[The current status of diffuse cutaneous leishmaniasis (DCL) in the state of Maranhão. II. The epidemiological and clinico-evolutionary aspects]. / Estado atual da leishmaniose cutânea difusa (LCD) no Estado do Maranhão. II. Aspectos epidemiológicos, clínico-evolutivos.

The authors describe a retrospective and prospective study of 6 patients with diffuse cutaneous leishmaniasis observed in the state of Maranhão, since 1974. The patients come from different rural regions of the state and in all of them Leishmania (Leishmania) amazonensis was the cause five of the patients initiated their disease in the first decade of life. All the patients first had a solitary, nodular lesion, that after a variable period of time, disseminated and acquired other aspects. Sequentially the patients presented multiple nodular and ulcerative lesions, negative Leishmania skin tests and a refractory response to the therapeutic schedules used up to the present.

[Fonsecaea pedrosoi-caused chromoblastomycosis in the state of Maranhão. I. The clinical, epidemiological and evolutionary aspects]. / Cromoblastomicose produzida por Fonsecaea pedrosoi no Estado do Maranhão. I--Aspectos clínicos, epidemiologicos e evolutivos.

The aim of this study was to observe the clinical and of epidemiological behavior of chromoblastomycosis in the State of Maranhão. A retrospective and prospective study of 13 cases was performed at the infectious diseases section of the Hospital dos Servidores do Estado do Maranhão, from November, 1988 to July, 1991. In the investigation a protocol record was used with a view to further analysis. A higher prevalence between 50 and 60 years of age (46.1%) and in male patients (92.3%) was noted. Twelve patients (92.3%) were from Maranhão State, and 10 of them (76.9%) came from the western microregion of the State of Maranhão. Regarding occupation, 92.3% were land workers, and most of them presented the lesions on the lower limbs (84.6%) of a vegetant warty aspect, brown in color with itching. Histopathological examination diagnosed chromomycosis in 100% of the cases. Culture was performed in 11 cases, and Fonsecaea pedrosoi isolated in 9 of them. Treatment with 5-fluorocytosine resulted in a good evolutive response. This study indicates the existence of a probable endemic area of chromomycosis in hinterland of Maranhão (western microregion) that hither to unknown.

[Spontaneous healing of leishmaniasis caused by Leishmania viannia braziliensis in cutaneous lesions]. / Cura espontânea da leishmaniose causada por Leishmania viannia braziliensis em lesões cutâneas.

In field clinics in the communities of Três Braços and Corte de Pedra, Bahia, we have attended 1.416 patients with tegumentary leishmaniasis in fourteen years, the predominant species in transmission is Leishmania Viannia brasi liensis (LVB). Because of the danger of metastasis with this infection treatment was routinely recommended with Glucan-time. However sixteen patients refused injection therapy and six women were pregnant when seen and not treated. All patients were followed up in our clinic. All these patients closed their skin ulcers although one subsequently relapsed. Patients were followed up for variable periods (four to twelve years), after the diagnosis. In nine patients (40.9%) of the cohort, the time to healing after initiation of the lesion was calculated as six months of evolution. At twelve months, nineteen patients (86.3%) had complete healing of their lesions. In three patients an active lesion was present for longer than one year. The determinants of this variable natural evolution of human LVB lesion remains completely unknown. It is difficult for us to understand and compare the effects of therapeutic agents in mucocutaneous leishmaniasis.