Human mucocutaneous leishmaniasis in Três Braços, Bahia - Brazil: an area of Leishmania braziliensis braziliensis transmission. I. Laboratory diagnosis

Abstract

L eishm a n ia lp a ra sites were detected in 71. 2% W e have presented evidence elsewhere4 that in this area L eish m a n ia braziliensis braziliensis (Lbb) is the parasite isolated from man in 96.7% of cases. W e will describe in these papers the clinicai presentation and initial evolution of this parasite in man. To date no animal model exists for Lbb and parasitological diagnosis in man is difficult1. Therefore in this first paper we discuss our diagnostic procedures in patients with cutaneous or mucosal disease consídered in the two subsequent papers. M A T E R IA L A N D M E T H O D SPatients on first consultation were alloted an LTB number (Leishm aniasis Três Braços) used for ali subsequent reference. A completed protocol included details of past and present residence for subsequent follow up and history of skin or mucosal lesions. Skin lesions were measured, their localisation recorded on a body map and their features described as regards morphology. A search for previous suggestive skin scars and evidence of mucosal disease was made.M ucosal lesions were examined using a good light source, nasal speculum, tongue depressor and indirect laryngoscopy. Exam ination of the post nasal space was not done.Recebido para publicação em 16/8/84.Two 4mm punch biopsies were taken from the 161

Species diversity causing human cutaneous leishmaniasis in Rio Branco, state of Acre, Brazil

“…In fact, patients with longer disease more frequently had negative isolation procedures. Despite our low unsuccessful Leishmania isolation, 13/50 (26%), which has also been reported by others in literature (Cuba et al. 1984; Weigle et al.…”

Sensitivity of a Vacuum Aspiratory Culture Technique for Diagnosis of Localized Cutaneous Leishmaniasis in an Endemic Area of Leishmania (Viannia) braziliensis Transmission

“…The greater sensiivity could be explained by modifications of culture medium specially those of lowvolume liquid phase which was not enriched as previously recommended by Shaw and Lainson (1981). Cuba et al (1984) showed that contamination with fungi was an important technical problem which affected 27.5% of cultures using the same culture medium. This observation indicates that the vacuum aspiration procedure could be crucial to diminish contamination rate.…”

“…has shown variable results depending on quality of culture media (Shaw & Lainson 1981, Cuba et al 1986), collection technique (Evans 1989) and other characteristics such as disease duration and previous use of anti-leishmanial drugs (Cuba et al 1984). Marzochi et al (1993) described a new collection technique using direct inoculation of culture tubes containing NNN media with a liquid phase through a skin puncture system with five to ten mililiters vacuum.…”

“…We used the same aspiratory puncture system with commercial needles but the aspiration was modified by allowing air to come into the tubes when pulling the needle out to obtain a larger amount of inoculum. We studied the sensitivity of this method for diagnosis of cutaneous leishmaniasis in a group of pa- (Llanos-Cuentas et al 1984, Rosa et al 1988. …”

IFN-γ Production to Leishmania Antigen Supplements the Leishmania Skin Test in Identifying Exposure to L. braziliensis Infection

“…Only a few parasites are found in the lesions due to L.braziliensis and because of this the leishmania skin test (LST) is widely used for diagnosis of ATL. A positive test in a patient with a typical cutaneous lesion has a high predictive value [5], [6]. The LST has been also used to measure exposure to leishmania infection, and a positive LST in the absence of clinical manifestations of ATL has been documented in up to 17% of healthy individuals living in endemic areas of L. braziliensis [6].…”