[Cutaneous leishmaniosis: unusual clinical manifestation]. / Leishmaniosis cutanea: manifestación clínica inusual

Clinical manifestations of leishmaniasis are diverse and related to the infecting species, its relationship with the environment and the host immune response. A case of late Andean cutaneous leishmaniasis with extensive manifestation is presented. The case was confirmed through microbiological and immunological studies; identification was performed by cytochrome b gene sequencing and the species was determined as Leishmania (Leishmania) amazonensis. The patient was treated with sodium stibogluconate and at the end of therapy the patient showed clinical improvement of the lesions. It is recommended to consider leishmaniasis in differential diagnosis when treating atypical dermatological chronic ulcers.

Leishmaniosis cutanea: manifestación clínica inusual / Cutaneous leishmaniosis: unusual clinical manifestation

Las manifestaciones clínicas de la leishmaniosis son variables y están relacionadas con la especie infectante, su relación con el medioambiente y con la respuesta inmune del hospedero. Se presenta un caso de leishmaniosis andina cutánea tardía con una manifestación extensa. El caso se confirmó a través de estudios microbiológicos e inmunológicos, la identificación se realizó mediante secuenciamiento del gen del citocromo b, determinándose la especie como Leishmania (Leishmania) amazonensis. La paciente recibió tratamiento con estibogluconato sódico y al término de la terapia, mostró mejoría clínica de las lesiones. Se recomienda considerar a la leishmaniosis en el diagnóstico diferencial cuando se atienda ulceras crónicas dermatológicas atípicas...

Clinical manifestations of leishmaniasis are diverse and related to the infecting species, its relationship with the environment and the host immune response. A case of late Andean cutaneous leishmaniasis with extensive manifestation is presented. The case was confirmed through microbiological and immunological studies; identification was performed by cytochrome b gene sequencing and the species was determined as Leishmania (Leishmania) amazonensis. The patient was treated with sodium stibogluconate and at the end of therapy the patient showed clinical improvement of the lesions. It is recommended to consider leishmaniasis in differential diagnosis when treating atypical dermatological chronic ulcers...

Conocimientos, actitudes y prácticas sobre la teniosis-cisticercosis en una comunidad altoandina rural peruana, año 2012 / Knowledge, attitudes and practices about teniosis-cysticercosis in a rural highland community of Peru, 2012

Objetivo: determinar el estado basal de los conocimientos, actitudes y prácticas (CAP) en los pobladores de un distrito alto andino rural de la región Ayacucho. Métodos: Se realizó un estudio observacional de tipo transversal en pobladores residentes del distrito de Luricocha, Ayacucho. Se enroló una cuota de 40 participantes de cada una de las 14 localidades del distrito mediante selección muestral no probabil¡stico por conveniencia. Personal de salud aplicó un cuestionario de conocimientos, actitudes y prácticas previo consentimiento informado oral. Resultados: Se incluyeron en el estudio 426 participantes. 63,6% de pobladores conoce el modo de infecció del cerdo, 66,7% conoce que el cisticerco puede ser visualizado a nivel sub-lingual y 58,0% sabe que la forma de infección humana es la v¡a fecal-oral. El 74,4% refiere haber visto carne de cerdo con “triquina”, 31,3% refiere sospecha de haber comido carne con “triquina”. Respecto a las prácticas, 77,1% refiere sacrificar y enterrar al cerdo cuando se le detecta “triquina”. Un 80,1% dejar¡a que las autoridades decomisen un cerdo afectado con “triquina”, y 4,2% considera que est  bien que los cerdos coman heces de humano. Conclusiones: Existe una brecha cognitiva, actitudinal y pragmática entre los pobladores estudiados que favorecer¡a la persistencia de la endemicidad de la teniosis/cisticercosis. Entre las personas con mejores niveles de conocimiento se observan prácticas y actitudes puntuales que facilitar¡an la adherencia a intervenciones de eliminación de este problema de salud pública.

Objective: To determine the baseline of knowledge, attitudes and practices (KAP) in residents of a highland andean rural district of Ayacucho. Methods: We performed a cross-sectional observational study in residents of Luricocha district, Ayacucho. We joined a quota of 40 participants from each of the 14 villages of the district by a non-probability sample selection by convenience. Health personnel administered a questionnaire of knowledge, attitudes and practices after oral informed consent. Results: The study included 426 participants. 63,6% of people know the mode of infection of pigs, 66,7% know that the cysticerci can be viewed at the sub-lingual and 58,0% know that the way of human infection is the fecal-oral route. 74,4% reported having seen pork with "trichina", 31,3% reported having eaten meat suspected to "trichina". Regarding practices, 77,1% refers to the pig slaughter and bury when he detects "trichina". A 80,1% would let the authorities to confiscate a pig affected with "trichina", and 4,2% think it's okay that pigs eat human feces. Conclusions: There is a cognitive, attitudinal and pragmatic gap among the people surveyed that would favor the persistence of endemicity of taeniasis/cysticercosis. Among people with higher levels of knowledge, attitudes and practices that facilitate adherence to interventions for eliminating this public health problem are observed.

Mycobacterium ulcerans disease, Peru.

Eight adult patients (ages 18-58, 5 women) with Buruli ulcer (BU) confirmed by at least 2 diagnostic methods were seen in a 10-year period. Attempts to culture Mycobacterium ulcerans failed. Five patients came from jungle areas, and 3 from the swampy northern coast of Peru. The patients had 1-5 lesions, most of which were on the lower extremities. One patient had 5 clustered gluteal lesions; another patient had 2 lesions on a finger. Three patients were lost to follow-up. All 5 remaining patients had moderate disease. Diverse treatments (antituberculous drugs, World Health Organization [WHO] recommended antimicrobial drug treatment for BU, and for 3 patients, excision surgery) were successful. Only 1 patient (patient 7) received the specific drug treatment recommended by WHO. BU is endemic in Peru, although apparently infrequent. Education of populations and training of health workers are first needed to evaluate and understand the full extent of BU in Peru.

Efficacy and tolerability of artesunate plus sulfadoxine-pyrimethamine and sulfadoxine-pyrimethamine alone for the treatment of uncomplicated Plasmodium falciparum malaria in Peru.

To assist the Peruvian Ministry of Health in modifying the malaria treatment policy for their north Pacific coastal region, we conducted an in vivo efficacy trial of sulfadoxine-pyrimethamine (SP) and SP plus artesunate (SP-AS) for the treatment for uncomplicated Plasmodium falciparum infections. A total of 197 patients were randomized to therapy with either SP (25 mg/kg of the sulfadoxine component in a single dose on day 0) or a combination of SP plus AS (4 mg/kg on days 0, 1, and 2) and were followed for 28 days for symptoms and recurrence of parasitemia. No statistically significant differences between the two groups were observed on enrollment with respect to age, sex, history of malaria, or geometric mean parasite density. A total of 185 subjects completed the 28-day follow-up. Of the 91 subjects treated with SP alone, two had recurrences of parasitemia on day 7 and one on day 21. Of the 94 subjects treated with SP-AS, one had a recurrence of parasitemia on day 21. Fever and asexual parasite density decreased significantly more rapidly and the proportion of patients with gametocytemia on days 3-28 was significantly lower in subjects treated with combination therapy than in those who received SP alone. No severe adverse drug reactions were observed; however, self-limited rash and pruritus were significantly more common and an exacerbation of nausea, vomiting, and abdominal pain were observed significantly more frequently among patients who had received SP-AS. These results have contributed to a National Malaria Control Program decision to change to SP-AS combination therapy as the first-line treatment for uncomplicated P. falciparum malaria in northern coastal Peru in November 2001, making Peru the first country in the Americas to recommend this combination therapy.

Efficacy of mefloquine and a mefloquine-artesunate combination therapy for the treatment of uncomplicated Plasmodium falciparum malaria in the Amazon Basin of Peru.

In the Amazon Basin of Peru, more than 50% of patients with uncomplicated Plasmodium falciparum malaria fail to respond to treatment with chloroquine or sulfadoxine-pyrimethamine. To assist the National Malaria Control Program in identifying an alternative first-line therapy for this region, we conducted a trial of the safety and efficacy of mefloquine (MQ) compared with mefloquine-artesunate (MQ-AS) combination therapy. Patients with uncomplicated P. falciparum infections between the ages of 5 and 50 years were randomly assigned to be treated with either MQ (15 mg/kg in a single oral dose) or MQ (15 mg/kg) plus AS (4 mg/kg/day for three days). A total of 98 patients were enrolled and followed for 28 days. None of the 47 patients who received MQ alone or the 51 patients who received MQ-AS combination therapy had recurrences of parasitemia during the 28-day follow-up period. Asexual parasite densities decreased significantly more rapidly and the proportion of patients with gametocytes was significantly lower on days 3-21 in the MQ-AS group than in patients treated with MQ alone. All patients tolerated the medication well. Based on the results of this study and with the objective of slowing the development of resistance, the Peruvian Ministry of Health has decided to revise its malaria treatment policy and recommend combination therapy with MO-AS as the new first-line treatment of uncomplicated P. falciparum malaria in the Amazon region.

Genetic polymorphism of Plasmodium falciparum isolates from Loreto, Peru.

Eight genotypes of Plasmodium falciparum were detected after analysing blood samples obtained from 30 Peruvian jungle-dwelling patients in Loreto, a high transmission area for P. falciparum, using amplification of the polymorphic marker gene GLURP (glutamate-rich protein). Genotypes I (GLURP450) and VIII (GLURP800) were the most common (15/30 and 13/30, respectively). This single copy gene showed 15 patients to be infected with a single genotype of P. falciparum; the other 15 were infected with mixed genotypes, one of them with 4 genotypes. These findings are compatible with a high genetic complexity of P. falciparum. Further investigations are needed, using this and other markers, in order to design malaria control measures in Peru.