RESUMO
In this present study, carried out between November 2020 and July 2023 at Londrina's University Hospital, patients with active lesions of cutaneous leishmaniasis (CL) were analyzed regarding pain perception and anatomopathological aspects of the ulcers. Pain was assessed using a numerical rating scale (NRS) to compare five patients diagnosed with CL with four control patients diagnosed with vascular skin ulcers. Histopathological evaluations were used to investigate the nociceptor neuron-Leishmania interface. Patients with CL ulcers reported less pain compared to patients with vascular ulcers (2.60 ± 2.30 and 7.25 ± 0.95, respectively, p = 0.0072). Histopathology evidenced Leishmania spp. amastigote forms nearby sensory nerve fibers in profound dermis. Schwann cells marker (S100 protein) was detected, and caspase-3 activation was not evidenced in the in the nerve fibers of CL patients' samples, suggesting absence of apoptotic activity in nerve endings. Additionally, samples taken from the active edge of the lesion were negative for bacilli acid-alcohol resistant (BAAR), which excludes concomitant leprosy, in which painless lesions are also observed. Thus, the present data unveil for the first time anatomopathological and microbiological details of painless ulcers in CL patients, which has important clinical implications for a better understanding on the intriguing painless clinical characteristic of CL.
Assuntos
Apoptose , Leishmania , Leishmaniose Cutânea , Úlcera Cutânea , Humanos , Masculino , Feminino , Leishmaniose Cutânea/patologia , Leishmaniose Cutânea/parasitologia , Adulto , Pessoa de Meia-Idade , Úlcera Cutânea/parasitologia , Úlcera Cutânea/patologia , Células Receptoras Sensoriais/patologia , Neurônios/patologia , Idoso , Pele/parasitologia , Pele/patologia , Pele/inervaçãoRESUMO
Cutaneous leishmaniasis (CL) is a neglected disease caused by an intracellular parasite of the Leishmania genus. CL lacks tools that allow its understanding and treatment follow-up. This article presents the use of metrical and optical tools for the analysis of the temporal evolution of treated skin ulcers caused by CL in an animal model. Leishmania braziliensis and L. panamensis were experimentally inoculated in golden hamsters, which were treated with experimental and commercial drugs. The temporal evolution was monitored by means of ulcers' surface areas, as well as absorption and scattering optical parameters. Ulcers' surface areas were obtained via photogrammetry, which is a procedure that allowed for 3D modeling of the ulcer using specialized software. Optical parameters were obtained from a spectroscopy study, representing the cutaneous tissue's biological components. A one-way ANOVA analysis was conducted to identify relationships between both the ulcers' areas and optical parameters. As a result, ulcers' surface areas were found to be related to the following optical parameters: epidermis thickness, collagen, keratinocytes, volume-fraction of blood, and oxygen saturation. This study is a proof of concept that shows that optical parameters could be associated with metrical ones, giving a more reliable concept during the assessment of a skin ulcer's healing.
Assuntos
Leishmaniose Cutânea , Úlcera Cutânea , Cricetinae , Animais , Úlcera , Leishmaniose Cutânea/tratamento farmacológico , Pele , Úlcera Cutânea/tratamento farmacológico , Úlcera Cutânea/parasitologia , Mesocricetus , Modelos Animais de DoençasRESUMO
BACKGROUND: Cutaneous leishmaniasis (CL) is generally diagnosed by molecular methods, including PCR, using biopsy samples, skin scrapings and clinical exudates. In this study, we assessed the PCR performance for diagnosis of CL using skin of biopsy samples vs PCR of skin lesion exudate samples on filter paper and compared the diagnostic concordance of PCR using both sampling methods. METHODS: We assessed the PCR performance using 80 skin biopsy samples and 80 filter paper samples containing exudates from skin lesions obtained from 74 patients with clinical suspicion of CL in Cusco, Peru. RESULTS: : PCR using skin biopsy samples had superior diagnostic accuracy compared with filter paper PCR (62.5% [50/80] vs 38.7% [31/80], respectively; pË0.005) and the diagnostic concordance between both sampling methods was 'moderate' (kappa coefficient=0.50, 95% CI 0.98 to 1.0). CONCLUSIONS: PCR using biopsy samples remains the standard for diagnosis of CL.
Assuntos
Biópsia , Leishmania/genética , Leishmania/isolamento & purificação , Leishmaniose Cutânea/diagnóstico , Reação em Cadeia da Polimerase/métodos , Úlcera Cutânea/parasitologia , DNA de Protozoário , Exsudatos e Transudatos , Humanos , Leishmania/classificação , Peru , Sensibilidade e Especificidade , Pele/patologiaRESUMO
Cutaneous leishmaniasis (CL) is a neglected tropical disease that requires novel tools for its understanding, diagnosis, and treatment follow-up. In the cases of other cutaneous pathologies, such as cancer or cutaneous ulcers due to diabetes, optical diffuse reflectance-based tools and methods are widely used for the investigation of those illnesses. These types of tools and methods offer the possibility to develop portable diagnosis and treatment follow-up systems. In this article, we propose the use of a three-layer diffuse reflectance model for the study of the formation of cutaneous ulcers caused by CL. The proposed model together with an inverse-modeling procedure were used in the evaluation of diffuse-reflectance spectral signatures acquired from cutaneous ulcers formed in the dorsal area of 21 golden hamsters inoculated with Leishmanisis braziliensis. As result, the quantification of the model's variables related to the main biological parameters of skin were obtained, such as: diameter and volumetric fraction of keratinocytes, collagen; volumetric fraction of hemoglobin, and oxygen saturation. Those parameters show statistically significant differences among the different stages of the CL ulcer formation. We found that these differences are coherent with histopathological manifestations reported in the literature for the main phases of CL formation.
Assuntos
Leishmaniose Cutânea/patologia , Úlcera Cutânea/patologia , Pele/química , Espectrofotometria/métodos , Animais , Colágeno/fisiologia , Cricetinae , Modelos Animais de Doenças , Processamento Eletrônico de Dados , Feminino , Hemoglobinas/química , Leishmaniose Cutânea/metabolismo , Masculino , Mesocricetus , Oxigênio/química , Pele/patologia , Úlcera Cutânea/metabolismo , Úlcera Cutânea/parasitologiaAssuntos
Humanos , Masculino , Idoso , Úlcera Cutânea/parasitologia , Úlcera Cutânea/patologia , Leishmaniose Cutânea/patologia , Compostos Organometálicos/uso terapêutico , Úlcera Cutânea/tratamento farmacológico , Resultado do Tratamento , Leishmaniose Cutânea/tratamento farmacológico , Antimoniato de Meglumina , Meglumina/uso terapêutico , Antiprotozoários/uso terapêuticoRESUMO
Cutaneous leishmaniasis (CL), characterized by an ulcerated lesion, is the most common clinical form of human leishmaniasis. Before the ulcer develops, patients infected with Leishmania (Viannia) braziliensis present a small papule at the site of the sandfly bite, referred to as early cutaneous leishmaniasis (E-CL). Two to four weeks later the typical ulcer develops, which is considered here as late CL (L-CL). Although there is a great deal known about T-cell responses in patients with L-CL, there is little information about the in situ inflammatory response in E-CL. Histological sections of skin biopsies from 15 E-CL and 28 L-CL patients were stained by hematoxilin and eosin to measure the area infiltrated by cells, as well as tissue necrosis. Leishmania braziliensis amastigotes, CD4+, CD8+, CD20+, and CD68+ cells were identified and quantified by immunohistochemistry. The number of amastigotes in E-CL was higher than in L-CL, and the inflammation area was larger in classical ulcers than in E-CL. There was no relationship between the number of parasites and magnitude of the inflammation area, or with the lesion size. However, there was a direct correlation between the number of macrophages and the lesion size in E-CL, and between the number of macrophages and necrotic area throughout the course of the disease. These positive correlations suggest that macrophages are directly involved in the pathology of L. braziliensis-induced lesions.
Assuntos
Leishmaniose Cutânea/patologia , Úlcera Cutânea/patologia , Adulto , Brasil , Linfócitos T CD4-Positivos/citologia , Linfócitos T CD8-Positivos/citologia , Estudos Transversais , Feminino , Humanos , Imuno-Histoquímica , Inflamação/parasitologia , Inflamação/patologia , Leishmania braziliensis/isolamento & purificação , Masculino , Pele/parasitologia , Pele/patologia , Úlcera Cutânea/parasitologia , Fatores SocioeconômicosAssuntos
Leishmaniose Cutânea/patologia , Úlcera Cutânea/patologia , Úlcera Cutânea/parasitologia , Idoso , Antiprotozoários/uso terapêutico , Humanos , Leishmaniose Cutânea/tratamento farmacológico , Masculino , Meglumina/uso terapêutico , Antimoniato de Meglumina , Compostos Organometálicos/uso terapêutico , Úlcera Cutânea/tratamento farmacológico , Resultado do TratamentoRESUMO
Skin ulcer development in cutaneous leishmaniasis due to Leishmania braziliensis infection is associated with a mononuclear cell infiltrate and high levels of tumor necrosis factor (TNF). Herein, we show that despite the absence of Leishmania-driven TNF, a cutaneous leishmaniasis patient with acquired immunodeficiency syndrome developed a skin ulcer. The presence of mononuclear phagocytes and high levels of TNF, chemokine (C-C motif) ligand 2 (CCL2), and metalloproteinase-9 in tissue are identified as potential contributors to immunopathology observed in L. braziliensis-infected patients.
Assuntos
Coinfecção/complicações , Infecções por HIV/complicações , Leishmaniose Cutânea/complicações , Fagócitos/fisiologia , Úlcera Cutânea/etiologia , Adulto , Quimiocina CCL2/sangue , Coinfecção/parasitologia , Coinfecção/virologia , Feminino , Infecções por HIV/parasitologia , Humanos , Leishmania braziliensis , Leishmaniose Cutânea/patologia , Leishmaniose Cutânea/virologia , Metaloproteinase 9 da Matriz/sangue , Úlcera Cutânea/parasitologia , Úlcera Cutânea/virologia , Fator de Necrose Tumoral alfa/sangueRESUMO
BACKGROUND: Cutaneous leishmaniasis (CL) is a skin disease caused by the protozoan parasite Leishmania. Few studies have assessed the influence of the sample collection site within the ulcer and the sampling method on the sensitivity of parasitological and molecular diagnostic techniques for CL. Sensitivity of the technique can be dependent upon the load and distribution of Leishmania amastigotes in the lesion. METHODOLOGY/PRINCIPAL FINDINGS: We applied a quantitative real-time PCR (qPCR) assay for Leishmania (Viannia) minicircle kinetoplast DNA (kDNA) detection and parasite load quantification in biopsy and scraping samples obtained from 3 sites within each ulcer (border, base, and center) as well as in cytology brush specimens taken from the ulcer base and center. A total of 248 lesion samples from 31 patients with laboratory confirmed CL of recent onset (≤3 months) were evaluated. The kDNA-qPCR detected Leishmania DNA in 97.6% (242/248) of the examined samples. Median parasite loads were significantly higher in the ulcer base and center than in the border in biopsies (P<0.0001) and scrapings (P = 0.0002). There was no significant difference in parasite load between the ulcer base and center (P = 0.80, 0.43, and 0.07 for biopsy, scraping, and cytology brush specimens, respectively). The parasite load varied significantly by sampling method: in the ulcer base and center, the descending order for the parasite load levels in samples was: cytology brushes, scrapings, and biopsies (P<0.0001); in the ulcer border, scrapings had higher parasite load than biopsies (P<0.0001). There was no difference in parasite load according to L. braziliensis and L. peruviana infections (P = 0.4). CONCLUSION/SIGNIFICANCE: Our results suggest an uneven distribution of Leishmania amastigotes in acute CL ulcers, with higher parasite loads in the ulcer base and center, which has implications for bedside collection of diagnostic specimens. The use of scrapings and cytology brushes is recommended instead of the more invasive biopsy.
Assuntos
DNA de Cinetoplasto/genética , Leishmania/genética , Leishmaniose Cutânea/parasitologia , Carga Parasitária , Úlcera Cutânea/parasitologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Leishmania/classificação , Leishmaniose Cutânea/patologia , Masculino , Pessoa de Meia-Idade , Úlcera Cutânea/patologia , Especificidade da Espécie , Adulto JovemRESUMO
We present a case of imported leishmaniasis in a 31-year-old woman from Slovakia, who visited the countries of South America for three months in 2011. On 29 and 31 August 2011, she was probably infected with Leishmania parasites in the jungles of Ecuador. Approximately one week after returning to Slovakia, a small papules appeared on patient's left leg. Another wound was found after two weeks. Both ulcers were enlarging. We proved amastigote forms of Leishmania spp. only in repeated dermal scrapings from the edge of the ulcer by Giemsa staining after negative results from examination of a wound scrape and biopsy specimen. We identified the species Leishmania (Viannia) panamensis as a causative agent by using the polymerase chain reaction (PCR) method and subsequent sequencing of the ITS region. Closure of wounds and scab formation were observed after 20 days of treatment with sodium stibogluconate. In the control microscopic examination after the end of the treatment, parasites were not present, and the PCR confirmed the negative result (Fig. 2, Ref. 31).
Assuntos
Leishmania/isolamento & purificação , Leishmaniose Cutânea/diagnóstico , Úlcera Cutânea/parasitologia , Viagem , Adulto , Animais , Gluconato de Antimônio e Sódio/uso terapêutico , Antiprotozoários/uso terapêutico , Transmissão de Doença Infecciosa , Equador , Feminino , Humanos , Leishmaniose Cutânea/tratamento farmacológico , Leishmaniose Cutânea/parasitologia , Reação em Cadeia da Polimerase , Eslováquia , Resultado do Tratamento , CicatrizaçãoRESUMO
The host immune response has a critical role not only in protection from human leishmaniasis but also in promoting disease severity. Although candidate gene approaches in mouse models of leishmaniasis have been extremely informative, a global understanding of the immune pathways active in lesions from human patients is lacking. To address this issue, genome-wide transcriptional profiling of Leishmania braziliensis-infected cutaneous lesions and normal skin controls was carried out. A signature of the L. braziliensis skin lesion was defined, which includes over 2,000 differentially regulated genes. Pathway-level analysis of this transcriptional response revealed key biological pathways present in cutaneous lesions, generating a testable 'metapathway' model of immunopathology and providing new insights for treatment of human leishmaniasis.
Assuntos
Genômica/métodos , Leishmania braziliensis/imunologia , Leishmaniose Cutânea , Úlcera Cutânea , Adolescente , Adulto , Feminino , Humanos , Inflamassomos/genética , Inflamassomos/imunologia , Leishmaniose Cutânea/genética , Leishmaniose Cutânea/imunologia , Leishmaniose Cutânea/parasitologia , Masculino , Pessoa de Meia-Idade , Psoríase/genética , Psoríase/imunologia , Pele/imunologia , Pele/parasitologia , Úlcera Cutânea/genética , Úlcera Cutânea/imunologia , Úlcera Cutânea/parasitologia , Transcrição Gênica/imunologia , Transcriptoma/imunologia , Adulto JovemRESUMO
Cutaneous leishmaniasis (CL) is the most frequent clinical form of tegumentary leishmaniasis and is characterised by a single or a few ulcerated skin lesions that may disseminate into multiple ulcers and papules, which characterise disseminated leishmaniasis (DL). In this study, cells were quantified using immunohistochemistry and haematoxylin and eosin staining (CD4+, CD68+, CD20+, plasma cells and neutrophils) and histopathology was used to determine the level of inflammation in biopsies from patients with early CL, late CL and DL (ulcers and papules). The histopathology showed differences in the epidermis between the papules and ulcers from DL. An analysis of the cells present in the tissues showed similarities between the ulcers from localised CL (LCL) and DL. The papules had fewer CD4+ T cells than the DL ulcers. Although both CD4+ cells and macrophages contribute to inflammation in early CL, macrophages are the primary cell type associated with inflammation intensity in late ulcers. The higher frequency of CD20+ cells and plasma cells in lesions demonstrates the importance of B cells in the pathogenesis of leishmaniasis. The number of neutrophils was the same in all of the analysed groups. A comparison between the ulcers from LCL and DL and the early ulcers and papules shows that few differences between these two clinical forms can be distinguished by observing only the tissue.
Assuntos
Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Linfócitos B/parasitologia , Leishmaniose Cutânea/patologia , Macrófagos/parasitologia , Neutrófilos/parasitologia , Pele/patologia , Antígenos de Protozoários/análise , Biópsia , Progressão da Doença , Derme/patologia , Amarelo de Eosina-(YS) , Epiderme/patologia , Hematoxilina , Imuno-Histoquímica , Inflamação/patologia , Leishmaniose Cutânea/imunologia , Leishmaniose Tegumentar Difusa/imunologia , Leishmaniose Tegumentar Difusa/patologia , Plasmócitos/parasitologia , Úlcera Cutânea/parasitologiaRESUMO
Cutaneous leishmaniasis (CL) is the most frequent clinical form of tegumentary leishmaniasis and is characterised by a single or a few ulcerated skin lesions that may disseminate into multiple ulcers and papules, which characterise disseminated leishmaniasis (DL). In this study, cells were quantified using immunohistochemistry and haematoxylin and eosin staining (CD4+, CD68+, CD20+, plasma cells and neutrophils) and histopathology was used to determine the level of inflammation in biopsies from patients with early CL, late CL and DL (ulcers and papules). The histopathology showed differences in the epidermis between the papules and ulcers from DL. An analysis of the cells present in the tissues showed similarities between the ulcers from localised CL (LCL) and DL. The papules had fewer CD4+ T cells than the DL ulcers. Although both CD4+ cells and macrophages contribute to inflammation in early CL, macrophages are the primary cell type associated with inflammation intensity in late ulcers. The higher frequency of CD20+ cells and plasma cells in lesions demonstrates the importance of B cells in the pathogenesis of leishmaniasis. The number of neutrophils was the same in all of the analysed groups. A comparison between the ulcers from LCL and DL and the early ulcers and papules shows that few differences between these two clinical forms can be distinguished by observing only the tissue.
Assuntos
Linfócitos B/parasitologia , Leishmaniose Cutânea/patologia , Macrófagos/parasitologia , Neutrófilos/parasitologia , Pele/patologia , Adolescente , Adulto , Antígenos de Protozoários/análise , Biópsia , Derme/patologia , Progressão da Doença , Amarelo de Eosina-(YS) , Epiderme/patologia , Feminino , Hematoxilina , Humanos , Imuno-Histoquímica , Inflamação/patologia , Leishmaniose Cutânea/imunologia , Leishmaniose Tegumentar Difusa/imunologia , Leishmaniose Tegumentar Difusa/patologia , Masculino , Pessoa de Meia-Idade , Plasmócitos/parasitologia , Úlcera Cutânea/parasitologia , Adulto JovemRESUMO
An 18-year-old female presented with a severe ulcerative lesion on her right ear of 6 weeks duration. Her right ear was edematous and erythematous with a large, painless ulcerative lesion covering a third of the pinna and satellite papular lesions on the posterior. She was diagnosed with chiclero's ulcer. A skin smear stained with Diff-quik showed abundant Leishmania parasites. Chiclero's ulcer is a rare clinical presentation and is typically severe and difficult to treat. Physicians in Ecuador recommend administering prolonged intramuscular Glucantime. Side effects are common and can be severe resulting in low patient compliance. Because of preferences of the patient and the large volume needed for her weight, we recommended topical treatment with a lotion of Glucantime mixed half and half with white Merthiolate. After applying this lotion to the lesion 3 to 4 times a day for 6 weeks, the lesion healed.
Assuntos
Antiprotozoários/uso terapêutico , Leishmaniose Cutânea/patologia , Meglumina/uso terapêutico , Compostos Organometálicos/uso terapêutico , Úlcera Cutânea/parasitologia , Timerosal/uso terapêutico , Administração Tópica , Adolescente , Antiprotozoários/administração & dosagem , Orelha/patologia , Equador , Feminino , Humanos , Leishmaniose Cutânea/tratamento farmacológico , Meglumina/administração & dosagem , Antimoniato de Meglumina , Compostos Organometálicos/administração & dosagem , Úlcera Cutânea/patologia , Timerosal/administração & dosagemRESUMO
The accurate diagnosis of canine visceral leishmaniasis (CanL) is essential for visceral leishmaniasis control. To this end, DNA detection on different biological samples has been employed. In this study, we report the use of polymerase chain reaction (PCR) assay on samples such as buffy coat, bone marrow, intact skin and cutaneous ulcers fragments, and lymph node aspirate collected from 430 dogs to determine the suitable biological sample for use in CanL diagnosis. The PCR results were correlated with clinical status and other tests previously performed. Leishmania chagasi DNA was detected in 14.6% (n = 63) of the dogs investigated, regardless of the sample analyzed. Our results showed that symptomatic cases were easily diagnosed when compared to asymptomatic animals; however, the PCR proved to be very useful for Leishmania DNA detection, mainly in lymph node aspirate (41; 9.6%), irrespective of the clinical status of the dog. The finding that the lymph node aspirate produced high positivity rates and the fact that this specimen was obtained by noninvasive methods highlight its use in epidemiological survey by PCR for CanL diagnosis.
Assuntos
Doenças do Cão/diagnóstico , Leishmania donovani/genética , Leishmaniose Visceral/veterinária , Reação em Cadeia da Polimerase , Úlcera Cutânea/veterinária , Animais , Infecções Assintomáticas , Doenças do Cão/epidemiologia , Doenças do Cão/parasitologia , Cães , Doenças Endêmicas , Feminino , Leishmaniose Visceral/diagnóstico , Leishmaniose Visceral/epidemiologia , Linfonodos/parasitologia , Masculino , Técnicas de Diagnóstico Molecular , Úlcera Cutânea/epidemiologia , Úlcera Cutânea/parasitologiaRESUMO
Conventional understanding suggests that simultaneous infection with more than one species of Leishmania is unlikely. In Peru, co-infections are clinically relevant because causative species dictates prognosis, treatment response, and follow-up. We describe a case of Leishmania (Viannia) braziliensis and L. (V.) lainsoni co-infection in a Peruvian patient with cutaneous leishmaniasis.
Assuntos
Coinfecção/parasitologia , Leishmania braziliensis/patogenicidade , Leishmaniose Cutânea/diagnóstico , Adulto , Gluconato de Antimônio e Sódio/uso terapêutico , Coinfecção/diagnóstico , Coinfecção/tratamento farmacológico , DNA de Protozoário/análise , Feminino , Humanos , Leishmania braziliensis/isolamento & purificação , Leishmaniose Cutânea/tratamento farmacológico , Reação em Cadeia da Polimerase , Polimorfismo de Fragmento de Restrição , Proteínas de Protozoários/análise , Úlcera Cutânea/tratamento farmacológico , Úlcera Cutânea/parasitologia , Úlcera Cutânea/patologiaRESUMO
Disseminated leishmaniasis (DL) is an emerging form of Leishmania braziliensis infection characterised by multiple cutaneous lesions on different parts of the body and a high rate of mucosal involvement. Systemic production of TNFα and IFNγ in DL patients is lower than in cutaneous leishmaniasis (CL) caused by L. braziliensis, which may account for parasite dissemination due to the decreased ability to control parasite growth. In this study, the systemic and in situ immune response of DL and CL patients was characterised through evaluation of chemokine and cytokine production. In situ evaluation showed similar production of IFNγ, TNFα, IL-10, transforming growth factor-beta (TGFß), chemokine (C-C motif) ligand 2 (CCL2), CCL3, CCL11 and chemokine (C-X-C motif) ligand 10 (CXCL10) in papular and ulcerative lesions from DL as well as in ulcerated lesions from CL. Serum levels of CXCL9, a chemokine that attracts T-cells, was higher in serum from DL than from CL. These data indicate that a decrease in the type 1 immune response in peripheral blood of DL patients is due to attraction of Leishmania antigen-activated T-cells to the multiple cutaneous lesions. This may account for the absence of or few parasites in the lesions and for the development of ulcers similar to those observed in CL.
Assuntos
Quimiocinas/imunologia , Interferon gama/imunologia , Leishmania braziliensis/imunologia , Leishmaniose Cutânea/imunologia , Úlcera Cutânea/imunologia , Úlcera Cutânea/parasitologia , Fator de Necrose Tumoral alfa/imunologia , Adulto , Animais , Antígenos de Protozoários/metabolismo , Brasil/epidemiologia , Feminino , Regulação da Expressão Gênica/genética , Humanos , Leishmaniose Cutânea/epidemiologia , Leishmaniose Cutânea/genética , Leishmaniose Cutânea/patologia , Masculino , Testes Cutâneos , Linfócitos T/imunologiaRESUMO
Cutaneous leishmaniasis (CL) is rarely seen in the United States, and the social and geographic context of the infection can be a key to its diagnosis and management. Four Somali and one Ethiopian, in U.S. Border Patrol custody, came to the United States by the same human trafficking route: Djibouti to Dubai to Moscow to Havana to Quito; and then by ground by Columbia/Panama to the United States-Mexico border where they were detained. Although traveling at different times, all five patients simultaneously presented to our institution with chronic ulcerative skin lesions at different sites and stages of evolution. Culture of biopsy specimens grew Leishmania panamensis. Soon thereafter, three individuals from East Africa traveling the identical route presented with L. panamensis CL to physicians in Tacoma, WA. We document here the association of a human trafficking route and new world CL. Clinicians and public health officials should be aware of this emerging infectious disease risk.
Assuntos
Leishmania/isolamento & purificação , Leishmaniose Mucocutânea/diagnóstico , Leishmaniose Mucocutânea/epidemiologia , Problemas Sociais , Adulto , África Oriental/etnologia , Anfotericina B/uso terapêutico , Análise por Conglomerados , Surtos de Doenças/prevenção & controle , Humanos , Leishmania/patogenicidade , Leishmaniose Mucocutânea/tratamento farmacológico , Masculino , Panamá/epidemiologia , Úlcera Cutânea/epidemiologia , Úlcera Cutânea/parasitologia , Viagem , Estados Unidos/epidemiologia , Adulto JovemRESUMO
En Venezuela se utiliza la inmunoterapia por su bondad terapéutica y operacional en el tratamiento de la leishmaniasis cutánea y se aprecian diferencias de su efectividad entre los servicios locales de salud que la emplean. En el estado Mérida, donde se tiene un bajo nivel de falla terapéutica, se desconocen los factores de riesgo ó de protección que la determinan. Por ello se planteó realizar un estudio epidemiológico de casos y controles para evaluar los factores individuales demográficos, clínicos, inmunológicos y adherencia terapéutica que influyen en dicha efectividad. El ajuste con regresión logística determinó según definición: a) Demográfica: como riesgo las edades extremas, tabaquismo y de oficio doméstico, con protección en el alfabeto educativamente, b) Clínica: como riesgo la forma intermedia, cinco o más lesiones, infección secundaria y ubicación en pié, con protección en la forma localizada y tamaño menor a 60 mm, c) Inmunológica: de riesgo las bajas respuestas a leishmánina y PPD, d) Adherencia terapéutica: son riesgo la aplicación tópica y aseo local inadecuados. Se concluye, hay factores de riesgo y protección que modelan la eficacia de la inmunoterapia, lo que en consecuencia demanda una dinámica vigilancia clínico-epidemiológica para potenciar dicha terapéutica.
Immunotherapy is used in Venezuela as treatment of cutaneous leishmaniasis and there are differences among the health services that use it. In Merida State there are a low proportion of failures, but the factors that are related to this failure are unknown. A case-control study was planned to evaluate the demographics, clinical, immunological factors and the treatment compliance that can be related to the effectiveness. Logistic regression showed that the factors related to failure were: a) demographics: lower and older ages, smoking, domestic labor and illiteracy; b) clinical: intermediate leishmaniasis, five or more lesions, aggregated infection, lesions in feet, and lesion size above 60 mm; c) Immunology: low reactivity to Montenegro and tuberculin tests; d) treatment compliance: use of incorrect topical substances and inadequate cleaning of ulcer. As a conclusion, there are several factors that influence treatment response, that require clinical and epidemiological surveillance to increase the effect of therapy.
Assuntos
Humanos , Masculino , Feminino , Leishmaniose Cutânea/epidemiologia , Leishmaniose Cutânea/etnologia , Leishmaniose Cutânea/imunologia , Leishmaniose Cutânea/prevenção & controle , Leishmaniose Cutânea/tratamento farmacológico , Imunoterapia , Úlcera Cutânea/epidemiologia , Úlcera Cutânea/parasitologia , Úlcera Cutânea/prevenção & controle , Úlcera Cutânea/tratamento farmacológicoRESUMO
The positivities of two methods for the diagnosis of localised cutaneous leishmaniasis (CL) were estimated in 280 patients enrolled in a clinical trial. The trial was conducted in an endemic area of Leishmania (Viannia) braziliensis and trial participants were patients with skin ulcers and positive leishmanin skin tests. Patients underwent aspirative skin punctures of the ulcerated lesions and lymph nodes for in vitro cultures, which were processed under field conditions at the local health centre. Skin lesion biopsies were tested at a reference laboratory using kinetoplastid DNA (kDNA)-PCR to detect DNA. The median time required to obtain a positive culture from the skin samples was seven days and the contamination rate of the samples was 1.8%. The positivities of the cultures from skin lesions, kDNA-PCR and the combination of the two methods were 78.2% (95% CI: 73-82.6%), 89.3% (95% CI: 85.1-92.4%) and 97.1% (95% CI: 94.5-98.5%). We conclude that parasite culture is a feasible method for the detection of Leishmania in field conditions and that the combination of culture and PCR has a potential role for the diagnosis of CL in candidates for clinical trials.