Estudo evolutivo da leishmaniose mucosa (7 a 17 anos de seguimento) causada por Leishmania (Viannia ) braziliensis em Três Braços, Bahia

Abstract

Seventy seven (68%) patients with mucosal leishmaniasis recorded during the period 1976-1986 in the region of Três Braços, Bahia were traced and re-evaluated clinically, diagnostically and therapeutically. Sixty-five patients were alive. The families of 12 dead patients were interviewed about probable cause of death. The 65 patients had a fresh clinical examination supplemented when necessary by a skilled ENT examination. All had a titre of circulating immunofluorescent antibodies estimated at the time. Eight patients with active mucosal lesions had triturated biopsies which were cultivated in NNN medium and inoculated in hamsters to attempt to recover Leishmania. The isolates were identified by monoclonal antibodies as Leishmania (Viannia) braziliensis. Fifty-six (86%) patients were judged clinically cured. Nine (13%) had active lesions. Of the 12 patients who died 5 (41%) had no signs of activity at death. Mucosal leishmaniasis was thought to be the direct cause of death in 3 patients. The field treatment programme at Três Braços has managed to clinically cure 61 patients (79%) during 17 years. Follow-up periods were a mean of 10 years (range 7-17).

Antigen-triggered interferon-γ and interleukin-10 pattern in cured mucosal leishmaniasis patients is shaped during the active phase of disease

“…Mucosal healing was defined as macroscopic absence of hyperaemia, oedema, ulceration and granulomatous or vegetative lesion, determined by clinical and endoscopic rhinolaryngological examination 17,20. As relapses of ML usually occur up to 5 years after clinical cure post-therapy 21–23, this time-point was used to classify patients into two groups: group 1, less than 5 years of the end of treatment (3·2 ± 1·2 years, median 3·4 years, n  = 10); and group 2, more than or equal to 5 years of the end of treatment (8·2 ± 3·7 years, median 7·0 years, n  = 10). None of these subjects had episodes of recurrence after being considered clinically cured.…”

Tratamento da Leishmaniose Tegumentar Americana

“…17 As recidivas após tratamento bem realizado são freqüentes na FM, constituindo relevante problema. [18][19][20][21][22] O pequeno número de casos observados de LM dificulta obter conclusões sobre a eficácia de novas drogas. 23 Casos de LM refratários ao tratamento com Sb tiveram boa resposta terapêutica quando se associou pentoxifilina ao NMG, tendo como possível explicação a imunomodulação mediante bloqueio do TNFalfa causada pela pentoxifilina.…”

Recombinant Leishmania infantum Heat Shock Protein 83 for the Serodiagnosis of Cutaneous, Mucosal, and Visceral Leishmaniases

“…In contrast, we did not detect a significant decrease in antibody levels post-treatment as measured by the ELISA-rHsp83. Control of cure by serological tests is a controversial subject in the literature 42. The persistence of antibodies after treatment could indicate the continued presence of viable parasites, raising the possibility of a relapse 43…”