RESUMO
Cutaneous leishmaniases are endemic over the entire territory of French Guiana. At least 5 distinct Leishmania species coexist in the sylvatic ecotopes of this French territory. The present paper checks the advances in the ecological research field during the past 5 years. The current epidemiological situation and trends are detailed successively Links between the recrudescence of leishmaniases and gold-mining are highlighted. The potential adaptation of the pathogenic complexes to the newly anthropized habitats is also described.
Assuntos
Doenças Endêmicas/estatística & dados numéricos , Leishmaniose Cutânea/epidemiologia , Animais , Reservatórios de Doenças , Ecossistema , Guiana Francesa/epidemiologia , Humanos , Incidência , Insetos Vetores/parasitologia , Leishmania/classificaçãoRESUMO
The first time the term phlebotomine sandfly was used, was by an Italian naturalist, Philippo Bonanni, in 1691. The first description though was made by another Italian naturalist, Scopoli, under the name Bibio papatasi. The name of the genus, Phlebotomus, was not given until 1840 by Rondani and Berté. The first description of an American phlebotomine sandfly was made by Coquillett, in 1907. The discovery of the three first sandflies in Brazil is the work of Lutz and Neiva, in 1912. From this date till 1921, 11 new species were described in this country and since then their number is still increasing and has reached 229 at this time. The history of the identification of phlebotomine sandflies as vectors, in Brazil like elsewhere in South America, is as complex as the one of the leishmaniases themselves, to which it is closely linked. The knowledge of cutaneous leishmaniasis in Brazil goes back to 1909, when Gaspar Vianna proposed to name the parasites that were found Leishmania braziliensis (1911). Following the observation of the Sergent brothers on the role of Phlebotomus papatasi in the transmission of cutaneous leishmaniasis in Algeria (1921), it became obvious that phlebotomine sandflies should be incriminated as vectors of cutaneous leishmaniasis in the Americas and that proof should be sought of their role. This is what various Brazilian scientists have done, like Aragão in 1922, Pessôa and Pestana in 1940. In the 1950s evidence was produced that the different forms of leishmaniasis that infest the American continent were caused by distinct species of the parasite. Subsequently, successful searches for the specific vectors were carried out. A by-product of the epidemiological studies of leishmaniases has been the discovery of the transmission of other parasites of the Trypanosomatid families (Crithidia, Endotrypanum, Trypanosoma). More recently, since the 1960s, a large number of viruses amongst which Rhabdoviridae, Bunyaviridae and Reoviridae, have been isolated from phlebotomine sandflies. Between 1961 and 1995, 69 serotypes of different arboviruses were obtained from different zones of Brazilian Amazonia.
Assuntos
Insetos Vetores/parasitologia , Leishmaniose/história , Parasitologia/história , Psychodidae/parasitologia , Animais , Arbovírus/isolamento & purificação , Brasil , História do Século XVII , História do Século XVIII , História do Século XIX , História do Século XX , Humanos , Insetos Vetores/virologia , Leishmaniose/transmissão , Phlebotomus/parasitologia , Phlebotomus/virologia , Psychodidae/virologia , Trypanosomatina/isolamento & purificação , Viroses/história , Viroses/transmissãoRESUMO
BACKGROUND: Few data are available on cutaneous leishmaniasis caused by dermotropic species in human immunodeficiency virus (HIV)-infected patients. OBJECTIVES: To describe nine cases of cutaneous leishmaniasis in HIV+ patients and to compare their clinical features and their response to treatment with those of HIV- patients with the forms of leishmaniasis commonly found in French Guiana. METHODS: A case-control study was carried out between July 1994 and December 2000 in French Guiana. We compared the following variables in nine HIV-infected patients with leishmaniasis and 27 matched controls: clinical type of leishmaniasis, number of lesions, presence of lymphangitis and adenopathy, the rate of recovery after treatment, and recurrence or reinfection. RESULTS: Eight of the HIV-infected patients had localized cutaneous leishmaniasis and one had mucocutaneous leishmaniasis. All of the controls had localized cutaneous leishmaniasis. Leishmania guyanensis was the only species isolated from HIV-infected subjects. HIV-Leishmania coinfected patients had a higher rate of recurrence or reinfection (P < 0.02) and a lower rate of recovery after one treatment cycle with pentamidine (P < 0.02) than did HIV- subjects. The CD4+ lymphocyte counts exceeded 200 mm(-3) in all HIV+ patients at the time of the diagnosis with leishmaniasis. CONCLUSIONS: In French Guiana, cutaneous leishmaniasis in moderately immunosuppressed HIV-infected subjects (> 200 CD4+ T cells mm(-3)) is characterized by a higher rate of recurrence or reinfection and is more difficult to treat than that in HIV- subjects.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/patologia , Leishmaniose Cutânea/patologia , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/imunologia , Adulto , Idoso , Antiprotozoários/uso terapêutico , Contagem de Linfócito CD4 , Estudos de Casos e Controles , Feminino , Humanos , Hospedeiro Imunocomprometido , Leishmaniose Cutânea/tratamento farmacológico , Leishmaniose Cutânea/imunologia , Masculino , Pessoa de Meia-Idade , Pentamidina , Recidiva , Resultado do TratamentoRESUMO
Disseminated cutaneous leishmaniasis is characterized by the presence of a large (> or =10) number of lesions at several anatomic sites (head, limbs, and trunk). Most of the lesions are small, papular, and appear simultaneously with or secondarily to one or several ulcerated lesions of localized cutaneous leishmaniasis. We report the first case of disseminated cutaneous leishmaniasis in French Guiana. It concerns a 24-year-old woman who tested negative for human immunodeficiency virus (HIV). The disease began with three lesions that became ulcerated. One week later, multiple papulo-nodular lesions appeared. We counted a total of 425 lesions. Leishmania were observed in the lesions. The species involved was L. guyanensis, which has never been described in a case of disseminated cutaneous leishmaniasis. The patient was rapidly cured by a single course of pentamidine. Disseminated cutaneous leishmaniasis should be distinguished from other types of leishmaniasis with multiple lesions. These include anergic diffuse cutaneous leishmaniasis, post-kala-azar leishmaniasis, and leishmaniasis associated with HIV infection.
Assuntos
Leishmania guyanensis , Leishmaniose Cutânea/diagnóstico , Adulto , Animais , Antiprotozoários/uso terapêutico , Dorso , Mama , Diagnóstico Diferencial , Feminino , Dedos , Guiana Francesa , Humanos , Leishmaniose Cutânea/tratamento farmacológico , Leishmaniose Cutânea/patologia , Masculino , Pentamidina/uso terapêuticoRESUMO
Two cases of skin lesions similar to those caused by Leishmania parasites have been reported from Martinique. Parasites isolated from these lesions were unlike Leishmania reference strains by isoenzyme analysis and electron microscopy and were assumed to be monoxenous trypanosomatids which normally only infect invertebrates. Both strains have now been retyped by isoenzyme analysis and found to be identical to each other and distantly related to all other Leishmania species. The sequence of the 18S ribosomal RNA gene and partial sequences of the DNA polymerase alpha and RNA polymerase II largest subunit genes were obtained. These sequences indicated that the Martinique parasites clustered with L. enriettii and were basal to all other euleishmania. However, support for both the position basal to all euleishmania and the clustering with L. enriettii was low. The Martinique parasites may cluster with L. (Leishmania) or L. (Viannia) or form a novel clade within the euleishmania either with or without L. enriettii.
Assuntos
Leishmania/classificação , Leishmaniose Cutânea/parasitologia , Animais , DNA Polimerase I/química , DNA Polimerase I/genética , DNA de Protozoário/química , DNA de Protozoário/genética , DNA de Protozoário/isolamento & purificação , DNA Ribossômico/química , DNA Ribossômico/genética , DNA Ribossômico/isolamento & purificação , Eletroforese em Gel de Amido , Humanos , Isoenzimas/metabolismo , Leishmania/enzimologia , Leishmania/genética , Leishmaniose Cutânea/patologia , Martinica , Filogenia , Reação em Cadeia da Polimerase , RNA Polimerase II/química , RNA Polimerase II/genética , Alinhamento de Sequência , Análise de Sequência de DNA , Homologia de Sequência do Ácido NucleicoRESUMO
Four human cases of localized cutaneous leishmaniasis caused by Leishmania naiffi are reported. Two of the cases were infected in French Guiana, one in French Guiana or Martinique, and the other in Ecuador or Peru. The geographical distribution of L. naiffi is clearly larger than that initially reported. Three zymodemes were represented by the four isolates, confirming that there is intraspecific polymorphism in L. naiffi.
Assuntos
Leishmania/isolamento & purificação , Leishmaniose Cutânea/parasitologia , Adulto , Animais , Eletroforese em Gel de Amido/métodos , Feminino , Humanos , Leishmania/classificação , Leishmania/enzimologia , Masculino , América do SulRESUMO
This report describes the results of epidemiological surveillance of cutaneous leishmaniasis in French military personnel in French Guiana. Data was collected regarding microscopic diagnosis, clinical manifestations, and lesion location as well as compliance with vector control measures. Year-to-year variations in the incidence in the general population have been attributed to changes in climatic conditions. Monitoring incidence and density curves, correlation of findings with local epidemiological data, and analysis of the most recent epidemic in 1998/99 (326 cases, attack rate 3.2% men years) highlight the importance of behavioral factors. The proportion of total cases involving military personnel varied widely from 20 to 85%. Investigation consistently showed that failure to apply elementary protective measures against sandfly bites was the most determinant factor in this proportion. Strict compliance with these measures appears to reduce the risk of infection considerably.
Assuntos
Leishmaniose Cutânea/epidemiologia , Militares , Animais , Clima , Estudos Epidemiológicos , Guiana Francesa/epidemiologia , Humanos , Incidência , Mordeduras e Picadas de Insetos , Controle de Insetos , Insetos Vetores , Vigilância da População , Psychodidae , Fatores de Risco , ZoonosesAssuntos
Ectoparasitoses/parasitologia , Dermatoses Faciais/parasitologia , Trypanosomatina/isolamento & purificação , Animais , Ectoparasitoses/epidemiologia , Ectoparasitoses/imunologia , Dermatoses Faciais/epidemiologia , Dermatoses Faciais/imunologia , Humanos , Imunocompetência , Masculino , Martinica/epidemiologia , Pessoa de Meia-Idade , Trypanosomatina/imunologiaRESUMO
In a visceral leishmaniasis endemic locality of northeast of Brasil where all settlements were treated with cypermethrin, a follow-up of Lutzomyia longipalpis populations was carried out by regular collections. The residual effect of the insecticide was studied using biological assays on three different types of walls. The results showed that the insecticides had an effect on intradomiciliar Lu. longipalpis populations limited to two months, and had no significant effect on peridomiciliar vector populations. The mortality rates of the tested sandflies were variable according to the type of wall. The decreasing of the insecticide effect was marked since the 3rd month, and mortality rates were identical whatever the type of wall since the 4th month. Unsufficient residual effect was detected after the 4th month.
Assuntos
Bioensaio/métodos , Insetos Vetores/efeitos dos fármacos , Inseticidas/farmacologia , Resíduos de Praguicidas/farmacologia , Psychodidae/efeitos dos fármacos , Piretrinas/farmacologia , Animais , Brasil , Monitoramento Ambiental , Seguimentos , Leishmaniose Visceral/parasitologia , Fatores de TempoRESUMO
La leishmaniasis mucocutánea americana es un grave problema de salud en el Perú, particularmente en la región montañosa de Cuzco, donde se produjeron 25 por ciento de todos los nuevos casos notificados en 1989. El número de casos ha aumentado notablemente desde principios del denenio de 1980, cuando hubo una emigración estacional en gran escala a las zonas endémicas, especialmente a la región forestal de Madre de Dios, debido al descubrimiento de nuevas minas de oro en esa zona y al deterioro económico en el Perú. Ante la falta de respuesta oficial del Gobierno peruano, centenares de enfermos de leishmaniasis en la zona de Cuzco formaron asociaciones de autoayuda con el objetivo de obtener los medicamentos necesarios para tratar su afección. El logro principal de este movimiento que surgió espontáneamente, apoyado por varias instituciones públicas y privadas, fue animar a los enfermos, particularmente a los pacientes con lesiones de las mucosas, a salir del aislamiento. Como resultado, se han reducido mucho la prevalencia e incidencia de la enfermedad en ese territorio
American mucocutaneous leishmaniasis is an important health problem in Peru, particularly in the mountainous Cuzco Region, where 25% of all new cases reported in 1989 were located. Cases have increased considerably since the beginning of the 1980s, when large-scale seasonal migration to endemic zones occurred, particularly in the forest area of Madre de Dios, following the discovery of new gold deposits there and the deterioration in the economic situation in Peru. Following the lack of official response from the Peruvian government, hundreds of people suffering from leishmaniasis in the Cuzco area formed self-help associations with the objective of obtaining the drugs needed to treat their disease. The major achievement of this spontaneous movement, which was supported by several public and private institutions, was to encourage sick people, particularly patients with mucosal lesions, to emerge from isolation. As a result, the prevalence and incidence of the disease have now considerably decreased in the region.
Assuntos
Grupos de Autoajuda/organização & administração , Leishmaniose Mucocutânea/patologia , PeruRESUMO
Biochemical characterization of 137 Leishmania braziliensis isolates from South and Central America, and from selected endemic foci in Bolivia, Brazil and Colombia, performed by isoenzymatic electrophoresis using 10 enzymatic systems, showed a high enzymatic polymorphism (44 zymodemes obtained) based on the variation of a small number of enzymes. Cladistic analysis showed close links between the zymodemes within the L. braziliensis s.s. cluster. The position of 2 Colombian zymodemes obtained (MON*204 and MON*205) justify the inclusion of L. peruviana within the L. braziliensis cluster.
Assuntos
Isoenzimas , Leishmania braziliensis/classificação , América/epidemiologia , Animais , Classificação , Evolução Molecular , Humanos , Leishmania braziliensis/enzimologia , Leishmaniose Cutânea/epidemiologia , Leishmaniose Cutânea/parasitologia , Filogenia , Polimorfismo Genético , Psychodidae/parasitologiaRESUMO
Tegumentary leishmaniasis due to Leishmania braziliensis is a parasitic disease that occurs in two stages after the infected sandfly bite: (1) a primary cutaneous lesion followed by (2) a secondary mucosal involvement generally resulting in severe facial deformities. In order to investigate the genetic and environmental factors involved in the development of the cutaneous lesion, a familial study was performed in a region of Bolivia in which the disease is endemic. Complete selection of 118 nuclear families (703 subjects, with 241 patients), each with at least one cutaneous affected subject, was achieved; 41 families were of native origin, and 77 (herein designated "migrant") recently had settled in the area. For the analysis, the trait under study was the time to onset of the primary cutaneous lesion. The start of the follow-up was birth, for native population, or date of arrival in the endemic area, for migrant population. Segregation analysis was performed by use of a model based on survival analysis methods that allows joint estimation of genetic and environmental effects and accounts for gene x covariate interactions. A significant effect of gender, home-forest distance, and forest-related activity was found. In the 77 migrant families there was evidence for a recessive major gene controlling the onset of the primary cutaneous lesion, with residual familial dependences and age x genotype interaction. Penetrance estimations show that young subjects are genetically more susceptible than older subjects, suggesting that this genetic component could concern mechanisms involved in the development of individual protection during childhood. There was also a significant genetic heterogeneity of the sample according to the native/migrant origin of the families, and no major-gene effect was found in the native subsample.
Assuntos
Leishmania braziliensis , Leishmaniose Cutânea/genética , Adulto , Fatores Etários , Animais , Bolívia , Criança , Suscetibilidade a Doenças , Feminino , Humanos , Indígenas Sul-Americanos/genética , Leishmaniose Cutânea/epidemiologia , Leishmaniose Tegumentar Difusa/genética , Leishmaniose Mucocutânea/genética , Masculino , Núcleo Familiar , Probabilidade , Fatores de Tempo , MigrantesRESUMO
A survival analysis was performed on data from an endemic area of Bolivia where two populations, natives and highland migrants, were living, to investigate risk factors for onset of cutaneous leishmaniasis (CL) and its mucosal form (MCL). In a first data set (703 subjects with 242 CL patients), significant risk factors for CL were gender, native/migrant status, activity, and home-forest distance. The instantaneous risk of CL increased until adolescence in both populations, and rapidly decreased thereafter. This risk was 3-10 times higher in migrants than in natives until 20 years of age, and became similar thereafter. Environmental and behavioral factors did not seem sufficient to explain this contrast between the two populations, and this evolution with age may suggest differences in the mechanisms involved in the development of individual protection during childhood. In a second data set (446 CL patients with 34 mucosal forms) the native/migrant status was the main factor associated with the onset of mucosal form.
Assuntos
Leishmaniose Cutânea/etiologia , Leishmaniose Mucocutânea/etiologia , Adolescente , Adulto , Fatores Etários , Bolívia/epidemiologia , Criança , Pré-Escolar , Emigração e Imigração , Feminino , Humanos , Lactente , Leishmaniose Cutânea/epidemiologia , Leishmaniose Mucocutânea/epidemiologia , Masculino , Análise Multivariada , Fatores de Risco , Fatores SexuaisRESUMO
American mucocutaneous leishmaniasis is an important health problem in Peru, particularly in the mountainous Cuzco Region, where 25% of all new cases reported in 1989 were located. Cases have increased considerably since the beginning of the 1980s, when large-scale seasonal migration to endemic zones occurred, particularly the forest area of Madre de Dios, following the discovery of new gold deposits there, and the deterioration in the economic situation in Peru. Following the lack of official response from the Peruvian government, hundreds of people suffering from leishmaniasis in the Cuzco area formed self-help associations with the objective of obtaining the drugs needed to treat their disease. The major achievement of this spontaneous movement, which was supported by several public and private institutions, was to encourage sick people, particularly patients with mucosal lesions, to emerge from isolation. As a result, the prevalence and incidence of the disease have now considerably decreased in the region.
PIP: The deterioration in Peru's economic situation and the discovery of new gold deposits in the mountainous Cuzco Region have been associated with a considerable increase in cases of American mucocutaneous leishmaniasis. Following a lack of government response to this serious health problem, people with leishmaniasis in the town of Sicuani formed a patients' association in 1983 to try to obtain appropriate drugs for treatment. In 1983-93, eight additional patients' associations were established and, in 1990, these associations (representing 1648 members) united with health authorities and other institutions in the Cuzco Region to form a committee to coordinate their activities. The role of these associations was studied in field work conducted in the region in 1993. In interviews, association activists expressed demands that the government make free drugs available, offer financial compensation to those who acquire the disease through work, improve working conditions in the mines and living conditions for migrant workers, and identify other seasonal employment opportunities in order to prevent migration to the mining areas. The leishmaniasis movement, which originated as a spontaneous initiative, has become more structured and organized over time. A control strategy based on active case finding, early diagnosis, and early treatment of disease has been defined. A major achievement of the patients' associations, especially in Sicuani and Ocongate, has been to encourage sick people to emerge from their isolation. This program provides an example of successful multisectoral coordination and community participation of potential relevance in other countries where mucocutaneous leishmaniasis is endemic.
Assuntos
Leishmaniose Mucocutânea/prevenção & controle , Grupos de Autoajuda , Animais , Antiprotozoários/uso terapêutico , Humanos , Incidência , Leishmania braziliensis , Leishmaniose Mucocutânea/epidemiologia , Leishmaniose Mucocutânea/parasitologia , Peru/epidemiologia , Prevalência , Grupos de Autoajuda/organização & administração , Fatores Socioeconômicos , MigrantesRESUMO
Three cases of cutaneous leishmaniasis in guinea-pigs from a rural area near Curitiba (Paraná State, Brazil) are reported. The three parasite isolates were characterized by isoenzyme electrophoresis as Leishmania enriettii, of which two distinct zymodemes were observed.
Assuntos
Cobaias , Leishmania enriettii/isolamento & purificação , Leishmaniose Cutânea/veterinária , Animais , Brasil , Eletroforese em Gel de Amido , Isoenzimas/análise , Leishmania enriettii/classificação , Leishmania enriettii/enzimologia , Leishmaniose Cutânea/parasitologia , Polimorfismo GenéticoRESUMO
The authors report the ninth case of cutaneous Leishmaniasis without mucosal involvement due to Leishmania (Viannia) braziliensis (isoenzymatic profile related to zymodeme MON-44) diagnosed in a legionnaire who recently arrived in French Guiana. The skin lesion as a single ulcerated nodule of the dorsum of the left ringfinger was cured after two courses of four intramuscular injections of pentamidine isothionate (total posology of pentamidine-base: 16.6 mg/kg). The transmission occurred during nocturnal trekking in forest and swamps just behind the coastal belt at Degrad Saramaka (7 km South of Kourou). In French Guiana, the good level of medical care and the early treatment of the majority of the cases of Leishmaniasis may explain the rarity of mucosal lesions. Since the clinical aspect of the lesion is not sufficient to prejudge the identity of the causative species, it is necessary to perform cultivation of Leishmania for iso-enzymatic identification. The adaptation of pentamidine doses and long term follow up of patients infected by L. (V.) braziliensis could be defined more precisely.
Assuntos
Leishmania braziliensis , Leishmaniose Cutânea/parasitologia , Adulto , Animais , Antiprotozoários/uso terapêutico , Guiana Francesa/epidemiologia , Humanos , Leishmaniose Cutânea/tratamento farmacológico , Leishmaniose Cutânea/epidemiologia , Masculino , Militares , Pentamidina/uso terapêutico , ÁrvoresRESUMO
Twenty-seven trypanosomatidae stocks isolated from various hosts in French Guiana have been surveyed by Multilocus Enzyme Electrophoresis on cellulose acetate plates. The variability observed at 22 different enzyme systems was considerable, since 21 different enzyme profiles (zymodemes) could be distinguished. Clustering analysis and comparison with four laboratory reference stocks showed clearly that three stocks were distantly related from the rest and most probably cannot be included in the species Trypanosoma cruzi. All the other stocks were more related to the formerly described zymodeme I than to the formerly described zymodemes II and III. Genotype variability in this T. cruzi sylvatic population was notably higher than in domestic populations of the same parasite. This could suggest more frequent genetic exchange occurring in sylvatic cycles. Nevertheless, a population genetic analysis of the data showed a considerable linkage disequilibrium, which rather favors the hypothesis that T. cruzi has a basically clonal population structure in this ecosystem too.