility of power spectral analyses of blood pressure and heart rate fluctuations measured by a non-invasive finger plethysmographic method in 24 healthy volunteers. 2. Intra-observer reproducibility was assessed from measurements obtained on 3 consecutive days and 1 month later in each subject. Inter-observer reproducibility was assessed by comparing measurements made by two observers on one occasion. 3. There was no significant difference in standard haemodynamic and spectral analysis parameters (low frequency: 60-130 mHz and high frequency: respiration rate +/- 30 mHz) measured on 3 consecutive days and 1 month later in each subject. The standard deviation of differences between systolic blood pressure or heart rate oscillations on different occasions was in the 150-200 and 50-100 mm Hg Hz-1/2 or beats min-1 Hz-1/2 range for low frequency and high frequency oscillations respectively. Similar results were found when inter-observer reproducibility was considered. 4. From these results, we derived a sample-size table giving the number of subjects to be included in studies of cross-over or parallel design in order to detect a non-random difference in spectral analysis parameters.(ABSTRACT TRUNCATED AT 250 WORDS)

[Histopathology of mucocutaneous leishmaniasis caused by Leishmania (Vianna) braziliensis]. / Histopathologie de la leishmaniose cutanéo-muqueuse à Leishmania (Viannia) braziliensis.

A histopathological study of mucocutaneous leishmaniasis due to Leishmania (Viannia) braziliensis was carried out on 28 cutaneous and 114 mucosal biopsies, taken from Bolivian and Peruvian patients. This study showed similar histopathological findings in cutaneous and mucosal lesions. The cutaneous biopsies showed a strong epidermal hyperplasia occasionnally budding in the dermis. In the ulcerative area, the epidermis was totally necrosed and replaced by a fibrino-leucocytic edge. In the dermis, histio-lympho-plasmocytic infiltration was constantly found. The histiocytes often gathered in follicles sometimes with diffuse fibrosis. The parasites were encountered in 28.6 p. 100 of the biopsies. Whatever the mucosa concerned (i.e. nasal, palatal or lingual), the mucosal lesion was not different from the cutaneous lesion. The malpighian epithelium is either absent or the seat of a pseudo-epitheliomatous hyperplasia. Major histio-lympho-plasmocytic infiltration was found and extended through the depth of the lamina propria. Suppurative and fibrinoid necroses coexisted superficially and sometimes penetrated in depth. The parasites were found in about 30 p. 100 of the cases.

Clinical healing of antimony-resistant cutaneous or mucocutaneous leishmaniasis following the combined administration of interferon-gamma and pentavalent antimonial compounds.

In an open trial, longer courses of pentavalent antimonials (Sbv) at sub-optimal doses (10 mg/kg body weight), in association with recombinant human interferon-gamma (IFN-gamma) (100 micrograms/m2 of body surface area) were administered, by daily intramuscular injections, to 13 patients with diagnoses of cutaneous or mucocutaneous leishmaniasis unresponsive to Sbv. Four patients presented with large skin ulcers, and 9 had mucosal involvement as the main manifestation, the latter affecting the nose (3 cases), nose and septum (2 cases), nose and oral cavity (1 case), and nose, pharynx and larynx (3 cases). Except for one case with severe involvement of the upper respiratory tract, the lesions were fully resolved by the end of therapy (mean duration 40 +/- 12 [SD] d, range 30-60 d) in the 11 patients who completed therapy. The main side effects were headache and fever (7 cases), together with leucopenia and eosinophilia (4 cases). It is concluded that combined administration of low doses of Sbv plus IFN-gamma may provide a novel therapeutic approach for the treatment of antimony-resistant cutaneous or mucocutaneous leishmaniasis. The possible mechanisms by which IFN-gamma contributes to resolution of the disease are discussed.

Fifteen years of cutaneous and mucocutaneous leishmaniasis in Bolivia: a retrospective study.

This paper present the results of a retrospective study of cases of cutaneous and mucocutaneous leishmaniasis in Bolivia between 1975 and 1991. The total number of cases reported was 4058, 739 of which were mucous. Three different areas of endemic leishmaniasis are defined in Bolivia.

[Epidemiological, clinical and biological features of mucocutaneous leishmaniasis in Bolivia after a 221 patient sample]. / Particularités épidémiologiques, cliniques et biologiques de la leishmaniose cutanéo-muqueuse en Bolivie d'après un échantillon de 221 malades.

The authors present a clinical, biological and epidemiological study of 221 cases of mucocutaneous leishmaniasis observed in Bolivia between January 1990 and April 1991. The patients exhibited cutaneous lesions in 136 cases and mucous involvement in 85 cases. It is stressed on the severity of the disease in Bolivia.

Isoenzyme characterization of Leishmania braziliensis braziliensis isolates obtained from Bolivian and Peruvian patients.

Thirty-four Leishmania isolates obtained from Bolivian and Peruvian patients infected with mucocutaneous leishmaniasis were characterized by isoenzyme electrophoresis using 10 enzymatic markers; all belonged to the subspecies L.b. braziliensis. Three isolates showed marked variation compared with the reference strain with respect to 5 or 6 enzymes. These variant isolates originated from patients with forms of the disease which were unresponsive to treatment.

[A new case of autochthonous visceral leishmaniasis in Bolivia]. / Nouveau cas autochtone de leishmaniose viscérale en Bolivie.

A sixth autochthonous case of visceral leishmaniasis is reported in Bolivia. It is also the fourth case detected in the Yungas Valley (Department of La Paz) confirming the long-term existence of the disease in this area where cases of canine leishmaniasis and natural infestation of the phlebotomine sandfly, Lutzomyia longipalpis, were previously reported.

Parasitological diagnosis of mucocutaneous leishmaniasis due to Leishmania b. braziliensis in Bolivia.

Parasitological diagnosis, using stained smears, culture and pathological examination of biopsy, was studied in 146 patients infected with mucocutaneous leishmaniasis, in Bolivia and Peru. The most efficient parasite detecting technique appeared to be the smear examination in cutaneous lesions (33% positive) and the pathology in case of mucous lesions (28% positive). In both, cutaneous and mucous lesions, the parasites were found most frequently in old lesions.