Numerical zymotaxonomy and variability of the internal transcribed spacers (ITS) between the small and large subunits of the rRNA genes were used to examine strain variation and relationships in natural populations of Leishmania (Viannia) braziliensis. A total of 101 strains from distinct hosts and Brazilian geographic regions were assigned to 15 zymodemes clustered in two major genetic groups. The great number of isolates (48.5%) placed in zymodeme IOC/Z-27 were collected on the Atlantic coast. The high molecular diversity found in populations in the Amazon Basin was related to the great number of sandfly vector(s) in that region. The results of the restriction fragment length polymorphism analysis of the ITS depicted considerable intraspecific variation. Genotypic groups A, B, and C contained 39, 40, and 22 isolates, which were divided into 16, 10, and 15 genotypes, respectively. The genetic polymorphism observed demonstrates the degree of diversity of L. Infections with the parasitic protozoan Leishmania (Viannia) braziliensis Vianna 1911 (Kinetoplastida: Trypanosomatidae) or strain variants are recognized as causing human illness in many areas of (sub)tropical America (at least 15 countries), where it constitutes a significant public health problem. Many of these parasites seem to have a unique life cycle, with different phlebotomine sandfly (Diptera: Psychodidae) vectors and/or animal reservoirs and a different geographic distribution (13). This pathogen is capable of producing a variety of clinical manifestations, such as (i) cutaneous leishmaniasis (CL), which may heal spontaneously; (ii) mucosal leishmaniasis (ML), a hyperergic invasive ulcerative form that progresses in the absence of any apparent cellular defect (15); and (iii) disseminated CL (4).Most of the environmental factors affecting the epidemiology of the various leishmaniases are still poorly understood. Wild mammals serve as reservoirs for most of the New World Leishmania spp. (21), but there is increasing evidence that some of the human pathogenic Leishmania strains can be maintained in both sylvan and urban cycles. In the case of L. (V.) braziliensis, the principal vertebrate hosts in the sylvan cycle have not been identified, but there is evidence that dogs, horses, and donkeys may serve as reservoir hosts of this parasite (15). The existence of an urban cycle involving peridomestic sandfly species for L. (V.) braziliensis reflects the ability of these parasites and their vectors to adapt to changes in their original forested habitats with important public health implications. Studies using molecular techniques to characterize L. (V.) braziliensis populations from different regions have shown a relationship between level of similarity among the parasite populations (12, 24) and their geographic range, but recent data have also indicated that the considerable variability detected among these parasites is more probably related to the sandfly vector(s) and/or animal reservoir(s) involved in the transmission cycles (18).Pathogens that produce...

BACKGROUNDAmerican tegumentary leishmaniasis (ATL) is a non-lethal parasitic disease that presents with cutaneous (CL) and mucosal (ML) clinical forms. ATL treatment aims at healing the lesions and preventing the development of the late mucosal form. Systemic meglumine antimoniate (MA) therapy with 10-20 mg Sb5+/kg/day is the first choice of treatment. However, alternative therapies using 5 mg Sb5+/kg/day or intralesional (IL) MA are the usual regimens at the National Institute of Infectious Diseases (NIID), Rio de Janeiro, Brazil.OBJECTIVESTo evaluate lethality and the incidence of relapse and development of late ML in CL patients treated at NIID from 2001 until 2013.METHODSData were recovered from records of all ATL patients diagnosed during that period.FINDINGSOut of 777 patients, 753 were treated with MA (96.9%). Of those, 89.1% received alternative therapy of 9.9% IL and 79.2% systemic 5 mg Sb5+/kg/day. Some patients required 1-3 additional courses of treatment, thus making a total of 997 courses; 85.2% of them were subjected to alternative therapies. Lethality was 0.1%, relapse incidence 5.8%, and late ML incidence 0.25%. As a final outcome for the 777 patients, 95.9% were cured, 0.1% died and 4.0% were not able to follow-up.MAIN CONCLUSIONSAlternative MA schedules resulted in low lethality without increase of relapse or late ML incidence.

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In Brazil, meglumine antimoniate is the first drug of choice for mucosal leishmaniasis treatment followed by amphotericin B and pentamidine isethionate. We report the case of a patient with severe mucosal lesions caused by Leishmania (Viannia) braziliensis that were difficult to treat. Over a 14-year period, the patient showed low adherence and three treatment attempts with meglumine antimoniate failed. Additionally, there was an unsatisfactory response to liposomal amphotericin B and nephrotoxicity when using amphotericin B deoxycholate that persisted after new treatment attempt with liposomal amphotericin B. Finally, healing was achieved with pentamidine isethionate and maintained during nine months of monitoring.