Mucosal leishmaniasis in brazil

Abstract

The clinical diagnosis and laboratory identification of Leishmania braziliensis braziliensis, a parasitic disease affecting the upper aerodigestive tract, is difficult. A retrospective computer-assisted analysis of patient records was done after examination of 58 patients with mucosal leishmaniasis in an endemic area of L. braziliensis braziliensis in Bahia, Brazil during January 1987. Biopsies of clinically active and clinically inactive mucosal patients were examined for parasites using routine hematoxylin and eosin histopathology and a new technique for rapid detection of Leishmania amastigotes using a genus-specific indirect immunofluorescent assay. No amastigotes were found in specimens from seven patients with clinically inactive mucosal disease using immunofluorescent monoclonal assay techniques, whereas specimens from seven out of 14 patients with clinically active mucosal disease were positive. These results suggest that the immunofluorescent antibody technique is markedly superior in identifying the intracellular amastigote in tissue sections of mucosal biopsies when compared to histopathology techniques or with other standard tests done in rural areas of Brazil. Various clinical and laboratory test data of the entire group of patients were examined and the efficacy of treatment evaluated. The median interval of time noted between cutaneous and mucosal disease was 4.5 years. Relapse was noted in 31% of patients treated with a low dose of meglumine antimoniate (10 mg per kg of body weight). Patients treated with a high dose of meglumine antimoniate (20 mg per kg of body weight) had a relapse rate of 27.3%. A chi-square statistical analysis revealed no significant difference (chi 2 = 0.049) between the two groups. Patients were considered cured if mucosal granulations were clinically absent after 4.6 years.

Intralesional Meglumine Antimoniate for Treatment of Cutaneous Leishmaniasis Patients with Contraindication to Systemic Therapy from Rio de Janeiro (2000 to 2006)

“…Marsden 25 suggested that even low doses of MA for the TTM of CL may prevent the occurrence of mucosal lesions in the future. Furthermore, Zajtchuk and others 26 did not observe significant differences in the development of mucosal lesions, within a period of 4.6 years, between low-dose (10 mg Sb…”

A proposed new clinical staging system for patients with mucosal leishmaniasis

“…13,14 Few studies exist in which a complete otolaryngological examination was carried out. 15 Radiological evaluation of patients with ML has shown erosion of the nasal septum, deformity of the nasal pyramid and alterations of the nasal conchae. 16 In a previous study, we called attention to the fact that mucosal involvement, in a high percentage of cases, occurred in the form of multiple lesions, and that this influenced the clinical evolution of the disease and therapeutic response.…”

Polymerase chain reaction with two molecular targets in mucosal leishmaniasis' diagnosis: a validation study

“…Parasite identification is difficult and sensitivity reports vary with different techniques, from 0.2% with direct smear to 68.6% when various methods are used (Weigle et al 1987, Zajtchuk et al 1989, Schubach et al 2001, Disch et al 2005. In cases where there is a strong clinical suspicion and no parasite is isolated, treatment is prescribed with pentavalent antimony which is highly effective, but has been associated with frequent adverse effects: malaise, headache, muscle pain, joint pain and hepatic, pancreatic, renal, hematologic, and cardiac toxicity that has lead to death in some cases (Chulay et al 1985, Hepburn et al 1994, Aronson et al 1998.…”