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

Abstract

The diagnosis for American cutaneous leishmaniasis is based on an association of clinical, epidemiological and laboratory characteristics. The present study identified the circulating species of Leishmania in the State of Pernambuco, described its clinical-epidemiological characteristics and diagnosed the disease. Nineteen patients presenting active lesions who had been diagnosed through clinical evaluation and laboratory tests were selected. The tests included direct investigation, in vitro culturing, Montenegro skin test, indirect immunofluorescence and polymerase chain reaction. The Montenegro Skin Test showed positive results in 89% of the patients; indirect immunofluorescence, in 79%; direct investigation, in 58%; and polymerase chain reaction in 75%. Seven Leishmania (Viannia) braziliensis samples were isolated from these patients and were characterized by means of specific monoclonal antibodies. These data confirm that a combination of different diagnosis techniques is needed in order to obtain efficient results and that, so far, Leishmania (Viannia) braziliensis is the only species responsible for American cutaneous leishmaniasis infection in Pernambuco. Thus, it is essential to identify the parasite species involved in cases of human disease in an endemic area in order to determine the clinical and epidemiological characteristics, especially with regard to diagnosis, therapy development and disease prognosis. Key-words:American cutaneous leishmaniasis. Leishmania (Viannia) braziliensis. Montenegro skin test. Indirect immunofluorescence. Polymerase chain reaction. RESUMOO diagnóstico da leishmaniose cutânea americana é baseado na associação dos aspectos clínicos, epidemiológicos e laboratoriais. O presente estudo identificou a espécie de Leishmania circulante no Estado de Pernambuco, descreveu os aspectos clínico-epidemiológicos e diagnosticou a doença. Foram selecionados 19 pacientes apresentando lesão ativa e diagnosticados através de avaliação clínica e pelos exames laboratoriais que incluíram a pesquisa direta, cultivo in vitro, intradermorreação de Montenegro, imunofluorescência indireta e reação em cadeia de polymerase. A intradermorreação de Montenegro apresentou resultado positivo em 89% dos pacientes. A imunofluorescência indireta apresentou 79% de positividade, a pesquisa direta apresentou 58% e a reação em cadeia de polymerase 75% de positividade. Sete amostras de Leishmania (Viannia) braziliensis foram isoladas desses pacientes e caracterizadas através de anticorpos monoclonais específicos. Esses dados confirmam que é necessário a combinação de diferentes técnicas diagnósticas para se obter resultados eficientes e que, até o momento, a Leishmania (Viannia) braziliensis é a única espécie responsável pela infecção da leishmaniose cutânea americana em Pernambuco. Portanto, a identificação da espécie do parasito envolvido nos casos da doença no homem em uma área endêmica é essencial para o conhecimento dos aspectos clínicos e epidemiológicos, sobretudo para o diagnóstico e para o desenvol...

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

“…This result was also found in other studies [11][12][13] . However, from 2001 to 2006, the number of reported cases in the City of Governador Valadares was similar for both genders, as 127 cases of ATL were male patients (52.7%) and 114 (47.3%) cases were female patients 14 .…”

Genus-specific kinetoplast-DNA PCR and parasite culture for the diagnosis of localised cutaneous leishmaniasis: applications for clinical trials under field conditions in Brazil

“…The combination of different molecular approaches allows appropriate parasite identification in areas where sympatric circulation of several Leishmania species is a problem (Bensoussan et al 2006, Tojal da Silva et al 2006. Our study demonstrated a PCR positivity of 89%, which is lower than has been described in other areas (Pirmez et al 1999, Gomes et al 2008, Reis et al 2008). However, our results are consistent with a previous study in the same area that reported a positivity of 88.3% for PCR performed with DNA obtained from fresh-frozen lesion biopsies and positivities of 87% and 85.7% for PCR performed with DNA obtained from biopsy imprints on filter paper in two independent laboratories (Romero et al 2009).…”

Clinical, laboratory, and therapeutic characteristics of American tegumentary leishmaniasis in the 15 th State Health Division, Northwest Paraná State, Southern Brazil

“…These rates are higher than those obtained by Silveira et al (7) for cutaneous form ATL (59.4%) and by Curti et al (14) for cutaneous form ATL (65.1%) in the same area. Murback et al (27) observed a rate of 58.8% for positive direct examination in Mato Grosso do Sul State, whereas Reis et al (29) observed a rate of 58% for positive direct examination in Pernambuco State. These variations may be due to several factors such as Leishmania species, parasite load, quality of the material collected, site of the lesion where the parasite is investigated, the number of microscopic fields and slides examined, and experience of the technician (30) .…”