RESUMO
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.
Assuntos
Leishmaniose Mucocutânea/diagnóstico , Leishmaniose Mucocutânea/terapia , Bolívia , Humanos , Avaliação de Programas e Projetos de Saúde , Saúde da População RuralRESUMO
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.
Assuntos
Leishmania braziliensis , Leishmaniose Mucocutânea/patologia , Adulto , Animais , Epiderme/parasitologia , Epiderme/patologia , Feminino , Humanos , Leishmaniose Mucocutânea/parasitologia , Masculino , Mucosa Nasal/parasitologia , Orofaringe/parasitologia , Pele/parasitologia , Pele/patologiaRESUMO
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.
Assuntos
Isoenzimas/metabolismo , Leishmania braziliensis/enzimologia , Adolescente , Adulto , Idoso , Animais , Bolívia , Criança , Pré-Escolar , Eletroforese , Feminino , Humanos , Lactente , Leishmania braziliensis/classificação , Masculino , Pessoa de Meia-Idade , Peru , Especificidade da EspécieRESUMO
The electrocardiographic (ECG) changes in Bolivian patients with mucocutaneous leishmaniasis, treated with meglumine antimoniate and allopurinol, were evaluated. Electric changes due to the antimonial compound appeared in 45% of the patients, and consisted of repolarization alteration, principally affecting the T wave and the S-T segment. The changes disappeared within 2 months following the end of the antimonial treatment. In patients with associated Chagas disease and leishmaniasis, antimonial therapy did not aggravate the ECG changes characteristic of Chagasic cardiopathy.
Assuntos
Alopurinol/uso terapêutico , Antiprotozoários/uso terapêutico , Eletrocardiografia/efeitos dos fármacos , Leishmaniose Mucocutânea/tratamento farmacológico , Meglumina/uso terapêutico , Compostos Organometálicos/uso terapêutico , Adolescente , Adulto , Cardiomiopatia Chagásica/fisiopatologia , Doença de Chagas/complicações , Feminino , Humanos , Leishmaniose Mucocutânea/complicações , Leishmaniose Mucocutânea/fisiopatologia , Masculino , Antimoniato de Meglumina , Pessoa de Meia-IdadeRESUMO
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.
