Leishmaniose tegumentar americana

Abstract

American cutaneous leishmaniasis is endemic in widespread areas of Latin America. The causative agents include L. (V.) braziliensis, L. (L.) mexicana, L. (V.) panamensis, and related species. The spectrum of disease includes single, localized, cutaneous ulcers, diffuse cutaneous leishmaniasis, and mucosal disease. The main reservoirs for L. (V.) braziliensis and other Leishmania (Vianna) spp. are small forest rodents. The vectors are ground-dwelling or arboreal Lutzomyia sandflies, which are abundant in the forest. Disease is most common in persons working at the edge of the forest and among rural settlers. The incubation period of cutaneous leishmaniasis varies from two weeks to several months. A wide variety of skin manifestations ranging from small, dry, crusted lesions to large, deep, mutilating ulcers may be seen. Ulcerative lesions are usually shallow and circular with well-defined, raised borders and a bed of granulation tissue. In L. (V.) braziliensis infection, regional lymphadenopathy often precedes the development of cutaneous lesions by one to 12 weeks. A definite diagnosis depends on the identification of amastigotes in tissue or promastigotes in culture. Antileishmanial antibodies are present in the serum of some patients with cutaneous leishmaniasis as detected by ELISA, immunofluorescent assays, direct agglutination tests or other assays, but the titers are usually low. The leishmanin skin test result usually becomes positive during the course of the disease. For treatment two pentavalent antimony-containing drugs are used: stibogluconate sodium, and meglumine antimoniate (Glucantime). Amphotericin B deoxycholate is an alternative for persons who fail to respond to pentavalent antimony. Immunoprophylaxis and immunotherapy are promising new approaches to prevention and treatment.

Clinical, epidemiological and laboratory aspects of patients with American cutaneous leishmaniasis in the State of Pernambuco

“…On the other hand, the trend towards reduced numbers of occurrences of mucocutaneous leishmaniasis is probably due to better knowledge of the disease, thereby leading to early treatment and accurate diagnosis 13 . Mucous manifestations may appear while cutaneous lesions are still active, or years after the healing, and are usually associated with delayed healing of the primary lesion and inadequate treatment 12 .…”

The effect of age on the frequency of adverse reactions caused by antimony in the treatment of American tegumentary leishmaniasis in Governador Valadares, State of Minas Gerais, Brazil

“…The use of pentavalent antimony is contraindicated for pregnant women, because these drugs may cause abortion; these drugs cross the transplacental barrier and may impregnate the nervous tissue of the fetus, leading to severe mental retardation syndromes. In these cases, the treatment involves local care, clinical observation, and the use of amphotericin B 1,3 .…”

Variables associated with the post-treatment healing of lesions in patients with American cutaneous leishmaniasis in Paraná State, Brazil

“…The sensitivity of IFA in the present study was similar to that found in studies on other endemic areas (Marzochi et al, 1980;Lugo de Yarbuh et al, 1996). Together, the three methods used for ACL diagnosis were able to detect 98.8% of the ACL cases, showing it to be a useful combination for diagnosing the disease (Gontijo, Carvalho, 2003).…”