American tegumentary leishmaniasis: correlations among immunological, histopathological and clinical parameters

Abstract

BACKGROUNDAmerican tegumentary leishmaniasis has an annual incidence of 1 to 1.5 million cases. In some cases, the patient's immune response can eliminate the parasite, and the lesion spontaneously resolves. However, when this does not occur, patients develop the disseminated form of the disease. OBJECTIVETo investigate the association between clinical, laboratory and pathological findings in cases of American tegumentary leishmaniasis. METHODSA retrospective study of the medical records of 47 patients with American cutaneous leishmaniasis. Clinical, laboratory and epidemiological data were collected, and semi-quantitative histopathological analyses were performed using the Spearman correlation coefficient (p <0.05). RESULTSMean patient age was 40.5 years. A total of 29.7% individuals were female and 70.2% were male, and 40.4% of the patients were farmers. The ulcerative form was found in 53.2% of patients, of whom 59.6% had lesions in the limbs. The average time to diagnosis was 22.3 months. The following positive correlations were significant: age and duration of the disease, Montenegro reaction, degree of granulomatous transformation and epithelioid cell count; duration of disease, Montenegro reaction and number of lymphocytes; epithelial hyperplasia and edema, hemorrhaging, and epithelial aggression; number of plasmocytes and number of parasites. The main negative correlations found were as follows: age and serology; time and parasite load; epithelial hyperplasia and degree of granulomatous transformation. CONCLUSIONThe long duration of the disease could be explained by the fact that lesions were relatively asymptomatic, and therefore ignored by patients with low literacy levels. Individuals may have simply waited for spontaneous healing, which proved to be dependent on the activation of hypersensitivity mechanisms.

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

“…ATL was considered an occupational disease since most of the affected individuals were men exposed to forest areas (21) . However, in recent decades, the vector has adapted to the peridomiciliary areas of rural regions and urbanized areas, and has hence begun infecting women and children as well (21) .…”

“…However, in recent decades, the vector has adapted to the peridomiciliary areas of rural regions and urbanized areas, and has hence begun infecting women and children as well (21) . A small portion (5.5%) of the cases reported in the 15 th RH Division were considered to have disease related to work activities, in contrast with the value of 33% previously reported by Silveira et al (7) in a study performed in the same area.…”

“…A small portion (5.5%) of the cases reported in the 15 th RH Division were considered to have disease related to work activities, in contrast with the value of 33% previously reported by Silveira et al (7) in a study performed in the same area. Martins et al (21) indicated that, in São Paulo State, ATL was prevalent among adult male patients and rural workers (40.4%), whereas Marlow et al (22) reported that, in the State of Santa Catarina, 67.3% of patients were male and 77.8% lived in urban zones. The presence of children (6.4%) and women (15%) among the patients indicates the possibility of peri-domiciliary transmission, and represents significant changes in vector behavior (23) .…”

“…Similarly, Pontello et al (17) reported a predominance of lesions in the upper limbs (41.4%), followed by lower limbs (30.3%). Moreover, Martins et al (21) reported that the regions of the body most frequently affected were the limbs (59.6%), followed by the face (34%). In addition, Murback et al (27) found that lesions were located in the lower limbs in 34%, in the face in 25.5%, and in the upper limbs in 19.1%, whereas Name et al (28) found that lesions were located in the lower limbs in 56.5%, in the upper limbs in 28.4%, and in the head in 13.6%.…”

Epitope Mapping of the HSP83.1 Protein of Leishmania braziliensis Discloses Novel Targets for Immunodiagnosis of Tegumentary and Visceral Clinical Forms of Leishmaniasis

“…In TL, a wide variety of skin manifestations, such as cutaneous leishmaniasis (CL) and mucocutaneous leishmaniasis (ML), have been described (2). The CL form is characterized by one or more painless ulcers with raised borders and a bed of granulation tissue that appear near the area of the sand fly bite, while ML is characterized by the progressive destruction of the nasopharyngeal mucosa (3,4). Although the determining factors involved in the development of each clinical form have not been elucidated, it is likely that host and parasite genetics are involved (2,5).…”