RESUMO
BACKGROUND: Diffuse cutaneous leishmaniasis (DCL), although rare, is profoundly incapacitating. At present there is no successful treatment for this progressive protozoan infection, which is associated with the absence of specific cell-mediated immunity (CMI) to Leishmania. This disease shares features with visceral leishmaniasis (VL), including specific CMI inactivity during active disease and a heavy parasitic burden, but VL responds well to treatment. Miltefosine is the first orally administered drug which has shown efficacy in the treatment of VL; it has not been adequately evaluated in the treatment of DCL. OBJECTIVES: To evaluate the efficacy of miltefosine in the treatment of DCL, using clinical, parasitological, histopathological and immunological criteria. METHODS: Sixteen patients with DCL were treated with miltefosine, 2.0-2.5 mg kg(-1) daily, for variable periods of time (75-218 days). Patients were hospitalized for the first month and evaluated every 2 weeks until the termination of treatment with routine laboratory chemistry, percentage clinical improvement, presence of parasites in skin smears, growth of parasites in culture medium and in hamsters, histopathological characteristics of the granulomas, adverse side-effects, and reactivity to leishmanin skin test antigen. Further cycles of treatment were given in some of these patients, particularly after suspension of treatment was followed by relapse. RESULTS: Patients showed dramatic clinical improvement and reduction in the parasite burden by day 15 after the initiation of treatment, which continued while treatment was maintained. By day 45, 15 patients showed 80-90% clinical improvement. Nevertheless, suspension of treatment was followed by the development of new lesions in all but one patient. Inoculation in hamsters was observed to be the most sensitive technique to detect persisting parasites. Adverse events were very mild. CONCLUSIONS: Miltefosine produced a dramatic clinical and parasitological response in patients with DCL and improvement continued during drug administration, but with a single exception all patients presented new lesions after suspension of treatment. There was no histological or skin test evidence to suggest the development of CMI during treatment, which may be an indispensable criterion for the evaluation of potentially effective drugs against DCL.
Assuntos
Antiprotozoários/uso terapêutico , Leishmaniose Tegumentar Difusa/tratamento farmacológico , Fosforilcolina/análogos & derivados , Adolescente , Adulto , Criança , Pré-Escolar , Resistência a Medicamentos , Feminino , Humanos , Leishmaniose Tegumentar Difusa/imunologia , Leishmaniose Tegumentar Difusa/parasitologia , Masculino , Pessoa de Meia-Idade , Fosforilcolina/uso terapêutico , Qualidade de Vida/psicologia , Recidiva , Falha de TratamentoRESUMO
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
An increase in the incidence of human visceral leishmaniasis (HVL) has been detected in recent years on Margarita Island, located off the NE coast of Venezuela. Recent studies have revealed reactivity to rK39 antigen (Leishmania chagasi) in 20% of 541 sera from domestic dogs in endemic communities; PCR reactions were positive using primers for the L. donovani complex. Here we report that isolates from human and canine infection, identified by isoenzyme analysis, correspond to L. infantum, zymodeme MON-1. This appears to be the first isolation and identification of an isolate from HVL on Margarita Island and demonstrates the presence of this zymodeme in the canine population.
Assuntos
Doenças do Cão/epidemiologia , Leishmania infantum/isolamento & purificação , Leishmaniose Visceral/epidemiologia , Leishmaniose Visceral/veterinária , Animais , Antígenos de Protozoários/sangue , Doenças do Cão/parasitologia , Cães , Humanos , Incidência , Isoenzimas/análise , Leishmania donovani/enzimologia , Leishmania donovani/isolamento & purificação , Leishmania infantum/enzimologia , Leishmaniose Visceral/parasitologia , Reação em Cadeia da Polimerase , Prevalência , Venezuela/epidemiologiaRESUMO
The phlebotomine sandflies in the northern areas of the state of Paraná, Brazil, particularly those in the '16a' health region, were investigated over a 3-year period. Using CDC light traps (with and without hamster bait) and Shannon traps (with lights and horse or human bait), 16 species were collected from seven municipal districts which were known foci for cutaneous leishmaniasis: Arapongas; Apucarana; Cambira; Marumbi; Faxinal; Florestópolis; and Sabáudia. Although the frequency at which each species was collected varied with the collection site, Lutzomyia whitmani predominated (62.0% of all the sandflies collected), followed by Lu. fischeri (13.3%), Lu. pessoai (10.8%), Lu. migonei (8.2%) and Lu. intermedia (2.8%). Lutzomyia monticola, Lu. shanonni, Lu. firmatoi, Lu. lanei, Lu. alphabetica, Lu. misionensis, Lu. correalimai, Lu. cortellezzii, Lu. longipenis, Brumptomyia brumpti and B. nitzulescui together represented the remaining 3.0% of the collected sandflies. Three of the 1961 female sandflies collected and dissected in the municipal district of Cambira, where a recent case of cutaneous leishmaniasis had been registered, were found to have flagellates in their guts. All three were Lu. whitmani. The parasites from each of these infections were successfully isolated in NNN and 'Tobie and Evans' media and/or by inoculation into a hind foot of a golden hamster. The results of isoenzyme electrophoresis indicated that all three isolates were of Leishmania (Viannia) braziliensis.
Assuntos
Insetos Vetores , Leishmania braziliensis/isolamento & purificação , Psychodidae/parasitologia , Animais , Brasil/epidemiologia , Cricetinae , Eletroforese , Doenças Endêmicas , Feminino , Leishmaniose Cutânea/epidemiologia , Leishmaniose Cutânea/transmissão , Psychodidae/classificaçãoRESUMO
Leishmaniasis is widespread in Colombia and is found in 30 of 32 Departments. More than 200 infection zones have been reported from different regions, which vary from sea-level to an altitude of 2,300 m along the Atlantic Coast, Pacific coast, Amazon basin, Cauca and Magdalena valleys. We report 76 Leishmania stocks isolated from humans, dogs and phlebotomine hosts. Isoenzyme electrophoresis revealed 16 zymodemes, which could be divided into four phylogenetic complexes, i.e., L. braziliensis, L. amazonensis, L. guyanensis/panamensis and L. infantum. Three zymodemes became integrated into the subgenus Leishmania and the other zymodemes into the subgenus Viannia. Cutaneous infections were due to the L. braziliensis (9.2%) and L. guyanensis/panamensis (85.54%) complexes. Mucous secondary involvement was due to the L. braziliensis and L. guyanensis/panamensis complexes. In this work the specific status of L. (V.) guyanensis and L. (V.) panamensis is discussed.
Assuntos
Leishmania/classificação , Animais , Colômbia , Doenças do Cão/parasitologia , Cães , Eletroforese em Gel de Amido , Humanos , Focalização Isoelétrica , Isoenzimas/análise , Leishmania/enzimologia , Leishmania/genética , Leishmaniose/parasitologia , Leishmaniose/veterinária , Filogenia , Polimorfismo Genético , Psychodidae/parasitologiaAssuntos
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
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
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 , ÁrvoresAssuntos
Leishmania/classificação , Animais , Isoenzimas/análise , Leishmania/enzimologia , FilogeniaRESUMO
A new case of cutaneous Leishmaniasis to L. braziliensis Vianna, 1911, contracted in French Guyana is reported. The parasite, isolated in culture, is identified by enzymatic typing (13 zymoden). The identified zymodem is zymodem MON-43. It is the same of the WHO reference strain L. braziliensis s. st.