We report for the first time the successful use of fluconazole to treat cutaneous leishmaniasis due to Leishmania braziliensis. We used escalating doses from 5 to 8 mg/kg per day. At a dose of 5 mg/kg per day, 75% patients were cured, and at 8 mg/kg per day, the cure rate was 100%. Fluconazole was well tolerated.

Abstract. A modified imprint method, Press-Imprint-Smear, was compared with histopathology for the diagnosis of cutaneous leishmaniasis. Amastigotes were seen in 69 (92%) of 75 individuals in one or both assays. The Press-Imprint-Smear was positive in 85.3%, and histopathology was positive in 44%. Press-Imprint-Smear is a rapid and relatively sensitive method for the diagnosis of cutaneous leishmaniasis.

Conhecimento dos leigos acerca da ressuscitação cardiopulmonar em pacientes adultos no Brasil Knowledge of laity about cardiopulmonary resuscitation in adults in Brazil

The initial encounter of Leishmania with its host's immune system is important in the outcome of infection. Previous studies have shown that PBMCs from healthy volunteers (HV) exposed to Leishmania differ in IFN-γ production. We have expanded such observations evaluating the profile and kinetics of cytokines (IFN-γ, IL-12p70, IL-10, IL-13), chemokines (CCL5, CCL3, CCL4, CXCL10), and chemokine receptors (CCR1,CCR5, CXCR3, CCR4) in vitro L. amazonensis-stimulated of HV's PBMCs. HVs were divided in groups of high (HR) or low (LR) IFN-γ responders. In both groups, HR and LR, after L. amazonensis infection there was a predominance of IL-10 and IL-13 over IFN-γ production, while IL-12 was produced in similar amount. Regarding chemokines, a more striking difference was observed for CCL3 expression that was lower at 12 hours and 48 hours post infection in LR than in HR. Interestingly, a downregulation of CCR5 and a greater expression of CCR4 were found in low IFN-γ responders. These data suggest that early after L. amazonensis infection there is a cytokine milieu dominated by IL-13 and IL-10, and despite of this environment, IFN-γ is produced, supporting the complexity of the response. It is noteworthy that the pattern of immune response is mounted in first hours after Leishmania stimulation, with the definition of the differentiation of Th1 versus Th2 cells. It remains to be determined if such an in vitro difference has an in vivo counterpart in terms of susceptibility to infection.

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A 46 year-old man, agriculturist, presented with an eight-month history of skin lesions all over his body. Patient did not refer systemic symptoms; however he was a heavy alcoholic drinker until three months after the beginning of disease, when he stopped drinking. Physical exam was inconspicuous except for multiples skin lesions (papular, crusted or ulcerated) on face, trunk (Panels A and B), scalp, arms, legs, genitalia and nasal mucosa. Complete blood count, liver and renal tests, glucose as well as chest x-ray were normal. Tuberculin (PPD) test was 5mm, Montenegro test (leishmanin) was non reactive, VDRL and anti-HIV test were negative. Three 2mm punch skin biopsies were done: for imprint, leishmania culture (NNN) and histopathology. Imprint showed amastigotes in many fields (100X) (Panels C, D and E -Arrows). Culture grew Leishmania. Histopathology showed moderate infiltrate of vacuolated macrophages with few lymphocytes, no granulomas were seen. Amastigotes were present in some macrophages. Patient was treated with intravenous pentavalent antimony (Glucantime®) 850mg per day for 30 days and all lesions healed. Leishmanin skin test at end of treatment was 8mm. Disseminated Cutaneous Leishmaniasis is seen in a small percentage of patients with cutaneous leishmaniasis in all endemic areas of Ceará State, northeastern Brazil. This patient was from one of these areas. Even though the Leishmania species was not characterized, the parasite in this case was probably Leishmania (Viannia) braziliensis, because this is the only species identified so far causing cutaneous leishmaniasis in Ceará.