Epidemiological and clinical characteristics of cutaneous leishmaniasis and their relationship with the laboratory data, south of Brazil

Abstract

Objective: To evaluate clinical, epidemiological and laboratorial aspects for the understanding of the disease characteristics and its relationship with diagnostic tests. Methods: A retrospective, descriptive and analytical study involving 2,660 American cutaneous leishmaniasis (ACL) suspected patients from southern Brazil was undertaken between April 1986 and December 2005. Data on population characteristics and laboratory tests were obtained. Diagnostic laboratory tests used were direct search for Leishmania spp. (DS), Montenegro skin test (MST) and indirect immunofl uorescent assay (IFA). Results: 62.3% of patients were positive for at least one laboratory test. DS test was positive in 65.1%; MST in 92.3% and IFA in 70.0%. Although Cohen's Kappa test did not reveal any agreement with laboratory diagnosis for ACL, the association between MST and IFA tests increased positiveness to 98.9%; MST and DS to 97.2%; and IFA and DS to 85%. IFA and MST positiveness were higher among patients with ≤ 2-month lesion-evolution time. Most ACL patients were male (72.6%) in the age range of 15-49 years, featuring lesions during two months or less (53.9%) and a cutaneous form of the disease (88.0%). Conclusion: Findings suggest that for the adequate identifi cation of ACL cases a combination of laboratory tests that involves the association of MST with at least another test should be used.

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.…”

“…In the present study, ATL was predominant in males (85%) and in those aged ≥30 years (76.8%). In previous studies in Paraná State, Silveira et al (7) , Castro et al (8) , and Curti et al (14) reported a higher prevalence of ATL in patients aged 15-49 years, whereas Pontello et al (17) reported an associated age of 21-40 years. According to Silva et al (18) , the ATL incidence in individuals aged >65 years has increased significantly in Brazil.…”

“…In the same area, Silveira et al (7) described MST positivity in 95.1%, whereas Curti et al (14) described MST positivity in 92.3% with cutaneous form ATL. Pontello et al (17) exhibited 84.4% positivity, Nunes et al (19) exhibited 56.1% positivity, and Murback et al (27) exhibited 91.4% positivity for MST among the ATL cases.…”

Evaluation of the reference value for the Montenegro skin test

“…The latter was expected because the PCL group had a parasitological diagnosis of ATL. In addition, the PCL group consisted of more men than women, which is consistent with the literature that indicates that men engage in more rural leisure activities, such as fi shing, than women (20) (25) . Within the PCL group, the mean age and mean induration diameter were not different between the sexes.…”

“…To evaluate the cut-off point for the MST, two groups were formed based on laboratory results and clinical and epidemiological data according to criteria that defi ne the epidemiologic characteristics of ATL in Northwestern Paraná (20) . The positive ATL [positive cutaneous leishmaniasis (PCL)] group included patients with skin lesions and positive DS results.…”